560 Poster - Breast referral management and outcome during COVID 19 Pandemic – A UK experience

Abstract

Background: The new respiratory illness commonly referred to as “corona virus” and officially called COVID-19 has changed life and delivery of health care worldwide. In UK it has resulted in major changes as not only halted the breast screening but also forced the breast unit to undergo reconfiguration for safety of patients and staff. The risk of becoming seriously ill from COVID-19 is low for most people. However, it’s very important to know that people being treated for breast cancer may have a higher risk of severe illness if they get COVID-19. We conducted this observational study to assess the impact of COVID 19 on breast referral and breast cancer management. Material and methods: We collected the data both retrospectively and prospectively from 16 March 2020 to 15 June 2020, while England was facing lock down restrictions. Total number of breast clinics scheduled, were 116 with 818 slots in Croydon University Hospital. We included 479 patients, 469 new referrals to breast clinic and 10 breast cancer patients referred back following neo adjuvant treatment. All new referrals were offered telephonic consultation (TC) prior to their face to face consultation (F2F) on the scheduled appointment day, within 2 weeks, 4–6 weeks and >12 weeks. All health care staff involved in direct care of these patients were provided with personal protective equipment (PPE) and guidelines.Tabled 1Number of new referrals469TCAllTC + discharge92F2 F112F 2 F in 2/52151F2F in 4-6/5260F2 F >3/1254B 311New breast cancer35Post NACT9Post neo RT1Recurrent cancer/sarcoma9Primary Surgery14Bridging-ET17Primary ET1NACT2Neo RT1NACT – Neoadjuvant chemotherapyNeo RT-Neo radiotherapy Open table in a new tab NACT – Neoadjuvant chemotherapy Neo RT-Neo radiotherapy Results: Out of 479 patients, 92 were discharged after TC due to low risk referral, 112 patients had F2F consultation on scheduled day, 151 within 2 weeks and 60 within 4–6 weeks after TC. 54 patients had their F2F appointments rescheduled after 3 months due to co-morbids. During this 3 months period, we diagnosed 35 new breast cancers, 5 recurrent cancer and 4 patients with sarcoma/malignant phyllodes. Primary surgery was performed in 14/35 patients with new cancer diagnosis, while 17 had bridging endocrine therapy prior to surgery. 10 patients had surgery following neoadjuvant treatment (chemotherapy in 9 and radiotherapy in 1). Total of 41 patients underwent surgery and COVID test was performed in all except 2 patients with one positive test result in whom surgery was deferred until converted negative. All patients had day case surgery with no adverse outcome noted. Conclusions: After required reconfiguration in both clinics and theatre settings and following precautions and guidelines we found it safe to manage patients referred with breast symptoms or diagnosed with breast cancer during COVID-19 restrictions. No conflict of interest.