Suggested Modifications in the Management of Breast Cancer Patients in the Era of COVID-19 Pandemic: a Web-based Survey.

BACKGROUND: Management of cancer patients in the current era of COVID-19 pandemic poses a significant challenge on health care systems. Breast cancer is the most common cancer internationally. Breast cancer is a disease that involves surgery, chemotherapy, hormonal therapy, target therapy, radiotherapy and more recently immunotherapy in the management plan. The immune system requires months to recover from these medications and the condition is even worse in patients with metastatic breast cancer who need ongoing treatment with these drugs. Some of these drugs can cause rare but life threating lung inflammation as the CD4/6 inhibitors. Breast cancer Patients with metastatic disease to lungs can experience deterioration of disease symptoms with COVID infection. Oncologists treating breast cancer patients found themselves in a difficult situation regarding treatment choice. The impact that the coronavirus has had on breast cancer care is unknown, including how to provide the best care possible without compromising patient and community safety.

OBJECTIVE: We explored the views of oncologists for the management of breast cancer patients during COVID-19 pandemic.

METHODS: A web-based questionnaire using SurveyMonkey was submitted to licensed oncologists involved in breast cancer management in Saudi Arabia, Egypt and United Arab Emirates. The survey focused on characteristics of participants, infection risk among cancer patients and possible treatment modifications related to different types of breast cancer.

RESULTS: The survey was completed by 82 participants. For early HR positive, HER2-negative breast cancer,74.4% supported using neoadjuvant hormonal therapy in selected patients, and 58.0% preferred giving 6 over 8 cycles of adjuvant chemotherapy when indicated. Only 42.7% preferred CDK4/6 inhibitor with hormonal therapy as first line in all patients with metastatic HR-positive disease. 67.1% of participants supported using adjuvant trastuzumab for 6 instead of 12 months in selected patients with HER2-positive breast cancer. For metastatic HER2-positive, HR-positive breast cancer, 80.5% of participants supported the use of hormonal therapy with dual anti-HER2 blockade in selected patients. The preferred choice of 1st line treatment in metastatic triple negative patients with BRCA mutation and PDL1<1%, was PARP inhibitor according to 42.5% of the participants, and atezolizumab with nabpaclitaxel if the PDL1>1% according to 70.4% of the participants.

CONCLUSIONS: Several modifications in breast cancer management is supported by the survey participants. These modifications need to be discussed on local basis taking into account the local infrastructure and available resources.