Abstract
Background
The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and potential impact of these treatment decisions.
Methods
This was a national cohort study of patients with early BC undergoing multi-disciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the pre-operative, operative, and post-operative setting.
Findings
Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n=951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n=299). Where adjuvant chemotherapy was omitted (n=81), median benefit was only 3% (IQR 2%-9%) using ‘NHS Predict’. There was rapid adoption of new evidence-based hypofractionated radiotherapy (n=781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.
Conclusions
The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, outwith this study, the potential impact of delays to BC presentation or diagnosis remains unknown.
The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and potential impact of these treatment decisions.
Methods
This was a national cohort study of patients with early BC undergoing multi-disciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the pre-operative, operative, and post-operative setting.
Findings
Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n=951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n=299). Where adjuvant chemotherapy was omitted (n=81), median benefit was only 3% (IQR 2%-9%) using ‘NHS Predict’. There was rapid adoption of new evidence-based hypofractionated radiotherapy (n=781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey.
Conclusions
The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, outwith this study, the potential impact of delays to BC presentation or diagnosis remains unknown.
| Original language | English |
|---|---|
| Journal | British Journal of Cancer |
| Publication status | Accepted/In press - 3 Dec 2020 |
