How the Pandemic Changed Breast Cancer Care

By Cara Murez
HealthDay reporter

TUESDAY, May 4, 2021 (HealthDay News) – As the COVID-19 pandemic moves, breast cancer experts have realized that space in operating rooms and hospitals may become scarce. It meant rethinking standard care, to provide the best way to treat patients in these suddenly constrained conditions.

One of the new ideas is to reverse the order of care for patients with a type of breast cancer known as estrogen receptor positive (ER +). ER + cancer is a common type of breast cancer and generally has a good outlook.

Instead of receiving a drug known as neoadjuvant endocrine therapy (NET) after surgery, as is more common, patients would receive a NET first and surgery later, as the operating rooms were so rare. And because doctors weren’t sure how long the postponement of surgeries could last, they set up a system to track what was happening to women affected by the delays across the United States.

Study leader Dr. Lee Wilke said her team wanted “to catalog across the country how long have patients had their surgery or treatment postponed, and what mechanisms have surgeons used to trying to make sure that they were always able to treat their patients in an efficient manner. Wilke is a professor of surgery in the Faculty of Medicine and Public Health at the University of Wisconsin, Madison.

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Preliminary results were presented Sunday at an online meeting of the American Society of Breast Surgeons (ASBrS). Research presented at meetings is generally considered preliminary until it is published in a peer-reviewed journal.

Treating cancers in this way was part of an effort by the group of breast surgeons and other cancer companies to develop treatment guidelines for times when access to operating rooms is limited.

Doctors have also developed a series of options to further assess patients, Wilke said. This included testing for gene mutations in tumor DNA to determine which patients needed chemotherapy.

Patients who needed standard approaches always had them, Wilke said. For example, women with aggressive triple negative and HER2 + tumors were still treated with chemotherapy.

The data used in the study came from nearly 4,800 patients listed in the registry as of March 2020. A total of 172 breast surgeons entered information into the registry.

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Due to COVID-19, NET was used to treat an additional 554 patients (36%) who would otherwise have had surgery between March 1 and October 28, 2020, according to the study. Subsequent results through March 2021 put the total at 31%.

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NET was also used in 6.5% to 7.8% of patients in registries who would have typically received this treatment, the study authors said in an ASBrS press release.

The patterns found in the registry are what cancer experts discussed at the start of the pandemic, said Dr Tari King, chief of breast surgery at the Dana-Farber / Brigham and Women’s Cancer Center in Boston, who did not participated in the study.

“We had good data to support that this would be a reasonable strategy for the majority of patients to come with ER + breast cancer, that we could use it as a bridge to surgery without negatively impacting their outcomes.” King said.

Several clinical trials had already validated the approach, which is more common in Europe.

Anti-estrogen endocrine therapy blocks or decreases the ability of hormones to develop certain types of cancer cells. In the United States, it’s typically used in postmenopausal women with larger tumors, Wilke said.

The study also found that there were fewer immediate breast reconstruction surgeries because shorter operative times prioritized cancer removal.

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About 24% of patients were tested for genetic mutations on biopsied tumor tissue, according to the study.

Dana-Farber / Brigham and the Women’s Cancer Center were already using the baseline biopsy for these genomic studies to determine which women needed chemotherapy before surgery, King said.

In places like Boston, cancer treatment returned to normal in late fall, she noted.

King said that many patients who had started preoperative endocrine therapy at the center did not stay on treatment for as long as they normally would if the goal had been to shrink the tumor because they were already candidates for lumpectomy.

While this change in treatment was temporary, King said he challenged researchers to think more broadly about patients who might benefit from NET in the future. It reduces tumors as well as chemotherapy, but it takes longer, she said.

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“But neoadjuvant endocrine therapy certainly has a lot less side effects, a lot less toxicity than chemotherapy,” King said. “I think this prompts us to think about using it more widely when we are trying to shrink an ER + tumor if the patient is not a candidate for chemotherapy.”

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Wilke added that it might take three to five years to understand the full impact of the changes resulting from the pandemic. Some of the new protocols can continue.

More information

The American Cancer Society has more on breast cancer.

SOURCES: Lee Wilke, MD, professor, surgery, University of Wisconsin School of Medicine and Public Health, and director, UW Health Breast Center, Madison; Tari King, MD, chief, breast surgery, Dana-Farber / Brigham and Women’s Cancer Center, professor, surgery, Harvard Medical School, and associate chair, multidisciplinary oncology, Brigham and Women’s Hospital, Boston; American Society of Breast Surgeons, Annual Meeting, May 2, 2021, online presentation

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