COVID-19 Drives Strategic New Breast Cancer Approaches to Avoid Hospitalizations

In Clinical Studies News by Barbara Jacoby

From: Health Flash Marketing

New Study Tracks Changes in Breast Cancer Therapies During the Pandemic

Abstract: Analysis of the Impact of the COVID-19 Pandemic on the Multidisciplinary Management of
Breast Cancer: Review from the First 8 Months of the American Society of Breast Surgeons COVID and
Mastery Registries*

COVID-19 rapidly altered breast cancer treatment approaches with a  significant rise in neoadjuvant endocrine therapy (NET) for estrogen receptor positive (ER+) tumors,  enabling immediate evidence-based treatment of women with an extremely common form of breast  cancer, while delaying surgery and hospitalization during the pandemic.

These were the preliminary findings of a new study presented this week at the American Society of  Breast Surgeons (ASBrS) Annual Meeting. The study also found that fewer immediate breast  reconstructions were performed due to a growth in outpatient surgeries to avoid patient  hospitalizations.

According to Lee Wilke, MD, Professor of Surgery from the University of Wisconsin School of Medicine  and Public Health, lead researcher, the study presents an accurate snapshot of treatment changes  wrought by the pandemic and was based on a representative geographic and ethnic cross section of  patients entered into an ASBrS database. “Interestingly,” she says, “COVID-related breast cancer  treatment changes may have provided the context for testing new protocols, with some likely to persist  beyond the pandemic.”

The preliminary analysis focused on data collected from 2,476 patients entered in an embedded COVID  segment in the ASBrS Mastery Program registry, which tracks the patient outcomes of ASBrS member

surgeons, as well as 2,303 within the Mastery registry itself from March 1, 2020 to October 28, 2021.  Data through March 15, 2021 showed similar trends and is now available.

Patient information was entered by 172 ASBrS breast surgeons nationwide and indicated whether  treatment was consistent with usual protocols or modified due to COVID. Researchers found that NET  was used to treat an additional 36% of patients with ER+/HER2- cancers than would have otherwise  received the therapy. Patients who would have received NET without COVID ranged from 6.5% to 7.8%  in the two segments of the registry. While the initial analysis reflects only data through the fall of 2020,  according to Dr. Wilke, trends are likely to remain consistent throughout the study period.

She notes that many women with ER+ cancers, which generally have a good prognosis, receive anti estrogen endocrine therapy at some point during their treatment. This therapy blocks or decreases the  ability of hormones to promote the growth of certain types of cancer cells. However, most patients in  the study would have received endocrine therapy following surgery if deemed appropriate—not in  advance.

“During COVID, however, these drugs provided a way to start cancer treatments when hospitalization  for breast cancer therapy was difficult or impossible due to operating room (OR) restrictions, with  surgery then scheduled for a later date,” she says. “The rise in NET showed significant regional variation  appearing earlier in the Northeast and Southeast U.S., correlating with earlier COVID infection spikes in  these areas.”

Dr. Wilke also notes that treating ER+ cancers with neoadjuvant endocrine therapy was part of an  initiative of the ASBrS and other well-recognized cancer societies to develop algorithm-based, tiered  guidelines for alternative treatments to help hospitals avoid surgeries when possible. “Especially early  during the pandemic these revised treatments were necessary because access to hospital ORs was  limited or unavailable. These algorithmic-based treatment guidelines allowed us to offer high-quality  evidence-based care fine-tuned for a patient’s specific cancer profile.”

“Physicians also developed a series of options for further evaluating patients with the goal of delivering  the most appropriate care possible,” she notes. “For example, genomic testing on a core biopsy  assessed the ability to forgo chemotherapy and thereby use NET or proceed to surgery. Patients that  needed standard approaches still got them. Women with aggressive triple negative and HER2+ tumors  were treated standardly with neoadjuvant chemotherapy.”

Researchers will continue to some follow patients post-pandemic to assess the effectiveness of COVID  treatment strategies and the impact on their outcomes.

Dr. Wilke believes certain changes in treatment protocols may continue into the future. “Internationally,  NET is used far more frequently than in the U.S. with good results,” she says. “Perhaps in the U.S., we  will see a shift in protocols with an increasing comfort level of endocrine therapy as an initial treatment  for appropriate cancers.”

*For full study data, which show similar trends, contact