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Pangarsa EA, Rizky D, Tandarto K, Setiawan B, Santosa D, Hadiyanto JN, Kyana S, Suharti C. The effect of multidisciplinary team on survival rates of women with breast cancer: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:2940-2948. [PMID: 37363480 PMCID: PMC10289736 DOI: 10.1097/ms9.0000000000000914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/14/2023] [Indexed: 06/28/2023] Open
Abstract
Breast cancer is quite frequent all around the world. This disease was responsible for an estimated 2.1 million malignancies in 2022, making it the seventh-highest cause of cancer deaths globally. A multidisciplinary team (MDT) care policy was developed in the United Kingdom (UK) in 1995 to enhance the quality of care for cancer patients. The purpose of this systematic review and meta-analysis study is to assess the effects of MDT on breast cancer survival rates. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Systematic search was conducted in several international databases including Google Scholar, PubMed, EBSCOhost, and Proquest from 2012 to 2022. The authors used RevMan 5.4 to do the meta-analysis of the pooled hazard ratio. Newcastle-Ottawa Scale to measure the risk of bias. Newcastle-Ottawa Scale evaluated participant selection, comparability, and reporting of results using eight subscale items. Egger's test funnel plot was used to assess the potential publication bias for this study. Results A total of 1187 studies were identified from research database. The authors found a total of six studies from six different countries (China, the UK, Taiwan, Australia, Africa, and France) included for this study. Based on the meta-analysis of the pooled hazard ratio of the included studies, the authors found that the overall effect size of the study was 0.80 (CI 95%: 0.73-0.88). Conclusions Breast cancer patients who participated in well-organized MDT discussions had a greater survival rate than those who did not.
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Affiliation(s)
- Eko A. Pangarsa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Daniel Rizky
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Kevin Tandarto
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Budi Setiawan
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Damai Santosa
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
| | - Jessica N. Hadiyanto
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Salma Kyana
- Department of Internal Medicine, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Indonesia
| | - Catharina Suharti
- Hematology Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Indonesia
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Hyeda A, da Costa ÉSM, Kowalski SC. The Negative Impact of the New Coronavirus Pandemic on the Trend of Breast Biopsies and Their Direct Costs: Interrupted Time Series Analysis. Value Health Reg Issues 2023; 35:8-12. [PMID: 36796115 PMCID: PMC9928534 DOI: 10.1016/j.vhri.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES The overload of health services because of the COVID-19 pandemic has reduced the population's access to treatment and prevention of other diseases. This study aimed to identify whether there was a change in the trend of breast biopsies and their direct costs during the COVID-19 pandemic in a developing country's public and universal healthcare system. METHODS This was an ecological time series study of mammograms and breast biopsies in women aged 30 years or older from an open-access data set of the Public Health System of Brazil from 2017 to July 2021. RESULTS In 2020, there was a reduction of -40.9% in mammograms and -7.9% in breast biopsies compared with the prepandemic period. From 2017 to 2020, there was an increase in the breast biopsies ratio per mammogram (1.37%-2.55%), the percentage of Breast Imaging-Reporting and Data System (BI-RADS) IV and V mammograms (0.79%-1.14%), and the annual direct cost of breast biopsies (Brazilian Real 3 477 410.00 to Brazilian Real 7 334 910.00). In the time series, the negative impact of the pandemic was lower on BI-RADS IV to V mammograms than on BI-RADS 0 to III. There was an association between the trend of breast biopsies and BI-RADS IV to V mammography. CONCLUSIONS The COVID-19 pandemic harmed the increasing trend of breast biopsies, their total direct costs, BI-RADS 0 to III and IV to V mammograms, observed in the prepandemic period. Furthermore, there was a tendency to screen women at a higher risk for breast cancer during the pandemic.
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Affiliation(s)
- Adriano Hyeda
- Postgraduate Program in Internal Medicine and Health Sciences, Federal University of Paraná, Curitiba, Brazil.
