Examining the Impact on Breast Cancer Treatment During COVID-19

Melissa L. Bondy, PhD, Chair, Department of Epidemiology and Population Health, Stanford University School of Medicine, CA, studies disease causes and ways to stop their spread. She introduced a Special Session called “Breast Cancer Care During COVID-19: How Did Patients and Clinicians Respond - A Global Perspective.” Dr Bondy provided a global perspective on the devastation caused by the coronavirus pandemic, with 67.6 million cases worldwide, 1.54 million individuals dying, and approximately 283,000 deaths in the United States alone as of December 7, 2020. The goal of this session was to examine how the pandemic has impacted breast cancer treatment as experienced by women and their partners and to share knowledge among researchers, clinicians, and patients.

Deborah Doroshow, MD, PhD, Assistant Professor, Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, discussed how the COVID-19 pandemic disproportionately affects the care of minority patients with cancer in the United States. She focused on how minority patients’ pain is often undermanaged and poorly treated. Her talk highlighted that, in general, minority patients with cancer are at greater risk for worse outcomes from COVID-19, and how members of minority groups generally are at higher risk for developing COVID-19 in the first place. Finally, she discussed how minority patients with cancer are at disproportionately high risk for pandemic-related disruptions in cancer care. She described how telehealth was being used to decrease exposure risk, and how the COVID-19 and Cancer Outcomes Study is being conducted to understand the impact of the pandemic on cancer care over time.

Anne Tang, MD, FACP, Researcher, Kaiser Permanente Northern California’s Permanent Medical Group Breast Research Collaborative, San Francisco, presented research focusing on breast cancer management during the COVID-19 pandemic. She noted that during the shelter-in-place period, changes in healthcare practices may have affected breast cancer diagnosis, timing of treatment, and choice of treatment. She compared a similar time period in 2019, and observed that in 2020, there was a 64% decrease in the number of patients who were diagnosed with breast cancer. More patients also presented with symptomatic disease in 2020, and cancers were more advanced, with more patients presenting with metastatic disease (ie, that had begun to spread outside the breast). She predicted that as screening mammography rates return to prepandemic levels, there may be a surge in new breast cancer diagnoses.

Christian Miller, a medical student from George Washington Cancer Center, George Washington University, Washington, DC, discussed telemedicine use for cancer care during the COVID-19 pandemic, noting that it increased greatly. Using questionnaires, he and his colleagues assessed patient preferences concerning telemedicine. They recognized that, initially, patients with breast cancer were quite skeptical about telemedicine as an adequate substitute for in-person visits, but this perspective improved significantly over time. Interestingly, it was clear that patients with breast cancer were most stressed by long periods of time without in-person visits, and older patients experienced greater stress.

Susan Rafte, a patient community advocate for the Lester and Sue Smith Breast Center at Baylor College of Medicine Breast Center, Houston, TX, spoke with Lidia Schapira, MD, Medical Oncologist, Stanford Women’s Cancer Center, Palo Alto, CA, about improving experiences of patients and caregivers by focusing on resilience in a crisis. Patients might feel more isolated and lonelier at a time when the pandemic disrupted support systems such as family visits and support groups. They discussed tools such as meditation apps (eg, the Calm and Headspace apps) to reduce stress. Some clinicians are screening for anxiety and depression before visits.