176P Breast cancer treatment during the first wave of the COVID-19 pandemic at a UK centre

Abstract

This study aimed to assess the impact of the first wave of the COVID-19 pandemic on treatment delivery in patients undergoing systemic anti-cancer therapy (SACT) for breast cancer at a major London Oncology centre within an acute general hospital. Patients receiving outpatient SACT for breast cancer over a two-month period from 23rd March - 17th May 2020 were included and compared to an equivalent period in 2019. The number of referrals for breast cancer diagnosis was reduced by 38%. This was primarily a result of suspended screening services and inevitably had an impact on the number of patients starting their first treatment, which was reduced by 34%. Treatment was most affected for patients receiving neoadjuvant chemotherapy, 85% (28/33) of whom were impacted. Eight-six percent (24/28) of these had surgery expedited. The treatment of 74% of adjuvant (23/31) and 57% (12/21) of palliative patients receiving chemotherapy was modified, deferred or stopped. Modifications included switching to oral or less immunosuppressive therapies, delaying anthracyclines until completion of taxanes and increased use of G-CSF. Patient preference, co-morbidities and benefit of therapy were used to guide treatment. Compared to 2019, SACT given in hospital was reduced by 39%, mainly due to a reduction in intravenous bisphosphonate administration. Recovery was evident during the 8 week period, with treatment numbers returning to near normal towards the end. Widespread COVID-19 testing was not available at this time but 1% (3/312) of patients had parenteral treatment delayed due to COVID-19 symptoms (either in themselves or a household contact) and 2 patients tested positive for COVID-19 during the study period. One of these confirmed cases died from COVID-19 infection. This study demonstrates that the first wave of COVID-19 had a significant effect on breast cancer diagnosis and treatment delivery. Future impact on survival for these patients is uncertain. Whilst recovery is now evident, better efforts must be made to ensure cancer services and patients are prioritised in future.