Changes in breast cancer treatment during the COVID-19 pandemic: a Dutch population-based study

Anouk H. Eijkelboom, Linda de Munck, The NABON-COVID-19 Consortium, The COVID and Cancer Care-NL Consortium, C. Willemien Menke-van der Houven van Oordt, Mireille J.M. Broeders, Desiree H.J.G. van den Bongard, Luc J.A. Strobbe, Marc A.M. Mureau, Marc B.I. Lobbes, Pieter J. Westenend, Linetta B. Koppert, Agnes Jager, Ester J.M. Siemerink, Jelle Wesseling, Helena M. Verkooijen, Marie Jeanne T.F.D. Vrancken Peeters, Marjolein L. Smidt, Vivianne C.G. Tjan-Heijnen, Sabine Siesling*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: 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.

Original languageEnglish
JournalBreast Cancer Research and Treatment
DOIs
Publication statusE-pub ahead of print - 5 Nov 2022

Bibliographical note

Funding Information:
Financial interests: HMV received funding by the Dutch Cancer Foundation, European Commission, ZonMw. MLS received grants from Servier Pharma and Nutricia. JW received funding from the Cancer Research UK KWF Dutch Cancer Society ZonMW and the Antoni van Leeuwenhoek Foundation. Non-financial interests: JW is a member of the Scientific Advisory Board Dutch Expert Centre for Screening. All other authors have no relevant financial or non-financial interests to disclose.

Funding Information:
This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw), project number: 10430022010014. We thank the NCR for providing the data and their data managers for collecting the data. The authors acknowledge the members of the COVID and Cancer-NL Consortium. Dr. J.C. van Hoeve, department of research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; prof. dr. M.A.W. Merkx, department of research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen; prof. dr. N.J. de Wit, department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht; M.Sc. I. Dingemans, Dutch Federation of Cancer Patient Organisations (NFK), Utrecht; prof. dr. I.D. Nagtegaal, department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, on behalf of the Automated Pathology Archive (PALGA); dr. A. Wilbrink, Dutch Hospital Data (DHD), Utrecht; prof. dr. C.H. van Gils, department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht; prof. dr. H.C.P.M. van Weert, department of General Practice, Amsterdam Public Health, Amsterdam UMC location AMC, Amsterdam; prof. dr. M. Verheij, department of Radiation Oncology, Radboud University Medical Center, Nijmegen, on behalf of SONCOS (Dutch Multidisciplinary Oncology Foundation); all the Netherlands. Finally, the authors acknowledge the members of the NABON COVID-19 consortium. Dr. E.J.T. Luiten, department of Surgery, Amphia Ziekenhuis, Breda; dr. A.E. van Leeuwen-Stok, Dutch Breast Cancer Research Group, Amsterdam; M.Sc. C. Guerrero Paez, Dutch Breast Cancer Society (BVN), Utrecht; dr. M.E.M.M. Bos, department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam; dr. M.J. Hooning, department of Medical Oncology, Erasmus University Medical Center, Rotterdam; dr. L.J. Boersma, department of Radiation Oncology (Maastro), School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht; prof. dr. S. Linn, divisions of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam; department of Pathology, University Medical Center Utrecht, Utrecht; prof. dr. M.K. Schmidt, division of Molecular Pathology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam; dr. C.P. Schröder, department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen; dr. M. Bessems, department of Surgery, Jeroen Bosch Hospital, Den Bosch; dr. A.H. Honkoop, department of Medical Oncology, Isala Clinics, Zwolle; M.Sc. Q.C. van Rossum-Schornagel, department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam; dr. S. van der Velde, department of Surgery, Amsterdam UMC/VU University Medical Center, Amsterdam; dr. E. Manten-Horst, Dutch AYA “Young & Cancer” Carenetwork, Regional AYA Carenetwork Radboudumc, Radboud University Medical Center, Nijmegen; IKNL, Utrecht; dr. N.T. van Ravensteyn, department of Public Health, Erasmus MC University Medical Center, Rotterdam; dr. J.C. Korevaar, Netherlands Institute for Health Services Research (NIVEL), Utrecht; dr. J. Verloop, department of research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; dr. T. van Dalen, department of Surgery, Diakonessenhuis Utrecht, Utrecht; M.Sc. A.W.G. van der Velden, department of Internal Medicine, Martini Hospital, Groningen; and prof. dr. M.A.M. Mureau, department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam; all the Netherlands.

Funding Information:
This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw), project number: 10430022010014.

Publisher Copyright:
© 2022, The Author(s).

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