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3
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Hyeda A, Costa ÉSMD, Kowalski SC. The New Coronavirus Pandemic and the Trend of Breast Cancer Diagnosis according to Age-Group: Total and Interrupted Time Series Study. Med Princ Pract 2023; 32:117-125. [PMID: 36927744 PMCID: PMC10826596 DOI: 10.1159/000530179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE There is a lack of studies evaluating the COVID-19 pandemic effect on breast cancer detection according to age-group. This study aimed to assess the pandemic impact on the trend of mammograms, breast biopsies, and breast cancer stage at diagnosis according to age-group. METHODS This was an ecological time series study by inflection point regression model. We used data from women aged between 30 and 49, 50 and 69, and 70 years or more available in an open-access dataset of the Brazilian public healthcare system (2017-2021). We analyzed the trend of the variables in the pre-pandemic and the pandemic effect on the total time series. RESULTS The decreasing or stationary trend of mammograms in the pre-pandemic has changed to a decreasing trend in the total time series in all age-groups. Before the pandemic, the increasing trend of breast biopsies has changed to stationary in the total time series in all age-groups. The increasing trend of tumors at stages 0 to II in the pre-pandemic has changed to decreasing or stationary in the total time series. Finally, the increasing trend of tumors at stage III or IV remained increasing in the total time series in all age-groups. CONCLUSION The pandemic has changed the stationary or increasing trend to a decreasing or stationary trend of mammograms, breast biopsies, and tumors at stages 0 to II but has not influenced the increasing trend of tumors at stages III and IV in all age-groups.
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Affiliation(s)
- Adriano Hyeda
- Post-Graduation Program in Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Brazil
| | | | - Sérgio Cândido Kowalski
- Post-Graduation Program in Internal Medicine and Health Sciences, Federal University of Paraná (UFPR), Curitiba, Brazil
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Velasco Yanez R, Frota Goyanna N, Carvalho Fernandes A, Moura Barbosa Castro R, Holanda da Cunha G, Silva Ferreira I, Miranda Mattos S, Magalhães Moreira T. Palliative Care in Breast Cancer During the COVID-19 Pandemic: A Scoping Review. Am J Hosp Palliat Care 2023; 40:351-364. [PMID: 35581537 PMCID: PMC9127630 DOI: 10.1177/10499091221101879] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has harmed the provision of palliative care (PC) services for women with breast cancer due to all the restrictions that came along with the virus. OBJECTIVE To map the available evidence on the situation of PC in breast cancer during the COVID-19 pandemic. METHODS A scoping review was carried out based on the methodology proposed by the Joanna Briggs Institute. The search was conducted in nine databases, one electronic repository, and one library, using controlled vocabularies. RESULTS Twenty-nine articles and seven documents were included. The majority (11.4% each) were published in the United Kingdom, Italy, and the United States, 38.9% addressed palliative radiotherapy (RT), and 47.2% consisted of recommendations. From the content analysis, five categories were obtained focused on the recommendations on changes in palliative treatment guidelines and the response of PC teams to the evolving crisis. CONCLUSIONS The evidence pointed to the management of general PC, palliative RT, palliative chemotherapy, management of metastatic breast cancer, and use of technologies in palliative care. No recommendations were found to manage frequent symptoms in PC, indicating the need to develop primary studies that investigate these aspects in detail in this vulnerable group. IMPLICATIONS The results contained in this document can provide professionals working in this field of care with a global view of how other teams have dealt with the pandemic, thereby identifying the best guidelines to apply in their reality, taking into account the clinical and social situation of each patient.
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Affiliation(s)
- Romel Velasco Yanez
- Universidade Federal do Ceará, Fortaleza, Brazil,Romel Velasco Yanez, Department of Nursing, Universidade Federal do Ceará, 1115 Alexandre Baraúna St, Rodolfo Teófilo, Fortaleza 60020-181, Brazil.
