1747P Chemotherapy prescriptions and emergency medical care utilization by patients in neo/adjuvant breast cancer treatment during COVID-19 pandemic: Patterns in a Brazilian University Hospital

Abstract

Cancer treatment during COVID-19 pandemic have been mainly focused on safety, and prioritization has been done to guide hierarchically choices according to clinical benefits considering resource scarcity. Considering the magnitude of benefit, neo/adjuvant breast cancer treatment is positioned at medium/high levels. Despite these recommendations, patients might be refusing chemotherapy or avoiding emergency care utilization because of COVID-19 infection concerns. A better understanding of the impact of the pandemic on breast cancer chemotherapy prescription patterns and demand for emergency care can support strategies to minimize unfavorable outcomes. Medical records from 299 breast cancer patients who started neo/adjuvant chemotherapy from January/2018 at the Hospital das Clínicas de Ribeirão Preto – USP (HCRP-USP) were retrospectively analyzed, with a total of 2,003 cycles. Clinical data, treatment information and outcomes were collected; COVID-19 pandemic period (CPP) (Mar/2020-Apr/2020) was compared to pre-pandemic period (PPP) (Jan/2018-Feb/2020). The mean number of neo/adjuvant chemotherapy cycles prescribed monthly and the mean number of treatments initiated monthly during CPP, respectively, 76 (± 9) and 10.5 (± 2.1) were similar to PPP, respectively, 77 (±12; p= 1) and 10.7 (±3.5; p=0.94). An average of 6.0% (± 1.6%) of the patients who received chemotherapy sought emergency care monthly during CPP compared to 10.9% (± 3.8%, p=0.07) before the pandemic. According to ESMO recommendation, neo/adjuvant breast cancer treatments have been prioritized considering its curative benefit. During COVID-19 pandemic there seems to be no compromising in patient acceptance or medical recommendations at our institution. On the other hand, there was a trend to decrease the attendance in the emergency units, what could compromise treatment safety. Telemedicine and continuous monitoring could minimize unfavorable outcomes. Further analyzes to correlate the impact of the pandemic on the safety and efficacy of the treatment in this population will be completed soon.