Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Rajiv V. Dave, Baek Kim, Alona Courtney, Rachel L O'Connell, Tim Rattay, Vicky Taxiarchi, Jamie J Kirkham, Elizabeth Camacho, Patricia Fairbrother, Nisha Sharma, Christopher W.J. Cartlidge, Kieran Horgan, Stuart A. McIntosh, Daniel R. Leff, Raghavan Vidya, Shelley Potter, Christopher Holcombe, Ellen Copson, Charlotte Coles, Ramsey I CutressAshu Gandhi, Cliona Kirwan

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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.
Original languageEnglish
JournalBritish Journal of Cancer
Early online date25 Mar 2021
DOIs
Publication statusEarly online date - 25 Mar 2021

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