COVID-19 Pandemic Forces Changes in Breast Cancer Care

The coronavirus disease 2019 (COVID-19) pandemic has forced health care institutions to get creative in how they treat chronic non-COVID-19 illnesses, such as breast cancer, according to a new study published in Bio Integration.

The COVID-19 pandemic has caused many institutions to redirect resources to pandemic management. This has caused the acute limitation of supplies available for non-COVID patients in critical care, according to the study.¹

The first case of COVID-19 in Singapore, where the study was conducted, was reported on January 23, 2020. By the end of January, Singapore had the highest number of COVID-19 cases outside of China. Breast cancer is the most common type of cancer amongst women in Singapore and treatment during the pandemic had to be modified for many patients.²

“Circuit breaker” measures were implemented in Singapore in April, which meant that remote work was implemented for all non-essential services. Schools went online and the Ministry of Health issued a set of definitions of essential face-to-face medical services.

All non-essential patient visits to hospitals had to be postponed; however, appointments for patients newly diagnosed with breast cancer, appointments for routine follow-ups for patients treated in the last 2 years, appointments for patients with a high risk of recurring breast cancer, and appointments for patients with new symptoms were not postponed. Additionally, non-cancer patients with recent investigations revealing potentially malignant abnormalities did not have to postpone appointments.²

The number of outpatient consults at the Division of Breast Surgery, Department of Surgery at the Changi General Hospital where the study was conducted fell to just 24% of the original consults. Screening was deemed a non-essential medical service.

However, cases that were considered high-risk were allowed to be screened, and attendance only fell approximately 10%. This gap was quickly filled by people wishing to move up their appointments. Patients coming in for surgery were kept separate from the general population.

Systemic treatment and radiation continued and measures were put in place to support social distancing measures. However, clinical trials involving patient contact were put on hold. Cancer support groups and other such events were also put on hold.²

“…managing breast cancer patients during the COVID- 19 pandemic requires swift and adaptable strategies to cope with the constantly changing demands. Prompt patient stratifications, quick adaptation to restricted resources whilst balancing the risks of exposure to patients and healthcare personnel are all crucial in providing optimal patient care,” the study authors wrote. “The importance of multidisciplinary team effort is pivotal in ensuring optimal delivery of care to breast cancer patients.”

Long-term effects of reducing clinical activities is not known. The number of patients missing appointments and not showing up at the hospital has increased over the course of the pandemic. Suspension of support actives may have a psychological impact on patients, as they have no outlet to share their concerns or worries, according to the study.

Reference:

Breast cancer multidisciplinary management during COVID-19 pandemic (News release) August 18, 2020 Singapore, EurekAlert! Accessed August 20, 2020

Wei Mok, Chi, et al. Breast Cancer Multidisciplinary Management during COVID-19 Pandemic: Experiences and Strategies Used by a Singapore Breast Surgical Unit (Study) August, Bio Integration, accessed August 20, 2020