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  • 1
    In: Journal of Hematology & Oncology, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2021-12)
    Abstract: The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. Methods Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2–17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. Results Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease ( p   〈  0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR] wks2–8 : 2.04, OR wks9–11 : 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (OR wks12–13 : 0.52) or by breast conserving surgery (OR wks14–17 : 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (OR wks9–11 : 0.59, OR wks12–13 : 0.66), but more likely for those diagnosed at the end (OR wks14–17 : 1.31). Primary hormonal treatment was more common (OR wks2–8 : 1.23, OR wks9–11 : 1.92, OR wks12–13 : 3.01). Only women diagnosed in weeks 2–8 of 2020 experienced treatment delays. Conclusion The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.
    Type of Medium: Online Resource
    ISSN: 1756-8722
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2429631-4
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  • 2
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 4_Supplement ( 2022-02-15), p. P3-12-29-P3-12-29
    Abstract: Introduction: The COVID-19 pandemic led to a decrease in the incidence of breast cancer diagnoses in the Netherlands. This was due to the encouragement to stay at home, a lack of capacity at the general practitioner (GP) and an increased reluctance of patients to visit the GP. Moreover, from the 16th of March the Dutch breast cancer screening program was halted and gradually restarted from June onwards. Part of the follow-up visits for breast cancer survivors were also postponed or changed to an appointment by phone. However, it is not known how this affected the incidence of second primary breast cancer (SPBC) and pathologically confirmed breast cancer recurrences . Objective: To investigate the effect of the COVID-19 pandemic on the diagnosis of SPBC and breast cancer recurrences. Methods: Women diagnosed with a pathological confirmed SPBC or recurrence (locoregional recurrences (LRR) + distant metastasis (DM)) between January 1st 2017 and February 28th 2021 were selected from the Netherlands Cancer Registry, based on diagnoses of the Nationwide Histopathology and Cytopathology Data Network and Archive (PALGA). Patients with a SPBC or recurrence who had their primary breast tumor diagnosed more than five years ago were excluded. March 1st 2020 till February 28th 2021 was regarded as the COVID-19 period. Incidence was expressed per 100,000 women, who were diagnosed with breast cancer less than 5 years ago, and who were still alive. Incidence of SPBCs and recurrences was calculated for the total COVID-19 period and for four subperiods, and compared with the corresponding periods in 2017/2019 (averaged). Results: A total of 393 patients were diagnosed with a SPBCs in 2017, 340 in 2018, 299 in 2019, 342 in 2020 and 71 up to February 2021. A total of 447 patients were diagnosed with a recurrence in 2017, 520 in 2018, 516 in 2019, 529 in 2020 and 80 up to February 2021. During the COVID-19 period a total of 449 patients were diagnosed with a SPBCs per 100,000 breast cancer survivors, this was comparable to the 445 patients diagnosed per year per 100,000 breast cancer survivors in 2017/2019 (p=0.91) (Table 1). The incidence of SPBCs was significantly lower during March-May 2020 compared to the same period in 2017/2019 (86 vs. 121) (p=0.03), leading to 50 less SPBCs diagnoses. The incidence was higher during June-August 2020 (124 vs. 95), however this was not significant (p=0.09). The incidence of recurrences in the COVID-19 period, and within all four subperiods, was comparable to the incidence in 2017/2019. Conclusion: The COVID-19 pandemic led to a decrease in the detection of SPBCs at the beginning of the pandemic. However, this drop in incidence was caught up in the period thereafter. This might be related to the restart of the regular follow-up visits (partly in real-life consultations), the call to go to the GP in case of complaints and the improved accessibility of the GPs. The incidence of recurrences did not decrease since it includes also DM, which cause worrisome symptoms for which care is sought. Incidence of pathological confirmed second primary breast cancer and breast cancer recurrencesSPBCP-value1Recurrence2P-value1Reference3445.00.91639.40.63COVID-19 period4448.7658.9March - May reference3120.70.03151.80.64March - May 202085.9142.3June - August reference395.30.09166.40.37June - August 2020124.3185.9September - November reference3125.00.78159.50.54September - November 2020120.5171.8December - February reference3104.80.44166.40.70December 2020 - February 2021117.9159.0Incidence is expressed per 100,000 women who were diagnosed with breast cancer less than 5 years ago and who were still alive SPBC: Second primary breast cancer Bold: incidence in that period of 2020/2021 is statistically significantly lower compared to the incidence in 2017/2019 (averaged) 1. Comparing 2020/2021 with the same period in 2017/2019 2. Recurrence included locoregional recurrences and distant metastasis 3. Reference period: 2017/2019 4. COVID-19 period: March 2020 - February 2021 Citation Format: Anouk H Eijkelboom, Linda de Munck, Jelle Wesseling, Pieter J Westenend, Desirée HJG van den Bongard, Mariëlle PWA Hendriks, Mireille JM Broeders, Luc JA Strobbe, Maud Bessems, Aafke H Honkoop, Marc BI Lobbes, Vivianne CG Tjan-Heijnen, Sabine Siesling, NABON-COVID-19 consortium and the COVID and Cancer Care-NL consortium. Effect of the COVID outbreak on detection of second primary breast cancer and breast cancer recurrences [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-29.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
    RVK:
    RVK:
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
    detail.hit.zdb_id: 2036785-5
    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 3
    In: Breast Cancer Research and Treatment, Springer Science and Business Media LLC, Vol. 197, No. 1 ( 2023-01), p. 161-175
    Abstract: We aimed to compare (1) treatments and time intervals between treatments of breast cancer patients diagnosed during and before the COVID-19 pandemic, and (2) the number of treatments started during and before the pandemic. Methods Women were selected from the Netherlands Cancer Registry. For aim one, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the treatment of women diagnosed within four periods of 2020: pre-COVID (weeks 1–8), transition (weeks 9–12), lockdown (weeks 13–17), and care restart (weeks 18–26), with data from 2018/2019 as reference. Wilcoxon rank-sums test was used to compare treatment intervals, using a two-sided p -value  〈  0.05. For aim two, number of treatments started per week in 2020 was compared with 2018/2019. Results We selected 34,097 women for aim one. Compared to 2018/2019, neo-adjuvant chemotherapy was less likely for stage I (OR 0.24, 95%CI 0.11–0.53), stage II (OR 0.63, 95%CI 0.47–0.86), and hormone receptor+/HER2− tumors (OR 0.55, 95%CI 0.41–0.75) diagnosed during transition. Time between diagnosis and first treatment decreased for patients diagnosed during lockdown with a stage I ( p   〈  0.01), II ( p   〈  0.01) or III tumor ( p  = 0.01). We selected 30,002 women for aim two. The number of neo-adjuvant endocrine therapies and surgeries starting in week 14, 2020, increased by 339% and 18%, respectively. The number of adjuvant chemotherapies decreased by 42% in week 15 and increased by 44% in week 22. Conclusion The pandemic and subsequently altered treatment recommendations affected multiple aspects of the breast cancer treatment strategy and the number of treatments started per week.
    Type of Medium: Online Resource
    ISSN: 0167-6806 , 1573-7217
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2004077-5
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