Table 1.
The effects of the COVID pandemic on the medical and surgical care of breast cancer (BC).
| Study | Time to Intervention (i.e. wait-times, discharge times, treatment initiation times) | Complications and Overall Survival | Study design | Critical appraisal score (%)a |
|---|---|---|---|---|
| Specht et al.21 | Time from surgical closure to discharge for patients that underwent mastectomy and reconstruction: 5.02 ± 1.29 h Time to discharge without reconstruction: 4.15 ± 1.89 h. |
No postoperative complications observed for same-day immediate breast reconstructions with 30-day post-op. No observed hematoma in 24 h post op period. No ED visits. | Quality improvement; Prospective case series (no control population) | 100% |
| Cadili et al.22 | 2019 average wait: 36 days after surgery for their first medical or radiation oncology consultation for BC. 2020 average wait: 29 days (p = 0.03). Other wait-times denoted in Table 2. |
2019 ED presentation: 2/99 (2%) presented post-op, both discharged home. 2020 ED presentation: 7/162 (4%) presented post-op: 5 home, 2 admitted. Not statistically significant; clinical significance cannot be determined. |
Retrospective cohort study | 100% |
| Hawrot et al.13 | Time of diagnosis and adjusted time to treatment initiation (TTI) was not different pre- or during COVID (p = 0.926). Across cohorts, Black patients were treated 16 days slower compared to White patients (15.7; 95% CI, 6.9 to 24.6; P < 0.001). Of 99 patients with completed COVID delay questionnaires, 55 (55.6%) had no care delay and 44 (44.4%) had delay, of which surgery (n = 41) and radiation therapy (n = 27) were most frequent. |
This article does not measure complications and changes in overall survival. | Retrospective cohort study | 100% |
| Nyante et al.12 | Pandemic-associated deficits in # of breast examinations decreased over time. Utilization differed by BC risk and insurance status. 79% of biopsies occurred within 7 days of abnormal diagnostic mammogram, compared with 55% occurring within 7 days during the pre-COVID period (P = 0.002). |
Deficits of 6501 screening mammograms, 1167 diagnostic mammograms, and 214 biopsies. 6501 screening examinations represent approximately 33 missed cancer diagnoses. | Retrospective cohort study | 100% |
| Johnson et al.17 | Time to surgery - 12 weeks Delaying surgery for 12 weeks may decrease overall survival (OS) in BC (HR 1.46, 95% CI 1.28–1.65). |
OS was decreased in stages I (HR 1.27, 95%CI 1.16–1.40) and II (HR 1.13, 95%CI 1.02–1.24), but not in stage III (HR 1.20, 95% CI 0.94–1.53) | Systematic review and meta analysis | 100% |
| Obeng-Gyasi et al.18 | Time to Surgery - 4 weeks 6–8% increased risk of mortality for each 4-week delay in time to surgery. |
Delays in BC surgical care for up to 12 weeks could result in 6100 excess deaths in the US. No association between delay in time to surgery (more than or equal to 30 days) and OS or disease-specific survival. | Systematic review | 27% |
a
As per JBI Critical Appraisal Tool Checklists.