Abstract P3-23-04: A comprehensive, multidisciplinary approach to breast cancer treatment during the COVID-19 pandemic improves time to treatment
Authors: Orucevic Amila , Hutson Robin , Heidel Robert , Lloyd Jillian , Morin-Ducote Garnetta , Lauro Christine , Perkins Ellen , Panella Timothy , Duncan Lisa , VanMeter Stuart , Bell John 
Published: March 2022

Abstract
A recently published study from the National COVID Cohort Collaborative (N3C) revealed that COVID-19 (CoV) positive status in cancer patients (pts) was associated with an increased risk of all-cause mortality at 1 year when compared to CoV negative status. In addition, age ≥65 years, Southern or Western US residence, an adjusted Charlson Comorbidity Index score ≥4, multi-tumor sites, and recent cytotoxic therapy were associated with increased risk of all-cause mortality. The CoV pandemic significantly impacted our hospital’s operations in 03/2020. Regardless, the hospital remained operational for cancer pts through the entire pandemic. The objective of this study is to investigate the impact of CoV pandemic on breast cancer (BC) treatment and outcomes in our academic medical center in East Tennessee. A retrospective cohort group was identified from a prospectively monitored Cancer Registry database of 706 pts comparing those diagnosed with BC from 3/1/2019-12/31/2019 (G1=406 pts) to those diagnosed from 3/1/2020-12/31/2020 (G2=300 pts). The impact of CoV pandemic was studied utilizing SPSS statistical software. During the pandemic, 26% fewer pts were treated for BC in our hospital, likely resulting from decreased screening rates. Pts in G2 were significantly younger than in G1 (mean age 61.4 vs 63.5), but no difference was observed in racial and insurance status or diagnosis with invasive BC vs DCIS (Table 1). CoV test results for 20 pts from G1 and all 300 pts in G2 (Table 2) were analyzed. Only 8 pts (2.6%) tested positive for CoV (all in G2). For 5 of these 8 pts, CoV positivity had no impact on their care or survival, since CoV infection happened either before or after their BC diagnosis and therapy. CoV caused delay of the first course of treatment in 9/300 (3%) G2 pts: 3/9 delays were due to CoV infection and 6/9 delays were due to implementation of nation-wide CoV pandemic guidelines for care of BC pts. Of the 6/9 pts who experienced delayed treatment, 5 were diagnosed with BC in 03/2020 and 1 in 06/2020, all in the time period of the national “lock-down”. Delayed surgical treatment had no impact on patient outcomes. During the pandemic, the number of days from diagnosis to chemotherapy or hormonal treatment was significantly shorter (p&lt;0.05) in the G2 cohort than in the pre-pandemic G1 cohort. The number of days to surgery or radiation treatment although non-significant was also lower in the G2 cohort. CoV did not impact readmission to our hospital within 30 days of surgery. None of the BC pts died from CoV. One-year overall survival of our BC pts was not negatively impacted by the CoV pandemic. Our results show that during the CoV pandemic, BC pts were receiving chemotherapy and hormonal treatment sooner than in the pre-pandemic time, likely due to effective teamwork while implementing national guidelines for triaging and administering neoadjuvant treatment during the pandemic. In contrast to N3C data, CoV pandemic did not negatively impact outcomes or 1-year overall survival in our patients. Future studies will determine if these findings remain at the 5 and 10-year follow-up period.
Table 1.Comparison of demographics, clinicopathologic characteristics and outcomes of patients diagnosed with breast carcinoma between 3/1/2019-12/31/2019 (Pre-COVID pandemic = G1) and 3/1/2020-12/31/2020 (COVID pandemic = G2)Demographics, clinicopathologic characteristics and outcomesG1 Cohort Pre-COVID 3/1/2019-12/31/2019G2 Cohort COVID era 3/1/2020-12/31/2020N = 706N = 406N = 300Age (mean +/- SD)63.51+/-12.6261.41+/-12.69*SexMale8 (2%)1 (0.3%)Female398 (98%)299 (99.7%)RaceCaucasian390 (98.1%)279 (93%)African American11 (2.7%)11 (3.7%)Other and unknown5 (1.2%)10 (3.3%)InsuranceUninsured1 (0.2%)4 (1.3%)Insured173 (42.6%)138 (46%)Medicare/Medicaid226 (55.7%)157 (52.3%)Veterans/Tricare6 (1.5%)1 (0.3%)Cancer behaviorDCIS54 (13.3%)44 (14.7%)Invasive carcinoma351 (86.7%)256 (85.3%)Treatment days from diagnosis (mean +/- SD) to:Surgery(N=391) 42.45+/-52.66(N=289) 37.69+/-41.28Chemotherapy(N=148) 68.34+/-42.75(N=110) 54.67+/-33.23*Hormone therapy(N=305) 146.47+/-95.63(N=209) 121.74+/-83.2*Radiation(N=196) 144.22+/-83.4(N=152) 142.09+/-74.42Readmission rate within 30 days of surgical dischargeNo readmission319 (92.5%)225 (92.2%)Unplanned readmission26 (7.5%)19 (7.8%)1-year overall survivalDead13 (3.2%)10 (3.3%)Alive393 (96.8%)290 (96.7%)Legend: *=significant, p&lt;0.05; N=number of patients; SD=standard deviation; DCIS=ductal carcinoma in-situ
Table 2.COVID-19 testing results in patients diagnosed with breast carcinoma between 3/1/2019-12/31/2019 (G1 cohort, Pre-COVID era) and 3/1/2020-12/31/2020 (G2 cohort, COVID pandemic era)G1 Cohort Pre-COVID 3/1/2019-12/31/2019G2 Cohort COVID era 3/1/2020-12/31/2020N=320N=20N=300COVID-19 testing results, preadmission or in-hospitalNegative test16 (80%)283 (94.3%)Positive for COVID-19 on at least one test0 (0%)8 (2.7%); 3/8 affected treatment; 5/8 did not affect treatmentUnknown4 (20%)9 (3%)COVID-19 treatment impactTreatment not affected18 (90%)289 (96.3%)First course of treatment timeline delayed0 (0%)9 (3%); 3/9 COVID-19 infection (+); 6/9 due to pandemic treatment guidelinesPatient refused treatment due to COVID-191 (5%)0 (0%)Unknown if treatment affected1 (5%)2 (0.7%)Note: Preadmission or in-hospital COVID-19 testing was performed on all patients treated in our hospital starting on 3/1/2020. Twenty patients from G1 and all 300 from G2 were treated in the time period from 3/1/2020-12/31/2020
Citation Format: Amila Orucevic, Robin Hutson, Robert Heidel, Jillian Lloyd, Garnetta Morin-Ducote, Christine Lauro, Ellen Perkins, Timothy Panella, Lisa Duncan, Stuart VanMeter, John Bell. A comprehensive, multidisciplinary approach to breast cancer treatment during the COVID-19 pandemic improves time to treatment [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-23-04.