Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic

Abstract

Practice and behaviour change in healthcare is complex, and requires a set of critical steps that would be needed to implement and sustain the change. Neoadjuvant chemotherapy for breast cancer is traditionally used for locally advanced disease and is primarily advantageous for surgical downstaging purposes. However, it does also offer patients with certain biologic subtypes such as the triple negative or Her2 positive breast cancers the opportunity to improve survival, even in early stage disease. During the height of the pandemic, an opportunity and motivation for the increased use of neoadjuvant therapy in breast cancer was identified. This paper describes the conditions that have supported this practice change at the provider and institutional levels. We also include our own institutional algorithm based on tumor biology and extent of disease that have guided our decisions on breast cancer management during the pandemic. Our processes can be adapted by other institutions and breast oncology practices in accordance with local conditions and resources, during and beyond the pandemic.

Keywords: breast cancer; neoadjuvant chemotherapy; pandemic; practice change.

Figure 1

Conditions during the pandemic that facilitated the use of neoadjuvant therapy for breast cancer.

Figure 2

Criteria for neoadjuvant chemotherapy before and during the pandemic at the Ottawa Hospital Cancer Center. “Bridging therapy” refers to endocrine therapy given to temporize surgical treatment. ChemoRX: Chemotherapy; Pts: Patients.