A tripartite approach can seek to optimize breast cancer management during a pandemic - Real-Time experience of a developing breast oncology unit in Singapore

Has the COVID-19 pandemic resulted in more advanced breast cancer? A hospital-based retrospective study

BACKGROUND

The suspension of breast cancer screening during the COVID-19 pandemic altered patient diagnosis and management. This study investigates the impact of the COVID-19 lockdowns, screening delays and reduced healthcare attendance on changes in tumour and treatment characteristics, particularly for biologically more aggressive breast cancers.

METHODS

This retrospective single-hospital analysis utilized data from a prospective cancer database between July 2019 and June 2022. Patient, tumour and treatment factors were compared across pre-pandemic, pandemic and post-pandemic groups.

RESULTS

Symptomatic breast cancer increased from 42.3% in the pre-, 53.1% in the pandemic and 57% in the post- respectively (P ≤ 0.05). Compared to the pre-pandemic group (4.6%), an increase in stages 3 or 4 breast cancers in the pandemic (8.5%) and post-pandemic (7.1%) was found. Increased node-positivity in Ki67 > 20%, grade 3 or ER- tumours post-pandemic (+5.4%, +14.8%, +33.4%, respectively) was identified. More neoadjuvant chemotherapy was found in both the pandemic (+4.3%) and post-pandemic (+11.3%, P = 0.0261) groups. An increase in hypofractionated radiotherapy in the post-pandemic group (+9.4%) was also identified.

CONCLUSION

Our study identified a decrease in early-stage cancers and an increase in node positivity, particularly for biologically more aggressive tumours. An increase in the number of patients receiving neoadjuvant chemotherapy or hypofractionated radiotherapy during the pandemic and post-pandemic periods was also identified.

One Year on: An Overview of Singapore's Response to COVID-19-What We Did, How We Fared, How We Can Move Forward

Background-One year has passed since the first COVID-19 case in Singapore. This scoping review commemorates Singaporean researchers that have expanded the knowledge on this novel virus. We aim to provide an overview of healthcare-related articles published in peer-reviewed journals, authored by the Singapore research community about COVID-19 during the first year of the pandemic. Methods-This was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. It included healthcare-related articles about COVID-19 published between 23 January 2020 and 22 January 2021 with a Singapore-affiliated author. MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Google Scholar, and local journals were searched. The articles were screened independently by two reviewers. Results-The review included 504 articles. Most of the articles narrated the changes to hospital practice (210), while articles on COVID-19 pathology (94) formed most of the non-narrative papers. Publications on public health (61) and the indirect impacts to clinical outcomes (45) were other major themes explored by the research community. The remaining articles detailed the psychological impact of the pandemic (35), adaptations of medical education (30), and narratives of events (14). Conclusion-Amidst a resurgence of community cases involving variant COVID-19 strains, the resources from the research community will provide valuable guidance to navigate these uncertain times.