Over the last few months the SARS-CoV-2 (coronavirus disease 2019, COVID-19), has spread world-wide (which is known as a pandemic). In January 2020, the World Health Organisation (WHO) Emergency Committee declared a global health emergency which has led to worldwide changes in healthcare delivery, including that of cancer care.
How could the pandemic effect breast cancer treatment?
Currently in many hospitals in the UK and around the world, staff and resources have had to be re-directed to look after patients who are suffering with COVID-19. This has meant that some doctors and nurses that usually work in breast cancer departments have been moved to look after patients with COVID-19. There is a shortage of operating theatre capacity and staff in many hospitals, meaning that less operations for breast cancer can take place. As well as this, there has also been an effort to reduce attendance in hospital for patients. This is to protect them from the risk of developing COVID-19. Therefore some patients have been advised to not undergo/postpone surgery, chemotherapy or radiotherapy.
Are there any new guidelines for this?
In the UK the Association of Breast Surgery (ABS), National Coordinating Committee for Breast Pathology (NCCBP), and Royal College of Radiology (RCP) have produced guidelines regarding the management of patients newly diagnosed with breast cancer during this time.
These guidelines include:
- Postponing surgery until the pandemic is under control for some women whose tumour is sensitive to hormone tablets. These tablets can stop growth of the tumour and in many cases shrink it.
- Avoidance of complex surgery such as breast reconstruction (rebuilding the breast after the breast tissue has been removed) due to the longer hospital stay and risk of complications (and therefore multiple hospital attendances). Such women have been undergoing a simple mastectomy (removal of all the breast tissue) without reconstruction with a plan for them to have reconstruction at a later date when the pandemic is under control.
- Avoidance altogether or reduced number of radiotherapy treatment doses (known as fractions of radiotherapy) in women who have surgery and the tumour is low risk.
- Avoidance of chemotherapy in women who might have previously (pre-COVID-19) been advised to have chemotherapy, but the risks associated with chemotherapy during the pandemic outweigh the benefit of have chemotherapy now (during pandemic).
Why are we undertaking a research study?
Since some women with a diagnosis of breast cancer are having an altered treatment pathway, the researchers behind this study and many breast cancer doctors and nurses in the UK feel that it is important to document and describe breast cancer management (surgery, chemotherapy and radiotherapy) during the COVID-19 pandemic and compare this to pre-COVID-19 treatment.
The study aims to look in detail at those patients:
- Who have been started on hormonal tablets and their surgery postponed to see what effect the hormonal tablets had on the size of the tumour.
- Who did not receive at all or received different to usual radiotherapy or chemotherapy
- Who had a mastectomy without reconstruction and how long they had to wait to receive a reconstruction.
How will the study be conducted?
The study is observational, that means that we are documenting and observing the treatment of patients during the pandemic. We are not intervening on the management plan that is put in place by the doctors looking after the patients during the pandemic.
The doctors and nurses involved in the study will be uploading data on the patients and their treatment onto a secure study website. There will be no identifiable information such as name or date of birth or address of the patients, therefore it will stay anonymous for the patients.
Can patients with breast cancer ask to be in the study or upload their own data?
If a patient has recently been diagnosed with breast cancer they are welcomed to mention the study to one of the doctors or nurses looking after them to see if their hospital is participating in the study. It is not possible for patients to upload their own data.
Do patients have to consent to be in the study?
Since this study is observational (i.e. there is no change in the management dictated by the study team) there is no need for patients to consent at this stage.
What if I don’t want to have my data in the study?
If you do not want your information to contribute to the study data please mention this to the doctor in charge of your care.
Who can I ask for more details?
Information and support is also available from Breast Cancer Now
If you are a patient or carer of someone recently diagnosed with breast cancer and you have any questions please contact us using this form: