Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
Rajiv Dave, Baek Kim, Alona Courtney, Rachel O’Connell, Tim Rattay, Vicky P. Taxiarchi, Jamie J Kirkham, Elizabeth Camacho, Patricia Fairbrother, Nisha Sharma, Christopher W. J. Cartlidge, Kieran Horgan, Stuart McIntosh, Daniel Leff, Raghavan Vidya, Shelley Potter, Chris Holcombe, Ellen Copson, Charlotte E. Coles, Ramsey Cutress, Ashu Gandhi, Cliona Kirwan, on behalf of the B-MaP-C study collaborative, Amit Agrawal, John R. Benson, Parto Forouhi, Primeera Wignarajah, Anu Shrotri, A Kattakayam, Jarin Noronha, Lee Martin, Mohamed Lafi, Rob Hardy, Khalid Amin, Abdalla Saad Abdalla Al‐Zawi, Mohamed Elamass, Ali Salih, Firas Alkistawi, Anna Heeney, Arnold D. Hill, Colm Power, Michael J. Allen, Ashok Chouhan, Rathi Rathinaezhil, Samy Shaheed, Charles Zammit, Gillian Clayton, Sascha Dua, Simon Smith, Tasha Gandamihardja, Chloe Williams, Donna Egbeare, Eleri Davies, Helen Sweetland, Sharat Chopra, Sumit Goyal, Dalia Elfadl, Dheer Singh Rana, Eliana Kalakouti, Musa Barkeji, Rajiv Vashisht, Ralia Bunza, Saung Hnin Phyu, Ciaran Hollywood, Iman Azmy, Julia Massey, Anita Hargreaves, Claudia Harding-Mackean, Jane Ooi, Joanna Seward, Helen Mathers, Norah Scally, Reem Salman, Hyunjin Shin, Jane Turner, Lubna Noor, Sanjay Joshi, Sarah Horne, Wail Al Sarakbi, Péter Liptay-Wagner, Rosamond Jacklin, Sankaran Chandrasekharan, Simon Marsh, Sunita Saha, Chris Wilson, Claire Rutherford, Julie Doughty, László Romics, Sheila Stallard, Anushka Chaudhry, Jennifer D. Peck, Nathan Coombs, Samantha Williams, Simon Hawkins, Ashutosh Kothari, Hisham Hamed, Urvashi Jain, Ian Daltrey, Nick Abbott, Russell Mullen
Abstract
BACKGROUND: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. METHODS: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated 'standard' or 'COVID-altered', in the preoperative, operative and post-operative setting. FINDINGS: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had 'COVID-altered' management. 'Bridging' endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2-9%) using 'NHS Predict'. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. CONCLUSIONS: The majority of 'COVID-altered' management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.