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Time to Treatment Initiation for Breast Cancer During the COVID-19 Pandemic: Single-Institution Study


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In a single-institution study reported in JCO Oncology Practice, Hawrot et al found that there was no increase in time to treatment initiation after histologic diagnosis in patients with newly diagnosed breast cancer during the first wave of the COVID-19 pandemic in 2020. However, they did find that patient volume decreased and that more patients received preoperative hormonal treatment as initial therapy.

Study Details

The study included patients at the Hospital of the University of Pennsylvania or its satellite sites with a new diagnosis of invasive breast cancer, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ between January 1, 2020, and May 15, 2020 (2020 cohort) or between January 1, 2018, and May 15, 2018 (2018 cohort). The adjusted time to time to treatment initiation was compared using multivariable linear regression.

Time to treatment initiation was maintained among patients diagnosed and treated for breast cancer during the COVID-19 pandemic at a single large academic center. There was a decrease in patient volume, specifically in patients with in situ disease, and a shift in initial therapy toward the use of preoperative hormonal therapy.
— Hawrot et al

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Key Findings

A total of 164 patients received a diagnosis in the 2020 cohort vs 202 in the 2018 cohort, representing an 18.8% decline in patient volume.

In analysis adjusting for race, age, clinical stage, breast cancer subtype, and histologic subtype, there was no significant difference in time to treatment initiation between the two cohorts (P = .926). Mean unadjusted time to treatment initiation was 45 days (median = 41 days, interquartile range [IQR] = 29–55 days) in 2018 vs 44 days (median = 36 days, IQR = 27–52 days) in 2020.

Clinical stage at presentation differed between cohorts (P = .040), and presentation with DCIS was more common in the 2018 cohort vs 2020 cohort (26.2% vs 13.4%).

More patients began treatment with preoperative systemic therapy in the 2020 cohort vs the 2018 cohort (43.9% vs 16.4%, P < .001), with the difference largely reflecting a greater use of preoperative hormonal therapy (23.2% vs 4.0%) rather than preoperative chemotherapy (20.7% vs 12.4%).

Among 99 patients in the 2020 cohort who completed COVID-19 delay questionnaires, 55 (55.6%) reported no care delay and 44 (44.4%) reported a delay, with delays in surgery (n = 41) and radiation therapy (n = 27) being the most common. Among patients identified as having a delay in surgery because of COVID-19, 70.7% (n = 29) were started on preoperative hormonal therapy.

The investigators concluded, “Time to treatment initiation was maintained among patients diagnosed and treated for breast cancer during the COVID-19 pandemic at a single large academic center. There was a decrease in patient volume, specifically in patients with in situ disease, and a shift in initial therapy toward the use of preoperative hormonal therapy.”

Rachel C. Jankowitz, MD, of Perelman School of Medicine at the University of Pennsylvania, is the corresponding author for the JCO Oncology Practice article.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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