Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK 'Alert Level 4' phase of the B-MaP-C study
File(s)
Published version
Author(s)
Type
Journal Article
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 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.
Date Issued
2021-05-25
Date Acceptance
2020-12-10
Citation
British Journal of Cancer, 2021, 124, pp.1785-1794
ISSN
0007-0920
Publisher
Springer Nature
Start Page
1785
End Page
1794
Journal / Book Title
British Journal of Cancer
Volume
124
License URL
Sponsor
Cancer Research UK
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33767422
PII: 10.1038/s41416-020-01234-4
Grant Number
25147
Subjects
Science & Technology
Life Sciences & Biomedicine
Oncology
Adult
Aged
Aged, 80 and over
Breast Neoplasms
COVID-19
Cohort Studies
Female
Humans
Middle Aged
Practice Guidelines as Topic
SARS-CoV-2
B-MaP-C study collaborative
Oncology & Carcinogenesis
1112 Oncology and Carcinogenesis
1117 Public Health and Health Services
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2021-03-25