Management of non-invasive tumours, benign tumours and breast cancer during the COVID-19 pandemic: recommendations based on a Latin American survey

Abstract

Introduction: The COVID-19 pandemic has changed health systems across the world, both in general hospitals and in oncology institutes or centres.For cancer specialists, particularly breast cancer (BC), the COVID-19 pandemic represents a combination of challenges since the hospital resources and staff have become more limited; this has obliged oncology specialists to seek a consensus and establish which patients with BC require more urgent attention and which patients can wait until there is a better control of this pandemic. The health system in Latin America has some special characteristics; in some of the countries, there are shortages which limit access to several specialities (surgery, clinical oncology and radiotherapy) in some regions.

Objective: After a systematic review of the most recent literature regarding the management of BC during the COVID-19 pandemic, the main objective is to understand the position of the different Latin American Societies of Mastology in terms of available alternatives for the treatment of BC.

Methods: After carrying out a comprehensive and exhaustive search of the most recent guides on the management of BC during the COVID-19 pandemic, the board members of the Latin American Federation of Mastology invited, via email, different specialists, all experts in BC care, to complete an anonymous survey online.The survey was distributed between 30 and 10 May 2020. The survey included 27 questions on four topics: demographic information, consultations, imaging and treatment of BC.The questionnaire was sent and then distributed to various health specialists including breast surgeons, clinical oncologists, radiation oncologists and radiologists via the Presidents of the different Latin American Societies of Mastology in 18 countries. The results are summarised as tallies based on the number of responses to each question.

Results: A total of 499 responses were received. The majority of the respondents were males (275 (55.11%)); 290 participants were over 45 years (58.11%).The questionnaire presented those surveyed with three possible answers (agree, disagree and neither agree nor disagree). The results reflect that there was consensus in the majority of situations presented. Only seven questions revealed disagreement among those responding. The results are presented as recommendations.

Conclusion: The management of patients with BC presents unique challenges during the current world health situation produced by COVID-19 pandemic. Breast care specialists (surgical oncologists, breast care clinicians, clinical oncologists, radiation oncologists and radiologists) from 18 countries in Central and South America submitted through their responses and recommendations for the treatment of BC during the COVID-19 pandemic.

Keywords: breast cancer; coronavirus; survey method.

Figure 1.. COVID-19: Progression of confirmed cases in Latin America, USA, Spain and China graph. Adapted from BBC News Mundo. Coronavirus en América Latina: 7 gráficos para entender el avance de la pandemia de COVID-19 en la región. BBC. 2020 [cited 2020 Apr 27]. Available at: https://www.bbc.com/mundo/noticias-america-latina-52405371.

Figure 2.. Participating countries and their responses.

Figure 3.. Sociodemographic characteristics of the specialist (AGE).

Figure 4.. State of the hospital of the respondents during the COVID-19 pandemic.

Figure 5.. Agreement on the necessity that the assessment of a patient with a recent diagnosis of cancer should be in person during the COVID-19 pandemic.

Figure 6.. Type of consultation for postoperative assessment and revision of anatomical pathology.

Figure 7.. Agreement on follow-up of asymptomatic patients, post-treatment by tele-consultation during the COVID-19 pandemic.

Figure 8.. Response to the possibility of delaying surgical treatment after having finished their neoadjuvant treatment during COVID-19 pandemic.

Figure 9.. Response to the possibility of deferring re-operation on patients with positive axila or compromised borders during the COVID-19 pandemic.

Figure 10.. Response to the possibility of delaying treatment with radiotherapy in patients with locally advanced cancer during the COVID-19 pandemic.