Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK 'Alert Level 4' phase of the B-MaP-C study

被引：25

作者：

Dave, Rajiv V. ^{[1
]}

Kim, Baek ^{[2
]}

Courtney, Alona ^{[3
]}

O'Connell, Rachel ^{[4
]}

Rattay, Tim ^{[5
]}

Taxiarchi, Vicky P. ^{[6
]}

Kirkham, Jamie J. ^{[6
]}

Camacho, Elizabeth M. ^{[6
]}

Fairbrother, Patricia ^{[7
]}

Sharma, Nisha ^{[8
]}

Cartlidge, Christopher W. J. ^{[9
]}

Horgan, Kieran ^{[2
]}

McIntosh, Stuart A. ^{[10
]}

Leff, Daniel R. ^{[3
]}

Vidya, Raghavan ^{[11
]}

Potter, Shelley ^{[12
,13
]}

Holcombe, Chris ^{[14
]}

Copson, Ellen ^{[15
,16
]}

Coles, Charlotte E. ^{[17
]}

Cutress, Ramsey I. ^{[15
,16
]}

Gandhi, Ashu ^{[1
,18
]}

Kirwan, Cliona C. ^{[1
,18
]}

机构：

[1] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Nightingale Breast Canc Ctr, Manchester M23 9LT, Lancs, England

[2] St James Univ Hosp, Dept Breast Surg, Leeds LS9 7TF, W Yorkshire, England

[3] Imperial Coll, Dept Surg & Canc, London, England

[4] Royal Marsden NHS Fdn Trust, Dept Breast Surg, Downs Rd, Sutton SM2 5PT, Surrey, England

[5] Univ Leicester, Leicester Canc Res Ctr, Clin Sci Bldg, Leicester LE2 2LX, Leics, England

[6] Univ Manchester, Sch Hlth Sci, Div Populat Hlth Hlth Serv Res & Primary Care, Manchester M13 9PL, Lancs, England

[7] Independent Canc Patients Voice, Manchester, Lancs, England

[8] St James Hosp, Breast Unit, Level 1,Chancellor Wing, Leeds LS9 7TF, W Yorkshire, England

[9] Queen Margaret Hosp, Whitefield Rd, Dunfermline KY12 0SU, Fife, Scotland

[10] Queens Univ Belfast, Patrick G Johnston Ctr Canc Res, 97 Lisburn Rd, Belfast BT9 7AE, Antrim, North Ireland

[11] Royal Wolverhampton NHS Trust, Wolverhampton Rd, Wolverhampton WV10 0QP, W Midlands, England

[12] Univ Bristol Sch Med, Populat Hlth Sci, Bristol Ctr Surg Res, Canynge Hall,Whatley Rd, Bristol BS8 2PS, Avon, England

[13] North Bristol NHS Trust, Bristol Breast Care Ctr, Southmead Rd, Bristol BS10 5NB, Avon, England

[14] Royal Liverpool & Broadgreen Univ Hosp, Linda McCartney Ctr, Prescot St, Liverpool L7 8XP, Merseyside, England

[15] Univ Southampton, Canc Sci Acad Unit, Tremona Rd, Southampton SO16 6YD, Hants, England

[16] Univ Hosp Southampton, Tremona Rd, Southampton SO16 6YD, Hants, England

[17] Univ Cambridge, Dept Oncol, Cambridge, England

[18] Univ Manchester, Manchester Canc Res Ctr, Fac Biol Med & Hlth, Sch Med Sci,Div Canc Sci, Oglesby Canc Res Bldg,Wilmslow Rd, Manchester M20 4BX, Lancs, England

来源：

BRITISH JOURNAL OF CANCER | 2021年 / 124卷 / 11期

基金：

英国医学研究理事会; 美国国家卫生研究院;

关键词：

D O I：

10.1038/s41416-020-01234-4

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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 the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated 'standard' or 'COVID-altered', in the preoperative, 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), the median benefit was only 3% (IQR 2-9%) using 'NHS Predict'. There was the 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, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.

引用

页码：1785 / 1794

页数：10

共 37 条

[1] Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials [J].

Alberro, J. A. ;

Ballester, B. ;

Deulofeu, P. ;

Fabregas, R. ;

Fraile, M. ;

Gubern, J. M. ;

Janer, J. ;

Moral, A. ;

de Pablo, J. L. ;

Penalva, G. ;

Puig, P. ;

Ramos, M. ;

Rojo, R. ;

Santesteban, P. ;

Serra, C. ;

Sola, M. ;

Solarnau, L. ;

Solsona, J. ;

Veloso, E. ;

Vidal, S. ;

Abe, O. ;

Abe, R. ;

Enomoto, K. ;

Kikuchi, K. ;

Koyama, H. ;

Masuda, H. ;

Nomura, Y. ;

Ohashi, Y. ;

Sakai, K. ;

Sugimachi, K. ;

Toi, M. ;

Tominaga, T. ;

Uchino, J. ;

Yoshida, M. ;

Coles, C. E. ;

Haybittle, J. L. ;

Moebus, V. ;

Leonard, C. F. ;

Calais, G. ;

Garaud, P. ;

Collett, V. ;

Davies, C. ;

Delmestri, A. ;

Sayer, J. ;

Harvey, V. J. ;

Holdaway, I. M. ;

Kay, R. G. ;

Mason, B. H. ;

Forbe, J. F. ;

Franci, P. A. .

