The COVID-19 Outbreak May Be Associated to a Reduced Level of Care for Breast Cancer. A Comparative Study with the Pre-COVID Era in an Italian Breast Unit.

Alessandro Fancellu,Maria Laura Ariu,Pietrina Cottu,Alberto Porcu,Gian Quirico Piana,Antonio Cossu,Claudia Piredda,Valeria Sanna,Giulia Deiana,Corrado Rubino,Angela Spanu

doi:10.3390/healthcare8040474

Abstract

The recent COVID-19 pandemic has caused profound changes to healthcare systems as well as had deleterious repercussions on the care of cancer patients. In this comparative study, we sought to evaluate the effects of the COVID-19 pandemic on the surgical management of breast cancer in a breast unit in an Italian region with a low incidence of COVID-19 infection. Eighty-three patients were included, of whom 41 received surgery during the height of the pandemic (Group A, operated on between March and April 2020), and 42 during the same period of the year in 2019 (Group B). Clinicopathological characteristics and surgical outcomes were compared between the two groups. There were no significant differences in the baseline characteristics of the two groups with regard to age (p = 0.62), tumour size (p = 0.25), grade (p = 0.27), histology (p = 0.43), positive lymph node status (p = 0.35), and ER positive status (0.35). Waiting time for surgery was slightly longer in Group A (49.11 vs. 46.39 days, p = 0.38). Patients receiving immediate breast reconstruction were significantly less in Group A (p < 0.001). The use of sentinel node biopsy was similar in the two groups (p = 0.84). Hospital stay was longer in patients of Group B (p = 0.008). The use of regional nerve blocks was lower in Group A (p < 0.001). Patients operated on during the height of the pandemic were less likely to receive immediate reconstruction and regional nerve blocks during surgery. These features configure a situation of reduced level of care for patients with breast cancer. Efforts should be taken by the healthcare systems to maintain standard of care, even in case of a new peak in the coronavirus outbreak.

Highlights

The COVID-19 is a recently discovered infectious disease caused by the SARS CoV-2 coronavirus, which was responsible for the current global outbreak of severe acute respiratory syndrome
We sought to evaluate the effects of the COVID-19 pandemic on the surgical management of breast cancer patients in a breast unit in a region with limited COVID-19 cases, by comparing treatment and outcomes of patients operated on during the pandemic with those operated on in the pre-pandemic period
The unit is a part of the SMAC (Senologia Multidisciplinare Aziendale Coordinata—Italian acronym for Healthcare Company Coordinated Multidisciplinary Senology), which represents the referral center for breast cancer treatment in Northern Sardinia, and satisfies the requirements of a specialist breast center, as identified by the European Society of Mastology (EUSOMA) [7]

Summary

Introduction

The COVID-19 is a recently discovered infectious disease caused by the SARS CoV-2 coronavirus, which was responsible for the current global outbreak of severe acute respiratory syndrome. Due to the highly infectious nature of COVID-19, the epidemic has rapidly spread since December 2019, and to date has caused more than 9,220,000 confirmed cases and almost 477,000 deaths worldwide [1]. Specific national regulations and guidelines have been adopted with the aim to mitigate the negative effects of the COVID-19 pandemic on cancer management [2,3,4,5]. Was the first country in Europe to be affected by the pandemic, and the one with the current highest number of deaths, important differences in the burden of the outbreak were registered between the northern and southern regions, the latter having the lower case rate [6]. The measures taken to contain the spread of COVID-19 infection were adopted across the country, with no distinctions in differences related to rates of disease burden

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