Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study

Etienne Guével; Sonia Priou; Guillaume Lamé; Johanna Wassermann; Romain Bey; Catherine Uzan; Gilles Chatellier; Yazid Belkacemi; Xavier Tannier; Sophie Guillerm; Rémi Flicoteaux; Joseph Gligorov; Ariel Cohen; Marc-Antoine Benderra; Luis Teixeira; Christel Daniel; Barbara Hersant; Christophe Tournigand; Emmanuelle Kempf; Assistance Publique-Hôpitaux de Paris (AP-HP) Cancer Group, a Cancer Research Application on Big Data (CRAB) initiative

doi:10.1002/cam4.6637

Impact of the COVID-19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study

Cancer Med. 2023 Nov;12(22):20918-20929. doi: 10.1002/cam4.6637. Epub 2023 Nov 1.

Authors

Etienne Guével¹, Sonia Priou^{1

2}, Guillaume Lamé², Johanna Wassermann^{3

4}, Romain Bey¹, Catherine Uzan^{4

5}, Gilles Chatellier⁶, Yazid Belkacemi⁷, Xavier Tannier⁸, Sophie Guillerm⁹, Rémi Flicoteaux¹⁰, Joseph Gligorov^{4

11}, Ariel Cohen¹, Marc-Antoine Benderra^{4

11}, Luis Teixeira¹², Christel Daniel^{1

8}, Barbara Hersant¹³, Christophe Tournigand¹⁴, Emmanuelle Kempf^{8

14}; Assistance Publique-Hôpitaux de Paris (AP-HP) Cancer Group, a Cancer Research Application on Big Data (CRAB) initiative

Affiliations

¹ Assistance Publique-Hôpitaux de Paris, Innovation and Data, IT Department, Paris, France.
² CentraleSupélec, Laboratoire Génie Industriel, Université Paris-Saclay, Gif-sur-Yvette, France.
³ Assistance Publique-Hôpitaux de Paris, Department of medical oncology, Pitié Salpétrière University Hospital, Sorbonne Université, Paris, France.
⁴ Assistance Publique-Hôpitaux de Paris, Institut Universitaire de cancérologie, Sorbonne Université, Paris, France.
⁵ Assistance Publique-Hôpitaux de Paris, Department of gynecology, Pitié Salpétrière University Hospital, Sorbonne Université, Paris, France.
⁶ Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université Paris CIté, Paris, France.
⁷ Assistance Publique-Hôpitaux de Paris, Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor and Albert Chenevier University Hospital, Université Paris Est Créteil, Créteil, France.
⁸ Sorbonne University Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
⁹ Assistance Publique-Hôpitaux de Paris, Department of radiation therapy, Saint Louis University Hospital, Université Paris Cité, Créteil, France.
¹⁰ Assistance Publique-Hôpitaux de Paris, Department of medical information, Paris, France.
¹¹ Assistance Publique-Hôpitaux de Paris, Department of medical oncology, Tenon University Hospital, Sorbonne Université, Paris, France.
¹² Assistance Publique-Hôpitaux de Paris, Department of senology, Saint Louis Teaching Hospital, Université Paris Cité, Paris, France.
¹³ Assistance Publique - Hôpitaux de Paris, Department of plastic surgery, Henri Mondor and Albert Chenevier University Hospital, Université Paris Est Créteil, Créteil, France.
¹⁴ Assistance Publique - Hôpitaux de Paris, Department of medical oncology, Henri Mondor and Albert Chenevier University Hospital, Université Paris Est Créteil, Créteil, France.

Abstract

Background: The SARS CoV-2 pandemic disrupted healthcare systems. We compared the cancer stage for new breast cancers (BCs) before and during the pandemic.

Methods: We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all female patients newly referred with a BC in 2019 and 2020. We assessed the timeline of their care trajectories, initial tumor stage, and treatment received: BC resection, exclusive systemic therapy, exclusive radiation therapy, or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020.

Results: In 2019 and 2020, 2055 and 1988, new BC patients underwent cancer treatment, and during the two lockdowns, the BC diagnoses varied by -18% and by +23% compared to 2019. De novo metastatic tumors (15% and 15%, p = 0.95), pTNM and ypTNM distributions of 1332 cases with upfront resection and of 296 cases with neoadjuvant therapy did not differ (p = 0.37, p = 0.3). The median times from first multidisciplinary meeting and from diagnosis to treatment of 19 days (interquartile 11-39 days) and 35 days (interquartile 22-65 days) did not differ. Access to plastic surgery (15% and 17%, p = 0.08) and to treatment categories did not vary: tumor resection (73% and 72%), exclusive systemic therapy (13% and 14%), exclusive radiation therapy (9% and 9%), exclusive BSC (5% and 5%) (p = 0.8). Among resected patients, the neoadjuvant therapy rate was lower in 2019 (16%) versus 2020 (20%) (p = 0.02). One-year OS rates were 99.3% versus 98.9% (HR = 0.96; 95% CI, 0.77-1.2), 72.6% versus 76.6% (HR = 1.28; 95% CI, 0.95-1.72), 96.6% versus 97.8% (HR = 1.09; 95% CI, 0.61-1.94), and 15.5% versus 15.1% (HR = 0.99; 95% CI, 0.72-1.37), in the treatment groups.

Conclusions: Despite a decrease in the number of new BCs, there was no tumor stage shift, and OS did not vary.

Keywords: COVID-19; breast neoplasms; early detection of cancer; health services research; quality of health care; routinely collected health data.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / diagnosis
Breast Neoplasms* / epidemiology
Breast Neoplasms* / therapy
COVID-19* / epidemiology
Cohort Studies
Communicable Disease Control
Female
Humans
Pandemics
Retrospective Studies

Grants and funding

COVID202001343/Fondation ARC pour la Recherche sur le Cancer