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5
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Hyeda A, da Costa ÉSM, Kowalski SC. The trend and direct costs of screening and chemotherapy treatment of breast cancer in the new coronavirus pandemic: total and interrupted time series study. BMC Health Serv Res 2022; 22:1466. [PMID: 36461119 PMCID: PMC9716149 DOI: 10.1186/s12913-022-08884-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has overloaded the healthcare systems of many countries and reduced the population's access to treatment and prevention of other diseases. This study aims to assess whether the COVID-19 pandemic has negatively interfered with the trend and the direct costs of screening and chemotherapy treatment of breast cancer in a public and universal healthcare system. METHOD This was an ecological time series study using an open database of a public and universal health system from 2017 to 2021. RESULTS In 2020, there was a 41% reduction in the coverage rate of breast cancer screening in women aged 50 to 69 years (about 1 million mammograms missed). The total direct cost of breast cancer screening reduced proportionally to the number of tests (BRL 67 million). On the other hand, the cost of chemotherapy treatment was higher in 2020, both in advanced (BRL 465 million) and localized (BRL 113 million) diseases. In the time series, mammograms' trend and direct costs changed from stationary to decreasing after the COVID-19 pandemic. The trend of direct costs with chemotherapy treatment for the advanced disease has been increasing and has not changed after the COVID-19 pandemic. On the other hand, in the case of localized disease, there was a trend toward reducing direct costs after the pandemic. CONCLUSION After COVID-19, there was a downward trend in breast cancer screening and its direct costs, an upward trend in chemotherapy costs for advanced disease, and a downward trend in chemotherapy costs for localized disease.
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Affiliation(s)
- Adriano Hyeda
- grid.20736.300000 0001 1941 472XFederal University of Paraná, Postgraduate Program in Internal Medicine and Health Sciences, Rua General Carneiro, 181, Central Building - 11th Floor, Alto da Glória, Curitiba, PR 80.060-900 Brazil
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Al-Sukhun S, Tbaishat F, Hammad N. Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35731988 DOI: 10.1200/edbk_349861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries, where 62% of the world's total new cases are diagnosed. Therefore, the productivity loss because of premature death resulting from female breast cancer is also on the rise. The major challenge in low- and middle-income countries is to reduce the proportion of women presenting with advanced-stage disease, a challenge unlikely to be overcome by adoption of expensive national mammography screening programs. Awareness and education campaigns should focus not only on patients and societies but also on policy makers to address and optimize breast cancer care. Adaptation of existing guidelines and prioritization according to local resources are essential to address the unique needs and overcome the unique barriers of each society to facilitate practical implementation and improve outcomes. Emphasis on the principle of a cancer groundshot in addressing value in cancer care is vital to improving access to therapies that are proven to work rather than chasing after new drugs or innovations of doubtful or marginal clinical benefit. Until we have drug-pricing interventions that take into account the local income of each society, we must acknowledge the fact that the delivery of cancer care will never be the same all around the world.
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Affiliation(s)
| | - Fayez Tbaishat
- Department of Oncology, Al Bashir Hospital, Amman, Jordan
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Joudi M, Moradi Binabaj M, Porouhan P, PeyroShabany B, Tabasi M, Fazilat-Panah D, Khajeh M, Mehrabian A, Dehghani M, Welsh JS, Keykhosravi B, Akbari Yazdi A, Ariamanesh M, Ghasemi A, Ferns G, Javadinia SA. A Cohort Study on the Immunogenicity and Safety of the Inactivated SARS-CoV-2 Vaccine (BBIBP-CorV) in Patients With Breast Cancer; Does Trastuzumab Interfere With the Outcome? Front Endocrinol (Lausanne) 2022; 13:798975. [PMID: 35299966 PMCID: PMC8923352 DOI: 10.3389/fendo.2022.798975] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/24/2022] [Indexed: 12/23/2022] Open
Abstract
AIM To determine the efficacy and safety of inactivated SARS-CoV-2 vaccine (BBIBP-CorV) in patients with breast cancer. METHODS In this multi- institutional cohort study, a total of 160 breast cancer patients (mean age of 50.01 ± 11.5 years old) were assessed for the SARS-CoV-2 Anti-Spike IgG and SARS-CoV2 Anti RBD IgG by ELISA after two doses of 0.5 mL inactivated, COVID-19 vaccine (BBIBP-CorV). All patients were followed up for three months for clinical COVID-19 infection based on either PCR results or imaging findings. Common Terminology Criteria for Adverse Events were used to assess the side effects. RESULTS The presence of SARS-CoV-2 anti-spike IgG, SARS-CoV2 anti-RBD IgG, or either of these antibodies was 85.7%, 87.4%, and 93.3%. The prevalence of COVID-19 infection after vaccination was 0.7%, 0% and 0% for the first, second and third months of the follow-up period. The most common local and systemic side-effects were injection site pain and fever which were presented in 22.3% and 24.3% of patients, respectively. DISCUSSION The inactivated SARS-CoV-2 vaccine (BBIBP-CorV) is a tolerable and effective method to prevent COVID-19.
