Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications

Abstract

During the COVID-19 pandemic, several priority diseases were not getting sufficient attention. Whilst breast cancer is a fatal disease affecting millions worldwide, identification and management of these patients did not initially attract critical attention to minimize the impact of lockdown, post-lockdown, and other measures. Breast cancer patients’ conditions may not remain stable without proper care, worsening their prognosis. Proper care includes the timely instigation of surgery, systemic therapy, and psychological support. This includes low-and middle-income countries where there are already concerns with available personnel and medicines to adequately identify and treat these patients. Consequently, there was a need to summarize the current scenario regarding managing breast cancer care during COVID-19 across all countries, including any guidelines developed. We systematically searched three scientific databases and found 76 eligible articles covering the medical strategies of high-income countries versus LMICs. Typically, diagnostic facilities in hospitals were affected at the beginning of the pandemic following the lockdown and other measures. This resulted in more advanced-stage cancers being detected at initial presentation across countries, negatively impacting patient outcomes. Other than increased telemedicine, instigating neo-adjuvant endocrine therapy more often, reducing non-essential visits, and increasing the application of neo-adjuvant chemotherapy to meet the challenges, encouragingly, there was no other significant difference among patients in high-income versus LMICs. Numerous guidelines regarding patient management evolved during the pandemic to address the challenges posed by lockdowns and other measures, which were subsequently adopted by various high-income countries and LMICs to improve patient care. The psychological impact of COVID-19 and associated lockdown measures, especially during the peak of COVID-19 waves, and the subsequent effect on the patient’s mental health must also be considered in this high-priority group. We will continue to monitor the situation to provide direction in future pandemics.

Keywords:

• COVID-19
• breast cancer
• healthcare system
• healthcare management
• treatment
• surgery
• guidelines
• unintended consequences

Abbreviations

AC, Adjuvant Chemotherapy; BCS, Breast Conservation Surgery; BR, Breast Reconstruction; DCIS, Ductal Carcinoma In-Situ; DLA, Dilutional Local Anesthetic; ER, Estrogen Receptor; ET, Endocrine Therapy; HER, Human Epidermal Growth Factor Receptor; HR, Hormone Receptor; IBR, Immediate Breast Reconstruction; IORT, Intraoperative Radiation Therapy; NAC, Neo-Adjuvant Chemotherapy; NAF, Nipple Aspirate Fluid; NET, Neo-Adjuvant Endocrine Therapy; PPE, Personal Protective Equipment; PR, Progesterone Receptor; SLNB, Sentinel Lymph Node Biopsy; ST, Systematic Therapy; TN, Triple-Negative; WLE, Wide-Local Excision.

Author Contributions

All authors made a significant contribution to the work, whether that is in the conception, study design, acquisition of data, analysis, and interpretation, or in all these areas; took part in writing, revising, or reviewing the article; gave final approval of the final version; have agreed on the journal choice; and agreed to be accountable for all aspects of the work. Consent for Publication: all authors reviewed and approved the final version and have agreed to be accountable for all aspects of the work, including any issues related to accuracy or integrity.

Disclosure

The authors report no conflicts of interest for this work and declare that they do not have any financial involvement or affiliations with any organization, association, or entity directly or indirectly with the subject matter or materials presented in this article. This also includes honoraria, expert testimony, employment, ownership of stocks or options, patents or grants received or pending, or royalties.

Additional information

Funding

This paper was not funded.