LANCET ONCOLOGY, 2018, 19 (01) :27-39

[2]

Association of Breast Surgery, 2020, CONF ADV HLTH PROF

[3]

BreastCancerOrg, 2020, U.S. Breast Cancer Statistics

[4] Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial [J].

Brunt, Adrian Murray ;

Haviland, Joanne S. ;

Wheatley, Duncan A. ;

Sydenham, Mark A. ;

Alhasso, Abdulla ;

Bloomfield, David J. ;

Chan, Charlie ;

Churn, Mark ;

Cleator, Susan ;

Coles, Charlotte E. ;

Goodman, Andrew ;

Harnett, Adrian ;

Hopwood, Penelope ;

Kirby, Anna M. ;

Kirwan, Cliona C. ;

Morris, Carolyn ;

Nabi, Zohal ;

Sawyer, Elinor ;

Somaiah, Navita ;

Stones, Liba ;

Syndikus, Isabel ;

Bliss, Judith M. ;

Yarnold, John R. .

LANCET, 2020, 395 (10237) :1613-1626

[5]

Coles C, 2020, GUIDELINES RAD THERA

[6] International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic [J].

Coles, C. E. ;

Aristei, C. ;

Bliss, J. ;

Boersma, L. ;

Brunt, A. M. ;

Chatterjee, S. ;

Hanna, G. ;

Jagsi, R. ;

Person, O. Kaidar ;

Kirby, A. ;

Mjaaland, I. ;

Meattini, I. ;

Luis, A. M. ;

Marta, G. N. ;

Offersen, B. ;

Poortmans, P. ;

Rivera, S. .

CLINICAL ONCOLOGY, 2020, 32 (05) :279-281

[7] The B-MaP-C study: Breast cancer management pathways during the COVID-19 pandemic. Study protocol [J].

Courtney, Alona ;

O'Connell, Rachel ;

Rattay, Tim ;

Kim, Baek ;

Cutress, Ramsey I. ;

Kirwan, Cliona C. ;

Gandhi, Ashu ;

Fairbrother, Patricia ;

Sharma, Nisha ;

Cartlidge, Christopher W. J. ;

Horgan, Kieran ;

McIntosh, Stuart A. ;

Leff, Daniel R. ;

Vidya, Raghavan ;

Potter, Shelley ;

Holcombe, Chris ;

Copson, Ellen ;

Coles, Charlotte E. ;

Dave, Rajiv V. .

INTERNATIONAL JOURNAL OF SURGERY PROTOCOLS, 2020, 24 :1-5

[8] Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. the COVID-19 pandemic breast cancer consortium [J].

Dietz, Jill R. ;

Moran, Meena S. ;

Isakoff, Steven J. ;

Kurtzman, Scott H. ;

Willey, Shawna C. ;

Burstein, Harold J. ;

Bleicher, Richard J. ;

Lyons, Janice A. ;

Sarantou, Terry ;

Baron, Paul L. ;

Stevens, Randy E. ;

Boolbol, Susan K. ;

Anderson, Benjamin O. ;

Shulman, Lawrence N. ;

Gradishar, William J. ;

Monticciolo, Debra L. ;

Plecha, Donna M. ;

Nelson, Heidi ;

Yao, Katharine A. .

BREAST CANCER RESEARCH AND TREATMENT, 2020, 181 (03) :487-497

[9] Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study [J].

Docherty, Annemarie B. ;

Harrison, Ewen M. ;

Green, Christopher A. ;

Hardwick, Hayley E. ;

Pius, Riinu ;

Norman, Lisa ;

Holden, Karl A. ;

Read, Jonathan M. ;

Dondelinger, Frank ;

Carson, Gail ;

Merson, Laura ;

Lee, James ;

Plotkin, Daniel ;

Sigfrid, Louise ;

Halpin, Sophie ;

Jackson, Clare ;

Gamble, Carrol ;

Horby, Peter W. ;

Nguyen-Van-Tam, Jonathan S. ;

Ho, Antonia ;

Russell, Clark D. ;

Dunning, Jake ;

Openshaw, Peter Jm ;

Baillie, J. Kenneth ;

Semple, Malcolm G. .

BMJ-BRITISH MEDICAL JOURNAL, 2020, 369

[10] Evidence-based guidelines for managing patients with primary ER+ HER2- breast cancer deferred from surgery due to the COVID-19 pandemic [J].

Dowsett, Mitch ;

Ellis, Matthew J. ;

Dixon, J. Michael ;

Gluz, Oleg ;

Robertson, John ;

Kates, Ronald ;

Suman, Vera J. ;

Turnbull, Arran K. ;

Nitz, Ulrike ;

Christgen, Matthias ;

Kreipe, Hans ;

Kuemmel, Sherko ;

Bliss, Judith M. ;

Barry, Peter ;

Johnston, Stephen R. ;

Jacobs, Samuel A. ;

Ma, Cynthia X. ;

Smith, Ian E. ;

Harbeck, Nadia .

NPJ BREAST CANCER, 2020, 6 (01)

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