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Affiliation(s)
- Maryam Joudi
- Department of Pediatrics, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Maryam Moradi Binabaj
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Pejman Porouhan
- Department of Radiation Oncology, Vasei Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Babak PeyroShabany
- Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohsen Tabasi
- Center for Inflammation and Lung Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | | | - Mahtab Khajeh
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Arezoo Mehrabian
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Dehghani
- Department of Radiation Oncology, Neyshabur University of Medical Sciences, Neyshabur, Iran
- *Correspondence: Mansoureh Dehghani,
| | - James S. Welsh
- Department of Radiation Oncology, Edward Hines Jr VA Hospital and Stritch School of Medicine, Loyola University Chicago, Chicago, IL, United States
| | - Batol Keykhosravi
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Azam Akbari Yazdi
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mona Ariamanesh
- Department of Pathology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ahmad Ghasemi
- Department of Basic Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Gordon Ferns
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Seyed Alireza Javadinia
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
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8
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Dutta S, Ishore K, Ghoshal A. Role of Integrative Oncology and Palliative Care Services in Improving Comfort Level and Compliance among Patients with Advanced Fungating Breast Cancer – Experience from a Rural Hospital of North Eastern India during the COVID-19 Pandemic. Indian J Palliat Care 2021; 28:256-261. [PMID: 36072251 PMCID: PMC9443120 DOI: 10.25259/ijpc_40_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/17/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives: Malignant fungating breast cancers are a definite challenge to treatment due to limited knowledge and prevailing distressing symptoms. Various treatment protocols with regard to radiotherapy (RT) and chemotherapy have been reported in the literature but the knowledge of proper integration of these regimes with effective palliative care nursing care, particularly in resource poor settings, is not well understood. Hence, this study was undertaken to assess the change in the degree of comfort achieved before and after treatment of these fungating breast cancer wounds along with issues regarding compliance to such treatment in a peripheral rural medical college hospital. Materials and Methods: A total of 20 patients were selected from the medical records files of the RT department of North Bengal Medical College and Hospital who were registered and treated during the period 1 June 2019– 31 July 2021. Palliative care nursing of malodour, bleeding, maggots, pain and assessment of psychological parameters was done based on the 11-point revised Edmonton Symptom Assessment Scale at the beginning and at each subsequent follow-up visits. Patients were also individualised for receiving palliative RT, chemotherapy, surgery and hormone therapy based on their clinicodemographic profiles. Informed consent was taken from all patients and every treatment was in accordance with the ethical permissions as sought from the Institutional Ethics Committee. Statistical analysis was done based on descriptive statistics and SPSS version 22. Results: Median follow-up was 13 months. Overall, there was a significant improvement in comfort and well-being as assessed by paired t-test before and after treatment (paired t-test = 16.548; P = 0.000). However, there was no significant correlation with palliative radiation dose and schedule as per spearman’s correlation coefficient. The mean radiation dose was BED 48.56 Gy3 (EQD2 = 29.3 Gy3) and the median number of fractions used was 10. Almost 50% of patients were noncompliant to treatment and this might be attributed to the prevailing COVID-19 pandemic situation. There was maximum relief with regard to bleeding control (100%), malodour dissipation (76.9%) and control of maggots infestation (71%) and these results were also found to be strongly associated with treatment as per analysis done by Chi-square test of difference of proportions. Conclusion: Effective comfort can be achieved with proper judicious combination of palliative care nursing and other oncological treatment such as radiation, chemotherapy and surgery.
