Abstract PS6-32: Impact of COVID-19 on breast cancer care at a Bay Area academic center
Authors: Wu Julie , Bobo Sally , Henry Solomon , Mills Meredith , Kurian Allison , Dirbas Frederick 
Published: February 2021

Abstract
Background: Oncology practice has been transformed in response to the COVID-19 pandemic. Oncologists are postponing chemotherapies, delaying curative surgeries, and switching intravenous to oral therapies. These decisions are based on competing risks, and treatments are proceeding if the malignancy is more lethal than the virus. There is currently limited information quantifying the impact of COVID-inspired policies on breast cancer care. Methods: This is a retrospective analysis of all patients with a new diagnosis of breast cancer between October 1, 2019 and May 27, 2020, and who had a stage documented in the Stanford electronic medical record (EMR). Cases who had a recurrence of previously diagnosed breast cancer or who had their breast cancer care primarily outside of Stanford and did not have their outside health records accessible were excluded. Changes in treatment plan due to COVID-19 were defined as including “COVID” or “coronavirus” in the clinical medical decision making documented in clinical notes supporting any treatment decision affecting timing or type of systemic therapy, surgery, or radiation. This includes treatment affected by new policies because of COVID-19 or concerns expressed by the provider or patient due to COVID-19. If treatment was changed and no rationale was given, this was categorized as “unknown.” If patients experienced a change in other breast cancer treatment-related services (for example, physical therapy for lymphedema) due to COVID, this was categorized as “other” and not included in the analysis. Treatment changes were noted if documented prior to June 26, 2020.Results: 291 cases were analyzed. Overall, the majority had early stage disease (Stage 0 or 1; n = 190, 65.3%) (Table 1). 46 (15.8%) patients had a change in therapy (systemic therapy, surgery, or radiation). The most common treatment change was a delay of surgery (n = 21, 45.7%), which were mostly early stage cancers (Tables 1 and 2). There was no significant difference in the ages of patients who had a COVID-related treatment change (all patients: mean 56.9 years old at diagnosis; patients with treatment change: mean 57.0 years old). Another 20 (6.9%) patients had a change in other breast cancer treatment-related services due to COVID-19 related causes.Conclusions: During the COVID-19 outbreak, a significant minority of patients with recently diagnosed breast cancer had their treatment plan changed in response to COVID-19. In particular, patients with early stage breast cancers who were candidates for neoadjuvant endocrine therapy had surgeries delayed. Further follow-up will be needed to fully understand the impact COVID-19 has had on cancer care, as more recently diagnosed patients have not yet completed treatment. However, this early analysis can begin to quantify the impact of COVID-19 on cancer care.
Table 1 – Stage at diagnosis of breast cancer patientsAll patients, n=291(%)Patients with a COVID-related treatment change, n=46 (%)Patients with delay in surgery, n =21 (%)Stage 033 (12%)11 (25%)7 (35%)Stage I1 (0.4%)Stage IA124 (45%)16 (36%)6 (30%)Stage IB32 (12%)6 (14%)3 (15%)Stage II2 (0.7%)5 (11%)Stage IIA25 (9.1%)1 (2.3%)2 (10%)Stage IIB14 (5.1%)Stage IIIA12 (4.4%)2 (4.5%)1 (5%)Stage IIIB12 (4.4%)2 (4.5%)1 (5%)Stage IIIC4 (1.5%)Stage IV16 (5.8%)1 (2.3%)Unknown14 (4.8%)2 (4.5%)1 (5%)
Table 1 – Types of COVID-related treatment changes (more than one possible per patient)N = 46 (%)Delay in chemotherapy administration5 (10.9%)Change in chemotherapy regimen to a different regimen4 (8.7%)Decided not to give chemotherapy3 (6.5%)Neoadjuvant endocrine therapy given17 (37.0%)Delay in endocrine therapy1 (2.2%)Delay in surgery21 (45.7%)Change in planned surgery type7 (15.2%)Change sequence of chemotherapy and surgery2 (4.3%)Delay in radiation8 (17.4%)Change in planned radiation course1 (2.2%)
Citation Format: Julie Wu, Sally Bobo, Solomon Henry, Meredith Mills, Allison Kurian, Frederick Dirbas. Impact of COVID-19 on breast cancer care at a Bay Area academic center [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-32.