Background: The global pandemic of coronavirus disease 2019 (COVID-19), caused considerable change to working practices in breast units across the UK. Prior to March 2020, at the Princess Royal University Hospital (PRUH), Kings College NHS Trust, Kent, almost daily face to face breast clinic follow ups occurred. This consisted of patients with both benign and malignant conditions. It encompassed post investigation/operative results, pre-operative planning, benign follow ups and 5 year surveillance patients. On March 23rd 2020 the UK went into official lockdown. The effect on breast elective follow up practice was swift. There was a move to cancellation and triaging of the majority of our follow ups, with replacement of face to face with telephonic or virtual consultations.
The aim of this study was to review the change of the follow up pattern, comparing pre and post COVID-19 setup, could this effect the future of follow up consultations at PRUH?
Material and methods: A comparison of all patients attending PRUH breast unit outpatients in January 2020 (pre COVID-19) for follow up and with those attending in April 2020 (post COVID-19). Categories analysed included numbers of patient attendances, patient demographics, type of follow up, and original diagnosis. All data was collected from clinic lists and electronic patient record notes and analysed using Excel version 16 (365).
Results: 368 patient follow ups were booked into clinic in Jan 2020 with 25 not attending (DNA’s), overall 343 attendances. 59 patient follow ups were booked in April 2020 with 6 DNA’s, overall 53 attendances. The mean age in January was 57 and in April 51. Sex distribution in January F:M 336:7 (98%:2%) was similar to that in April F:M 51:2. In January 65% of cases were malignant and 60% in April. Benign/B3 diagnosis were 35% in January and 20% in April.
| 5 year surveillance | Benign f/up | Post Biopsy Results | Post Investigation Results | Post Operative Results | Pre Operative Planning | Primary Endocrine f/up | |
|---|---|---|---|---|---|---|---|
| Pre COVID – April 2020 | 134(39%) | 15(4%) | 26(8%) | 79(23%) | 68(20%) | 16(5%) | 5(1%) |
| Post COVID – April 2020 | 5(9%) | 7(13%) | 14(26%) | 15(28%) | 11(21%) | 2(3%) | 0(0%) |
Summary of follow up types
Conclusions: Impacts of COVID have been widespread in our practice. Our results show a significant reduction in face to face appointments. Further evaluation of this model will show if this is sustainable. Patient satisfaction will also have to be taken into account and assessed. Implementation of 5 year post cancer treatment surveillance without a clinical follow up (open access follow up) is becoming a standard practice in many breast units. Social distancing in the waiting areas has been one of the limiting factors for face to face consultations. Options of video/telephone consultations are a possibility, although clinical review is sometimes necessary.
No conflict of interest.