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Affiliation(s)
- Samrat Dutta
- Department of Radiotherapy, North Bengal Medical College, Siliguri, West Bengal, India,
| | - Kaushik Ishore
- Department of Community Medicine, North Bengal Medical College, Siliguri, West Bengal, India,
| | - Arunangshu Ghoshal
- Department of Palliative Care, University Health Network, Toronto, Canada
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COVID 19 pandemic: Effect on management of patients with breast cancer; single center retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021; 35:100386. [PMID: 34568622 PMCID: PMC8359567 DOI: 10.1016/j.ijso.2021.100386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022]
Abstract
Background (SARS-COV-2) infection, led to a pandemic affecting many countries, resulting in hospitals diverting most of their resources to fight the pandemic. Breast cancer, already a healthcare dilemma, is also affected in this scenario. Our aim was to find out the impact of COVID-19 on presentation of breast cancer stage and its effects on overall onco-surgical management. Methods This cohort single-centered retrospective review was carried out at our hospital, over a period of 18 months. Females with known breast cancer were included in the study. Data was collected on performas by a single researcher. Effect of COVID pandemic on presentation stage and its impact on overall management was studied. SPSS 23.0 used for data analysis. A 95% CI was used. Descriptive statistics were presented as range/means. Categorical data was analyzed by Fisher exact test, t-test was applied to numerical data, p value ≤ 0.05 was considered significant. Results Out of 87 patients presenting with suspicious lump, 69 who had malignancy on histo-pathology were included in study. Twelve out of 69 were COVID positive. Sixty patients presented with advanced stage (≥stage 2b) out of which 21 underwent upstaging of disease due to delay in presentation/management. We found that 9 out of 12 (majority) Covid positive patients had disease upstaging. Overall main reason for delay in presentation was found to be unawareness of disease. Conclusion We concluded that COVID-19 pandemic had no impact on presentation delay, breast cancer management/treatment and disease upstaging as compared to figures available for our population before the pandemic. However, our study showed significant correlation between disease upstaging and COVID status. This led us to reconsider our preformed protocols for COVID positive breast cancer patients. Our results can be used by future researchers to investigate if COVID itself can contributes in patho-physiology of upstaging in breast cancer or not.
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Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines. Crit Rev Oncol Hematol 2021; 164:103402. [PMID: 34214608 PMCID: PMC8242203 DOI: 10.1016/j.critrevonc.2021.103402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.
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Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Neda Goharpey
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Tehran, Iran.
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Jones BM, Green S. Modern radiation techniques in early stage breast cancer for the breast radiologist. Clin Imaging 2021; 80:19-25. [PMID: 34224950 DOI: 10.1016/j.clinimag.2021.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023]
Abstract
Partial breast irradiation (PBI) and ultra-hypofractionated whole breast irradiation (uWBI) are contemporary alternatives to conventional and standard hypofractionated whole breast irradiation (WBI), which shorten treatment from 3 to 6 weeks to 1-2 weeks for select patients. PBI and accelerated PBI (APBI) can be delivered with external beam radiation (3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT)), intraoperative radiation (IORT), or brachytherapy. These new radiation techniques offer the advantage of convenience and lower cost, which ultimately improves access to care. Globally, the COVID 19 pandemic has accelerated APBI/PBI and ultra-hypofractionated regimens into routine practice for carefully selected patients. Recent long-term data from randomized controlled trials (RCTs) have demonstrated these techniques are safe and effective in suitable patients demonstrating equivalent or improved local recurrence, acute/late toxicity, and cosmesis. PBI and APBI should be limited to low risk unifocal invasive ductal carcinoma and ductal carcinoma in situ with tumor size < 2 cm, clear margins (≥2 mm), ER+, and negative nodes. Based on the results from UK Fast-Forward and UK FAST ultra-hypofractionated breast radiation can be safely employed for early stage node negative patients, but is not yet considered an international standard of care. In this review, authors will appraise recent data for these shorter course radiation treatment regimens, as well as, considerations for breast radiologists including surveillance imaging and radiographic findings.
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Affiliation(s)
- Brianna M Jones
- Icahn School of Medicine at Mount Sinai, United States of America.
| | - Sheryl Green
- Icahn School of Medicine at Mount Sinai, United States of America.
