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Multicenter Study
. 2021 May;124(11):1785-1794.
doi: 10.1038/s41416-020-01234-4. Epub 2021 Mar 25.

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

Rajiv V Dave  1 , Baek Kim  2 , Alona Courtney  3 , Rachel O'Connell  4 , Tim Rattay  5 , Vicky P Taxiarchi  6 , Jamie J Kirkham  6 , Elizabeth M Camacho  6 , Patricia Fairbrother  7 , Nisha Sharma  8 , Christopher W J Cartlidge  9 , Kieran Horgan  2 , Stuart A McIntosh  10 , Daniel R Leff  3 , Raghavan Vidya  11 , Shelley Potter  12   13 , Chris Holcombe  14 , Ellen Copson  15 , Charlotte E Coles  16 , Ramsey I Cutress  15 , Ashu Gandhi #  17   18 , Cliona C Kirwan #  19   20 ; B-MaP-C study collaborative
Collaborators, Affiliations
Multicenter Study

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

Rajiv V Dave et al. Br J Cancer. 2021 May.

Erratum in

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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Conflict of interest statement

The authors declare no competing interests. R.V.D., B.K., A.C., R.O’C., V.P.T., R.V., J.J.K., P.F., N.S., C.W.J.C., K.H., S.P., A.G., S.A.M., E.M.C., D.R.L. and C.H. have nothing to declare. Dr Tim Rattay (T.R.) is currently an NIHR Clinical Lecturer. Charlotte E Coles (C.E.C.) is supported by the National Institute Health Research Cambridge Biomedical Research Centre. Ramsey I Cutress (R.I.C.) has equipment provided by Seca to analyse body composition to University Hospital Southampton as part of an NIHR model industry collaborative agreement (MiCA). This equipment is used in an Academic Investigator-led charity-funded study of which Ramsey Cutress is CI. Ellen Copson (E.C.) declares honoraria from Roche, Pfizer, Astra-Zeneca, Lilly, Nanostring and expert panel work for World Cancer Research Fund. Cliona C. Kirwan (C.C.K.) is Royal College of Surgeons/University of Manchester Professor of Surgical trials funded by a Royal College of Surgeons of England/Masonic Charitable Foundation professorship.

Figures

Fig. 1
Fig. 1. Study schematic showing the points at which patients may enter into the study, the number of patients in each group and the timelines reported in the study.
Patients may have ‘standard’ treatment at all stages in their management journey or may have ‘COVID-altered’ treatment. This latter group may have ‘COVID-altered’ management in the preoperative, operative or post-operative stage, and may indeed have ‘standard’ management decision at some stage. Overlapping ovals indicate overlapping sub-cohorts. ET   endocrine therapy, NACT   neoadjuvant chemotherapy, BCS   breast-conserving surgery, SM   simple mastectomy, Adj. adjuvant, CT   chemotherapy, RT   radiotherapy, HER2   human epidermal growth factor receptor.
Fig. 2
Fig. 2. Change over time in the number of patients presenting with screen-detected versus symptomatic breast cancer during the study period.
Week 1 begins on 16th March, and week 8 ends on 8th May.
Fig. 3
Fig. 3. Transition to ‘green’ (COVID low-risk) theatres.
Change over time during the ‘study period, showing an increase in the number of operations performed in a ‘green’ (COVID low-risk) versus ‘red’ (COVID high-risk) zone.
Fig. 4
Fig. 4. National Variations in management of breast cancer during the COVID-19 pandemic.
a Variation in management decisions in the top 10 recruiting units, comparing the percentage of patients with (i) standard management (light grey bar), (ii) bridging ET (grey bar) and (iii) 5-fraction RT (black bar). b Trends in management decisions during the study period, by date of diagnosis at weekly intervals.
See this image and copyright information in PMC

References

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