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

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

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.

0007-0920
Dave, Rajiv V
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Kim, Baek
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Courtney, Alona
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O'Connell, Rachel
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Rattay, Tim
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Taxiarchi, Vicky P
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Kirkham, Jamie J
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Camacho, Elizabeth M
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Fairbrother, Patricia
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Sharma, Nisha
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Cartlidge, Christopher W J
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Horgan, Kieran
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McIntosh, Stuart A
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Leff, Daniel R
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Vidya, Raghavan
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Potter, Shelley
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Holcombe, Chris
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Copson, Ellen
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Coles, Charlotte E
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Cutress, Ramsey I
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Gandhi, Ashu
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Kirwan, Cliona C
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B-MaP-C study collaborative
Dave, Rajiv V
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Kim, Baek
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Courtney, Alona
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O'Connell, Rachel
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Rattay, Tim
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Taxiarchi, Vicky P
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Kirkham, Jamie J
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Camacho, Elizabeth M
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Fairbrother, Patricia
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Sharma, Nisha
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Cartlidge, Christopher W J
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Horgan, Kieran
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McIntosh, Stuart A
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Leff, Daniel R
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Vidya, Raghavan
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Potter, Shelley
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Holcombe, Chris
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Copson, Ellen
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Coles, Charlotte E
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Cutress, Ramsey I
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Gandhi, Ashu
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Kirwan, Cliona C
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Dave, Rajiv V, Kim, Baek, Courtney, Alona, O'Connell, Rachel, Rattay, Tim, Taxiarchi, Vicky P, Kirkham, Jamie J, Camacho, Elizabeth M, Fairbrother, Patricia, Sharma, Nisha, Cartlidge, Christopher W J, Horgan, Kieran, McIntosh, Stuart A, Leff, Daniel R, Vidya, Raghavan, Potter, Shelley, Holcombe, Chris, Copson, Ellen, Coles, Charlotte E, Cutress, Ramsey I, Gandhi, Ashu and Kirwan, Cliona C , B-MaP-C study collaborative (2021) Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK 'Alert Level 4' phase of the B-MaP-C study. British Journal of Cancer. (doi:10.1038/s41416-020-01234-4).

Record type: Article

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.

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More information

Accepted/In Press date: 10 December 2020
e-pub ahead of print date: 25 March 2021

Identifiers

Local EPrints ID: 449143
URI: http://eprints.soton.ac.uk/id/eprint/449143
ISSN: 0007-0920
PURE UUID: 1d8e43c7-5518-4295-b8b3-4266d767d7e5

Catalogue record

Date deposited: 18 May 2021 16:31
Last modified: 18 May 2021 16:31

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Contributors

Author: Rajiv V Dave
Author: Baek Kim
Author: Alona Courtney
Author: Rachel O'Connell
Author: Tim Rattay
Author: Vicky P Taxiarchi
Author: Jamie J Kirkham
Author: Elizabeth M Camacho
Author: Patricia Fairbrother
Author: Nisha Sharma
Author: Christopher W J Cartlidge
Author: Kieran Horgan
Author: Stuart A McIntosh
Author: Daniel R Leff
Author: Raghavan Vidya
Author: Shelley Potter
Author: Chris Holcombe
Author: Ellen Copson
Author: Charlotte E Coles
Author: Ashu Gandhi
Author: Cliona C Kirwan
Corporate Author: B-MaP-C study collaborative

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