Impact of COVID-19 pandemic on breast cancer care: report from a regional cancer centre

Abstract

BackgroundThe COVID-19 pandemic has deeply disrupted cancer care, both during and after lockdowns. In this study, we analysed the treatment delay in patients with breast cancer due to COVID-19 pandemic in India.MethodsFrom March 2, 2020, to March 31, 2021, patients with breast cancer who presented to the breast clinic in the department of Radiotherapy & Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India were included in this analysis. Delays to the start of chemotherapy, surgery, and radiotherapy faced by patients with breast cancer were recorded. Delays to the patient treatment due to the COVID-19 pandemic were calculated and its impact on disease outcomes was analysed.Findings405 women were registered in the breast clinic. Diagnosis was delayed for up to 3 months for 144 (36%) patients, 4–6 months for 70 (17%) patients, 7–9 months for 43 (11%) patients, 10–11 months for 37 (9%) patients, and 12 or more months for 111 (27%) patients. Localised disease at presentation was observed in 360 (89%) patients, and metastatic disease in 45 (11%) patients. A total of 161 (40%) patients had delays to their treatment: chemotherapy was delayed for 45 (11%) patients, surgery for 56 (14%) patients, and radiotherapy for 90 (22%) patients. 19 (5%) patients were lost to follow-up. Disease progression occurred in 33 (20%) of 161 patients who had delays to start of treatment. Significantly more patients (64 [40%] of 161) who faced delays to treatment presented with T4 disease than patients who did not face delays (58 [26%] of 225; p=0·010). A significantly greater number of patients required neoadjuvant chemotherapy because of the delay at the start of treatment (90 [56%] vs 59 (26%) patients who did not face delays; p<0·0001). 142 (88%) of 161 patients who faced treatment delays and in 193 (86%) of 225 patients who did not face delays underwent surgery (either lumpectomy or mastectomy). More patients who faced treatment delays (107 [75%] of 142) had to undergo mastectomy than did patients who did not face delays (131 [68%] of 193). In patients with disease progression, median delay to start of chemotherapy was 3 months (IQR 2–8), median delay to start of surgery was 3 months (2–6), and median delay to start of radiotherapy was 2 months (2–4).InterpretationDue to delays in diagnosis and start of treatment, more patients presented with advanced tumours, which resulted in a greater number of patients needing neoadjuvant chemotherapy. Presentation in advanced stage translated to more mastectomies in these patients. Smaller delays to the start of radiotherapy could be because radiotherapy facilities were still operational during the COVID-19 pandemic. Delays to the start of treatment of breast cancer led to disease progression in one-fifth of affected patients, which can negatively affect their survival. Patients affected by delays to diagnosis or start of treatment need to be followed-up on for monitoring of effects of these delays on survival.FundingNone.