Background: The COVID-19 pandemic presents unique challenges in breast cancer (BC) management. Clinicians at our institution along with members from COVID-19 breast cancer consortium, published and adopted practice guidelines assigning patients to COVID-19 priority groups with associated treatment recommendations. Groups were based on histology, clinical stage, receptor status, tumor grade, genomic testing, & patient age. The purpose of this study was to evaluate clinician adherence to these guidelines, evaluate treatment disparities among groups, and assess for treatment delays. Methods: From 3/26/20 to 5/14/20 BC patients were assigned at tumor board to Priority groups A, B1-3, or C. The one patient classified as Priority A was excluded from analysis. Treatments were categorized as “delay” or “no delay”. If suggested COVID-19 management was equivalent to the actual management, cases were classified as adhering to COVID-19 guidelines. If management differed from recommended COVID-19 guidelines, patients were classified as non-adherent. T-tests were performed to assess differences in continuous variables and Chi Square tests were performed to assess differences in categorical variables. Analyses were performed in R (version 3.6.3); p value < 0.05 was considered statistically significant. Results: 124 female patients were included in our analysis and categorized as shown in Table 1. There was a statistically significant difference in age between priority groups (p<0.001); mean age in Priority B1 was 55 years while Priority C was 73 years. No differences in race were seen between priority groups (p=0.625). No significant differences in adherence among any of the treatment categories were noted: surgical management (p=0.761), systemic therapy (p=0.93), or radiation (p=0.97). There were significant differences in types of treatments given, such as how aggressive initial management was, as outlined per the guidelines, among patient groups in all 3 areas, surgery (p<0.001), systemic therapy (p<0.001), & radiation therapy (p=0.008). Patients in Priority C had the highest proportion of delays for surgery (81.2%), and radiation therapy (50%) while Priority B2 had the highest proportion of delay in systemic therapy (20%). Conclusions: This study demonstrates that BC COVID-19 guidelines can be incorporated into weekly tumor boards as a clinical tool for patient prioritization during the ongoing pandemic.
COVID - Breast Cancer Treatment Delays stratified by COVID Priority Group*, University Hospitals