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12
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The Novel Coronavirus (COVID-19) Pandemic and the Response in Low-to-Middle Income Countries. CURRENT BREAST CANCER REPORTS 2021; 13:63-68. [PMID: 33880139 PMCID: PMC8051280 DOI: 10.1007/s12609-021-00409-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/12/2022]
Abstract
Purpose of Review The COVID-19 pandemic has posed an unprecedented challenge to healthcare, particularly in resource-constrained low and middle-income countries (LMICs). We aim to summarize the challenges faced by LMICs in providing breast cancer care during the pandemic and their response during this crisis. Recent Findings Conversion of oncology centers into COVID-19 isolation centers and lack of LMIC applicable guidelines for breast cancer treatment worsened the challenge for providers. Few LMICs changed their management framework, taking steps like triaging patients, prioritizing care, therapeutic spacing, and a shift to telehealth. Summary Modified protocols where available have served LMICs well for resource allocation; however, effectiveness of these cannot be determined due to lack of outcomes reporting. This pandemic has underscored the importance of flexibility, prompt intervention, good communication, and reassessment to address unexpected healthcare challenges and has been a learning lesson to help tailor guidelines early in the future.
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Benbrahim Z, Mula-Hussain L, Al-Shamsi HO, El Saghir N, Al Asiri M, Al Bahrani B, Al Nassar M, Bounedjar A, Fahed Z, Khatib S, Khorshid O, Labidi S, Mellas N, Saleh A, Jazieh A. National approaches to managing cancer care: responses of countries in the MENA region to the COVID-19 pandemic. Ecancermedicalscience 2021; 15:1189. [PMID: 33889198 PMCID: PMC8043675 DOI: 10.3332/ecancer.2021.1189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic presents serious challenges to cancer care because of the associated risks from the infection itself and the disruption of care delivery. Therefore, many professional societies have published recommendations to help manage patients with cancer during the current pandemic. The objective of our study is to assess the national responses of Middle East North Africa (MENA) countries in terms of publishing relevant guidelines and analyse various components of these guidelines. METHODS A survey based on the preliminary review of the literature regarding cancer care adaptations has been developed and then completed by a group of oncologists from the following Arab countries affected by the pandemic: Algeria, Egypt, Iraq, Jordan, Kuwait, Lebanon, Morocco, Oman, Saudi Arabia, Syria, Tunisia, United Arab Emirates and Yemen. The survey inquired about COVID-19 cases, national recommendations regarding general measures of COVID-19 prevention and patient care in oncology as well as their implementation about cancer care adaptations during the pandemic. RESULTS Analysis of the COVID-19 pandemic-related guidelines revealed at least 30 specific recommendations that we categorised into seven essential components. All included countries had national guidelines except one country. Estimated full compliances with all specific category recommendations ranged from 30% to 69% and partial compliance ranged from 23% to 61%. CONCLUSION There is a very good response and preparedness in the Arab Middle East and North Africa region surveyed. However, there are inconsistencies in the various components of the guidelines across the region, which reflects the evolving status of the pandemic in each country as well as the lack of clear evidence-based guidelines for many of the issues in question. There is a need for a clear framework on essential components that should be included in these guidelines to assure providing the best guidance to the oncology community.
