Editor
The management of cancer surgeries is challenged during the COVID-19 pandemic1–3, and the patients may have to face a treatment delay due to hospital space, traffic barriers by quarantine measures, the desire to social distance, and additional COVID-19 screening before admission. West China Hospital the gaps in cancer care and ensure the homogenization of the management that patients received in local hospitals, remote consultation between large medical centres/specialised hospitals was encouraged.
Table 1.
Demographic, pathologic, and clinical characteristics of patients by TTS intervals
| Time-to-surgery | |||||
|---|---|---|---|---|---|
| Characteristics | Overall (n = 201) | ≤14 days (n = 71) | 15-42 days (n = 86) | ≥ 43 days (n = 44) | p-value |
| Age at diagnosis (mean ± SD) | 48·89 ± 9·86 | 49·17 ± 8·16 | 48·4 ± 10·54 | 49·39 ± 11·13 | 0·827 |
| Tumor size (mm, mean ± SD) | 25·53 ± 15·24 | 26·87 ± 14·06 | 24·47 ± 16·59 | 25·16 ± 15·24 | 0·635 |
| Setting | 0·812 | ||||
| City of the hospital | 97 (48·3%) | 37 (52·1%) | 42 (48·8%) | 18 (40·9%) | |
| Other cities in the same province | 87 (43·3%) | 29 (40·8%) | 36 (41·9%) | 22 (50·0%) | |
| Other provinces | 17 (8·5%) | 5 (7·0%) | 8 (9·3%) | 4 (9·1%) | |
| Insurance type | 0·680 | ||||
| Private | 30 (14·9%) | 13 (18·3%) | 13 (15·1%) | 4 (9·1%) | |
| Governmental | 152 (75·6%) | 52 (73·2%) | 65 (75·6%) | 35 (79·5%) | |
| Uninsured | 16 (8·0%) | 4 (5·6%) | 7 (8·1%) | 5 (11·4%) | |
| Others | 3 (1·5%) | 2 (2·8%) | 1 (1·2%) | 0 (0·0%) | |
| Degree level | 0·505 | ||||
| Junior high school or lower | 89 (44·3%) | 28 (39·4%) | 39 (45·3%) | 22 (50·0%) | |
| High school or college | 77 (38·3%) | 28 (39·4%) | 31 (36·0%) | 18 (40·9%) | |
| Bachelor degree or above | 35 (17·4%) | 15 (21·1%) | 16 (18·6%) | 4 (9·1%) | |
| Marital Status | 0·148 | ||||
| Married | 187 (93·0%) | 69 (97·2%) | 77 (89·5%) | 41 (93·2%) | |
| Unmarrieda | 14 (7·0%) | 2 (2·8%) | 9 (10·5%) | 3 (6·8%) | |
| Method of detection | 0·281 | ||||
| Symptom-detected | 178 (88·6%) | 64 (90·1%) | 78 (90·7%) | 36 (81·8%) | |
| Screen-detected | 23 (11·4%) | 7 (9·9%) | 8 (9·3%) | 8 (18·2%) | |
| Menstrual status | 0·490 | ||||
| Premenopausal | 102 (50·7%) | 32 (45·1%) | 46 (53·5%) | 24 (54·5%) | |
| Menopausal | 99 (49·3%) | 39 (54·9%) | 40 (46·5%) | 20 (45·5%) | |
| Neoadjuvant therapy | <0·001 | ||||
| Yes | 41 (20·4%) | 3 (4·2%) | 23 (26·7%) | 15 (34·1%) | |
| No | 160 (79·6%) | 68 (95·8%) | 63 (73·3%) | 29 (65·9%) | |
| Excision biopsy before surgery | 0·001 | ||||
| Yes | 16 (8·0%) | 0 (0·0%) | 11 (12·8%) | 5 (11·4%) | |
| No | 185 (92·0%) | 71 (100·0%) | 75 (87·2%) | 39 (88·6%) | |
| Type of surgery | 0·072 | ||||
| Mastectomy | 168 (83·6%) | 60 (84·5%) | 76 (88·4%) | 32 (72·7%) | |
| Lumpectomy | 33 (16·4%) | 11 (15·5%) | 10 (11·6%) | 12 (27·3%) | |
| Reconstruction after mastectomy | 0·822 | ||||
| Yes | 11 (5·5%) | 3 (4·2%) | 5 (5·8%) | 3 (6·8%) | |
| No | 190 (94·5%) | 68 (95·8%) | 81 (94·2%) | 41 (93·2%) | |
| Histological diagnosis | 0·067 | ||||
| Ductal | 158 (78·6%) | 62 (87·3%) | 65 (75·6%) | 31 (70·5%) | |
| Others/multiple | 43 (21·4%) | 9 (12·7%) | 21 (24·4%) | 13 (29·5%) | |
| Histological grade | 0·039 | ||||
