Abstract PS1-13: The impact of corona virus disease-2019 on breast services at university hospitals of North Midlands, United Kingdom
Authors: Gowda S Manoj , Kabeer Kirti , Mansour Fatima , Hasan Ammara , Nael Eisa , Gopalan Vallipuram , Gahir Daljit , Jegannathen Apurna , Marla Sekhar , Soumian Soni , Narayanan Sankaran , JafferBhoy Sadaf 
Published: February 2021

Abstract
Introduction: The COVID-19 pandemic has disrupted routine cancer care and training globally. Breast units adopted modified national guidelines in the UK, and significant changes were implemented to ensure the safety of patients and staff. The national breast screening services were temporarily suspended from March 2020. Patients underwent surgery in COVID-19 free zones. Complex oncoplastic procedures and immediate reconstructions were not offered. Adjuvant treatments were modified to reduce the risk of complications and hospital readmission. The objective of our study is to assess the impact of COVID-19 on breast cancer management and surgical training. Methods: The resource reallocation was implemented for 100 days, commencing from the 16th of March,2020. Patients diagnosed with breast cancer during this period were identified from the cancer database, and a comparison was made with patients diagnosed last year within the same time frame. We assessed the time taken from the decision to treatment and modifications made to cancer management due to the pandemic. The impact on resident training was evaluated by comparing the number of cases performed or assisted during this period. Results: During the pandemic period, out of 1064 patients seen in the Breast one-stop clinic, 64 patients (6.0%) were diagnosed with breast cancer. During the same time frame in 2019, out of 1881 new symptomatic patients, 90 (4.8%) were diagnosed with cancer. In 2019, sixty-three patients were treated for screen-detected cancer, whereas only 23 patients entered the screening pathway before the services were suspended. Majority of patients underwent surgery in 2019 as compared to 2020 (80% versus 36%). Fifty-six percent of patients received endocrine treatment as primary or bridging therapy; whereas, in 2019, only 12% received primary endocrine therapy. In 2020, time from decision to surgical treatment has decreased by half as compared to 2019 (8.6 versus 19.1 days). One patient who underwent surgery developed COVID-19 infection after two weeks, and no postoperative mortality was reported. On average, each trainee was involved in 35 procedures during 2020; whereas in 2019, 54 procedures were assisted or performed by a trainee. Conclusion: Our study shows that COVID-19 has made a significant impact on patients’ management and surgical training. Majority of the patients were commenced on neoadjuvant endocrine therapy instead of surgery. The conversion rate to cancers in one-stop clinic improved possibly due to a smaller number of benign referrals during the pandemic. The impact on surgical training is due to the reduction in the number of patients operated during this period, and constraints of performing complex oncoplastic procedures and breast reconstruction.
2019 (16.03.2019 to 22.06.2019)2020COVID period (16.03.2020 to 22.06.2020)Impact on Clinic: Total number of patients seen in OPD18811064Impact on Breast cancer Diagnosis1.Total153862.Screening63(41.17%)22(34.37%) (who were already in pathway)3.Symptomatic90(58.83%)64(65.63%)Impact on Breast cancer Treatment: 1st treatment1.Started on Neo-adjuvant chemotherapy13(8.49%)7(8.13%)2.Started on endocrine therapy (Both primary and neo-adjuvant)18(11.76%)48(55.81%)3.Surgery122(79.73%)31(36.04%)Mean days from decision to initiation of treatment1.Neo-adjuvant chemotherapy13.321.72.Endocrine therapy0.40.13.Surgery19.18.6Total number of surgeries performed Including those diagnosed before the pandemic.160102Breast surgical training Number of surgeries performed/ assisted by a trainee5435
Citation Format: Manoj Gowda S, Kirti Kabeer, Fatima Mansour, Ammara Hasan, Eisa Nael, Vallipuram Gopalan, Daljit Gahir, Apurna Jegannathen, Sekhar Marla, Soni Soumian, Sankaran Narayanan, Sadaf JafferBhoy. The impact of corona virus disease-2019 on breast services at university hospitals of North Midlands, United Kingdom [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 PS1-13.