Care in the time of COVID-19: impact on the diagnosis and treatment of breast cancer in a large, integrated health care system.

Autor: Tang A; Department of Surgery, University of California San Francisco, San Francisco, USA., Neeman E; Department of Medical Oncology, San Francisco Medical Center, Kaiser Permanente, San Francisco, USA., Vuong B; Department of Surgery, South Sacramento Medical Center, Kaiser Permanente, Sacramento, USA., Arasu VA; Department of Radiology, Kaiser Permanente Vallejo Medical Center, Vallejo, USA., Liu R; Department of Medical Oncology, San Francisco Medical Center, Kaiser Permanente, San Francisco, USA.; Division of Research, Kaiser Permanente Northern California, Oakland, USA., Kuehner GE; Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, USA., Savitz AC; Department of Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, USA., Lyon LL; Division of Research, Kaiser Permanente Northern California, Oakland, USA., Anshu P; Department of Surgery, Fremont Medical Center, Kaiser Permanente, Fremont Medical Center - 39400 Paseo Padre Pkwy, Fremont, CA, 94538, USA., Seaward SA; Department of Radiation Oncology, Kaiser Permanente Oakland Medical Center, Oakland, USA., Patel MD; Department of Radiation Oncology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, USA., Habel LA; Division of Research, Kaiser Permanente Northern California, Oakland, USA., Kushi LH; Division of Research, Kaiser Permanente Northern California, Oakland, USA., Mentakis M; Department of Surgery, South Sacramento Medical Center, Kaiser Permanente, Sacramento, USA., Thomas ES; Department of Medical Oncology, Kaiser Permanente Oakland Medical Center, Oakland, USA., Kolevska T; Department of Medical Oncology, Kaiser Permanente Vallejo Medical Center, Vallejo, USA., Chang SB; Department of Surgery, Fremont Medical Center, Kaiser Permanente, Fremont Medical Center - 39400 Paseo Padre Pkwy, Fremont, CA, 94538, USA. sharon.b.chang@kp.org.
Jazyk: angličtina
Zdroj: Breast cancer research and treatment [Breast Cancer Res Treat] 2022 Feb; Vol. 191 (3), pp. 665-675. Date of Electronic Publication: 2022 Jan 06.
DOI: 10.1007/s10549-021-06468-1
Abstrakt: Purposes: To delineate operational changes in Kaiser Permanente Northern California breast care and evaluate the impact of these changes during the initial COVID-19 Shelter-in-Place period (SiP, 3/17/20-5/17/20).
Methods: By extracting data from institutional databases and reviewing electronic medical charts, we compared clinical and treatment characteristics of breast cancer patients diagnosed 3/17/20-5/17/20 to those diagnosed 3/17/19-5/17/2019. Outcomes included time from biopsy to consultation and treatment. Comparisons were made using Chi-square or Wilcoxon rank-sum tests.
Results: Fewer new breast cancers were diagnosed in 2020 during the SiP period than during a similar period in 2019 (n = 247 vs n = 703). A higher percentage presented with symptomatic disease in 2020 than 2019 (78% vs 37%, p < 0.001). Higher percentages of 2020 patients presented with grade 3 (37% vs 25%, p = 0.004) and triple-negative tumors (16% vs 10%, p = 0.04). A smaller percentage underwent surgery first in 2020 (71% vs 83%, p < 0.001) and a larger percentage had neoadjuvant chemotherapy (16% vs 11%, p < 0.001). Telehealth utilization increased from 0.8% in 2019 to 70.0% in 2020. Times to surgery and neoadjuvant chemotherapy were shorter in 2020 than 2019 (19 vs 26 days, p < 0.001, and 23 vs 28 days, p = 0.03, respectively).
Conclusions: During SiP, fewer breast cancers were diagnosed than during a similar period in 2019, and a higher proportion presented with symptomatic disease. Early-stage breast cancer diagnoses decreased, while metastatic cancer diagnoses remained similar. Telehealth increased significantly, and times to treatment were shorter in 2020 than 2019. Our system continued to provide timely breast cancer treatment despite significant pandemic-driven disruption.
(© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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