| 1 | 5 (2·5%) | 2 (2·8%) | 3 (3·5%) | 0 (0·0%) | |
| 2 | 86 (42·8%) | 36 (50·7%) | 34 (39·5%) | 16 (36·4%) | |
| 3 | 78 (38·8%) | 29 (40·8%) | 32 (37·2%) | 17 (38·6%) | |
| Unknown | 32 (15·9%) | 4 (5·6%) | 17 (19·8%) | 11 (25·0%) | |
| AJCC stage | 0·997 | ||||
| I | 61 (30·3%) | 21 (29·6%) | 26 (30·2%) | 14 (31·8%) | |
| II | 95 (47·3%) | 35 (49·3%) | 39 (45·3%) | 21 (47·7%) | |
| III | 40 (19·9%) | 13 (18·3%) | 19 (22·1%) | 8 (18·2%) | |
| Unknown/others | 5 (2·5%) | 2 (2·8%) | 2 (2·3%) | 1(2·3%) | |
| Axillary involvement | 0·711 | ||||
| Yes | 80 (39·8%) | 27 (38·0%) | 37 (43·0%) | 16 (36·4%) | |
| No | 121 (60·2%) | 44 (62·0%) | 49 (57·0%) | 28 (63·6%) | |
| Hormone receptor status | 0·415 | ||||
| ER+/PR+ | 122 (60·7%) | 45 (63·4%) | 50 (58·1%) | 27 (61·4%) | |
| ER+/PR− | 10 (5·0%) | 3 (4·2%) | 4 (4·7%) | 3 (6·8%) | |
| ER−/PR+ | 11 (5·5%) | 7 (9·9%) | 3 (3·5%) | 1 (2·3%) | |
| ER−/PR− | 58 (28·9%) | 16 (22·5%) | 29 (33·7%) | 13 (29·5%) | |
| HER-2 gene amplification | 0·541 | ||||
| Positive | 48 (23·9%) | 21 (29·6%) | 18 (20·9%) | 9 (20·5%) | |
| Negative | 97 (48·3%) | 29 (40·8%) | 46 (53·5%) | 22 (50·0%) | |
| Uncertainb | 56 (27·9%) | 21 (29·6%) | 22 (25·6%) | 13 (29·5%) | |
| Ki-67 expression | 0·247 | ||||
| ≤ 20% | 64 (31·8%) | 19 (26·8%) | 27 (31·4%) | 18 (40·9%) | |
| >20% | 135 (67·2%) | 51 (71·8%) | 59 (68·6%) | 25 (56·8%) | |
| Unknown | 2 (1·0%) | 1 (1·4%) | 0 (0·0%) | 1 (2·3%) | |
| Lymphovascular invasion | 0·052 | ||||
| Yes | 38 (18·9%) | 14 (19·7%) | 21 (24·4%) | 3 (6·8%) | |
| No | 163 (81·1%) | 57 (80·3%) | 65 (75·6%) | 41 (93·2%) | |
single/divorced/widowed/separated.
HER-2 status detected 2+ by immunohistochemistry but results of fluorescence in situ hybridization was not obtained.
Abbreviations: SD, standard deviation; AJCC, American Joint Committee on Cancer; ER, estrogen receptor; PR, progesterone receptor; HER-2, human epithelial growth factor receptor 2.
The subjective feeling of depression and anxiety were routinely measured with the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS), respectively. A total of 11·5 per cent (23/200) patients on admission and 22·9 per cent (46/200) on discharge reported mild depression. The SDS and SAS scores were generally increased through hospitalisation, except the depression status in patients with TTS within two weeks (Table 2). Longer TTS did not deteriorate mental status, presumably because major reason was the impact of the breast cancer and background of the pandemic.
Table 2.
Change in SDS and SAS scores through hospitalization by TTS intervals
| SDS (n = 200) | SAS (n = 199) | |||||
|---|---|---|---|---|---|---|
| TTS | Admission | Discharge | p-value | Admission | Discharge | p-value |
| ≤14 days | 34·41 ± 7·62 | 35·79 ± 8·54 | 0·124 | 30·72 ± 5·30 | 33·96 ± 6·57 | <0·001 |
| 15-42 days | 34·26 ± 7·10 | 37·99 ± 8·08 | <0·001 | 32·41 ± 5·19 | 35·19 ± 5·88 | <0·001 |
| ≥ 43 days | 34·31 ± 8·13 | 38·36 ± 9·78 | 0·009 | 30·70 ± 5·04 | 34·27 ± 6·30 | <0·001 |
| Overall | 34·35 ± 7·48 | 37·30 ± 8·67 | <0·001 | 31·44 ± 5·24 | 34·56 ± 6·21 | <0·001 |
Abbreviations: TTS, time-to-surgery; SDS, Self-Rating Depression Scale; SAS, Self-Rating Anxiety Scale.
Reference
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