COVID-19 Pandemic: Effect on Management of Patients With Breast Cancer
Condition: Covid19; Breast Cancer Stage; Isolation, Social; Locally Advanced Breast Cancer
MeSH terms: COVID-19; Breast Neoplasms
Study type: Observational [Patient Registry]

Summary: 
      The objective was to find out the impact of COVID-19 on stage of breast cancer at
      presentation and its effects on overall onco-surgical management. The investigator carried
      out this research to see the presenting stage of breast cancer in the participants in this
      pandemic and correlate its effect on stage of breast cancer and upstaging of disease
    

Detailed description: 
      This retrospective observational study was conducted at department of surgery PNS Shifa
      hospital Karachi after obtaining permission from ethical review committee. Participant's data
      of all operated cases for suspicious lump breast (abnormal findings on ultrasound and
      mammogram, BIRAD III or above and abnormal FNAC results;C3 or above) from January1,2020 to 31
      January 2021 was retrieved. Out of these only those participants were included in whom the
      diagnosis of breast cancer was confirmed on histo-pathological examination. Participants who
      had already had their surgery pre covid (December 2019), were excluded. Data were collected
      on standard pre-designed questionnaire and from paper documents retrieved from patient
      records. Participant presentation time was calculated as the time interval between the
      appearance of the first symptoms of breast cancer (day 0) and the date of initial
      presentation to hospital by patient and consultation for breast symptoms. Time taken for
      start of treatment was calculated by counting number of days from the first presentation day
      to hospital until the date when definitive treatment for Carcinoma Breast was initiated
      (chemo/radio/surgery). Time duration for definitive surgery was counted from the day of first
      presentation to the hospital till the date surgery was conducted(modified radical mastectomy
      (MRM)/breast conserving surgery (BCS)/toilet mastectomy).

      Presentation 'Delay' was defined as a patient reporting to the hospital for medical advice 30
      days after noticing the first possible symptoms of breast cancer while time taken for start
      of treatment was calculated form time of first presentation to hospital (day 0) till the
      first day of start of definitive first treatment for breast cancer. The investigator labelled
      delay in treatment if it was initiated later than 62days .

      The questionnaire inquired about the symptoms, date of presentation of the first symptoms,
      date of first reporting to hospital, reasons for the delayed presentation.

      All patients who were admitted and underwent pre anesthesia assessment underwent COVID
      testing according to the protocol. If the patient turned out COVID positive, their symptoms
      were noted and the COVID team (infectious disease department) was notified. The quarantine
      protocol at investigating hospital was, complete isolation for 14 days with one PCR-negative
      report after completing quarantine, with no residual respiratory symptoms of cough, fever,
      and shortness of breath. This protocol was followed for all elective breast surgery patients
      admitted in the hospital. All COVID-positive patients underwent the same treatment protocol
      as non-COVID patients with regards to management of breast cancer. Patients with early breast
      cancer (upto stage 2A) underwent modified radical mastectomy/breast conservative surgery
      first, followed by chemotherapy/radiotherapy, locally advanced cases (stage 2B and above) had
      neo-adjuvant treatment first followed by surgery, and advanced cases(stage 4/metastatic)
      underwent palliative treatment.

      All the data obtained were analyzed using IBM SPSS 23.0. Descriptive statistics like age were
      presented as range and means. Categorical data were analyzed using fisher exact test and
      t-test was applied to numerical data. In all cases, a 95% confidence interval was used and p
      value <0.05 was considered significant.
    

Intervention name(s): MRM , Toilet Mastectomy , BCS
Intervention type(s): Procedure
Intervention description(s): MRM , modified radical mastectomy : removing breast and axilla toilet mastectomy : palliative removal of tumor load BCS ,Breast conservative surgery
Observational model: Case-Only
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        Patient's data of all operated cases for suspicious lump breast (abnormal findings on
        ultrasound and mammogram, BIRAD III or above and abnormal FNAC results;C3 or above) from
        January1,2020 to 31 January 2021was retrieved. Out of these only those patients were
        included in whom the diagnosis of breast cancer was confirmed on histo-pathological
        examination. Patients who had already had their surgery pre covid (December 2019), were
        excluded. Data were collected on standard pre-designed questionnaire and from paper
        documents retrieved from patient records.

        All patients who were admitted and underwent pre anesthesia assessment underwent COVID
        testing according to the protocol.
      
Keywords: Breast Cancer; Covid-19; Modified Radical Mastectomy; Breast Conservation Surgery