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Affiliation(s)
- Zineb Benbrahim
- Hassan II University Hospital, Faculty of Medicine and Pharmacy of Fez, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | | | | | | | - Mushabbab Al Asiri
- Saudi Cancer National Institute, Riyadh, Saudi Arabia
- King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | - Adda Bounedjar
- Laboratoire de cancérologie, Faculté de Médecine, Université Blida 1, Blida, Algeria
| | - Zahera Fahed
- St Louis Hospital, Damascus, Syria
- Dar Al Shifaa Hospital, Damascus, Syria
| | | | | | - Soumaya Labidi
- Medical Oncology Department SOMA, Abderrahmane Mami Hospital, Ariana, Tunisia
- Faculty of Medicine, Tunis El Manar University, Tunis, Tunisia
| | - Nawfel Mellas
- Hassan II University Hospital, Faculty of Medicine and Pharmacy of Fez, University Sidi Mohamed Ben Abdellah, Fez, Morocco
| | | | - Abdulrahman Jazieh
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
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Triple-Negative Breast Cancer and the COVID-19 Pandemic: Clinical Management Perspectives and Potential Consequences of Infection. Cancers (Basel) 2021; 13:cancers13020296. [PMID: 33467411 PMCID: PMC7830590 DOI: 10.3390/cancers13020296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary The Coronavirus disease (COVID-19) pandemic has resulted in challenges to cancer management, exacerbated by limited clinical resources and caution in preventing COVID-19 transmission between patients and healthcare professionals. The neglect of breast cancer (in particular, triple-negative breast cancer (TNBC)) patients during the outbreak could negatively impact their overall survival, as delays in treatment and consultations provide vital time for tumor progression and metastasis. Herein, we review the shifting clinical management of TNBCs during the COVID-19 outbreak. The suggested treatment recommendations can hopefully minimize virus exposure without sacrificing patient care during times when healthcare systems are overburdened. Further, we review published RNA-seq data to assess the theoretical infectability of metastatic TNBCs to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. These analyses highlight the potential of the virus to infect TNBC cells. Given the known increased susceptibility of cancer cells to viral infection, this additional host cell reservoir may make patients with metastatic disease particularly vulnerable to COVID-19 morbidities. Abstract The COVID-19 pandemic has caused the need for prioritization strategies for breast cancer treatment, where patients with aggressive disease, such as triple-negative breast cancer (TNBC) are a high priority for clinical intervention. In this review, we summarize how COVID-19 has thus far impacted the management of TNBC and highlighted where more information is needed to hone shifting guidelines. Due to the immunocompromised state of most TNBC patients receiving treatment, TNBC management during the pandemic presents challenges beyond the constraints of overburdened healthcare systems. We conducted a literature search of treatment recommendations for both primary and targeted TNBC therapeutic strategies during the COVID-19 outbreak and noted changes to treatment timing and drugs of choice. Further, given that SARS-CoV-2 is a respiratory virus, which has systemic consequences, management of TNBC patients with metastatic versus localized disease has additional considerations during the COVID-19 pandemic. Published dataset gene expression analysis of critical SARS-CoV-2 cell entry proteins in TNBCs suggests that the virus could in theory infect metastasized TNBC cells it contacts. This may have unforeseen consequences in terms of both the dynamics of the resulting acute viral infection and the progression of the chronic metastatic disease. Undoubtedly, the results thus far suggest that more research is required to attain a full understanding of the direct and indirect clinical impacts of COVID-19 on TNBC patients.
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Sattar AK, Shahzad H, Jabbar AA, ValiMohammed AT, Khan S, Vellani Y, Idrees R, Ali N, Masroor I, Saeed H, Lakhani G, Ayoub N, Waqar A, Zia-Ul Islam M, Kirmani S, Latif A, Enam SA. A multidisciplinary approach to triage patients with breast disease during the COVID-19 pandemic: Experience from a tertiary care center in the developing world. Cancer Rep (Hoboken) 2021; 4:e1309. [PMID: 33439546 PMCID: PMC7941551 DOI: 10.1002/cnr2.1309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/10/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting. AIM In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease. METHODS AND RESULTS The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers' schedules, operating room reallocation, and protocols. We also describe the "Virtual Blended Clinics", a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine. CONCLUSION Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians' clinical judgment to provide the best quality care.
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Affiliation(s)
- Abida K Sattar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Yasmin Vellani
- Department of Nursing Services, Aga Khan University Hospital, Karachi, Pakistan
| | - Romana Idrees
- Department of Pathology, Aga Khan University, Karachi, Pakistan
| | - Nasir Ali
- Department of Radiation Oncology, Aga Khan University, Karachi, Pakistan
| | - Imrana Masroor
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Humera Saeed
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | - Gulzar Lakhani
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nadia Ayoub
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Atif Waqar
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| | | | - Salman Kirmani
- Department of Pediatrics and Child Health/Section of Medical Genetics, Aga Khan University, Karachi, Pakistan
| | - Asad Latif
- Department of Anesthesiology, Aga Khan University, Karachi, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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