Tuesday, May 4, 2021 (HealthDay News)-A pandemic of COVID-19 has led breast cancer professionals to realize that operating room and hospital space may be scarce. That meant rethinking standard care to provide the best way to treat patients under these suddenly restricted conditions.
One of the new ideas: Reverses the order of care given to patients with the type of breast cancer known as estrogen receptor positive (ER +). ER + cancer is a common type of breast cancer and generally has good visibility.
As is more common, instead of receiving medication known as neoadjuvant endocrine therapy (NET) after surgery, the OR is so low that patients will have NET first and then surgery. I will. Doctors also didn’t know how long the postponement of surgery would last, so they set up a system to track what was happening to women affected by delays throughout the United States.
Research leader Dr. Lee Wilke said her team “catalogs nationally how long patients have postponed surgery or postponed treatment, and what mechanisms surgeons have used to ensure that patients can be treated. Wilke is a professor of surgery at the University of Wisconsin School of Medicine and Public Health in Madison.
Preliminary findings were presented at an online conference of the American Academy of Breast Surgery (ASBrS) on Sunday. Studies presented at conferences are usually considered preliminary until published in a peer-reviewed journal.
Treating cancer in this way was part of an effort by a group of breast surgeons and other cancer associations to develop treatment guidelines for times when access to the operating room is restricted.
Doctors have also developed a set of options for further evaluation of patients, Wilke said. This included testing genetic mutations in the tumor’s DNA to determine which patients needed chemotherapy.
Patients who needed a standard approach still got them, Wilke said. For example, women with aggressive triple negatives and HER2 + tumors were still being treated with chemotherapy.
The data used in this study were from approximately 4,800 patients listed in the registry since March 2020. A total of 172 breast surgeons entered the information in the registry.
COVID-19 used NET to treat an additional 554 patients (36%) who would have initially had surgery between March 1st and October 28th, 2020. Was found in the study. Subsequent results up to March 2021 totaled 31%.
NET was also used in 6.5% to 7.8% of registry patients who would normally receive this treatment, the study authors said in an ASBrS news release.
The patterns found in the registry were discussed by cancer experts early in the pandemic, said Dr. Taliking, head of breast surgery at the Dana-Farber / Brigham and Women’s Cancer Center in Boston.
“There was good data to support that this is a rational strategy for the vast majority of patients with ER + breast cancer and that it can be used as a bridge to surgery without adversely affecting results,” King said. ..
Some clinical trials have already validated a more common approach in Europe.
Anti-estrogen endocrine therapy blocks or reduces the ability of hormones to grow certain types of cancer cells. In the United States, it is commonly used in postmenopausal women with larger tumors, Wilke said.
The study also found that shorter surgery times had less immediate breast reconstruction surgery because cancer removal was prioritized.
According to the study, about 24% of patients were tested for genetic mutations in biopsied tumor tissue.
According to King, the Dana-Farber / Brigham and Women’s Cancer Center is using core biopsies for these genomic studies to identify women who need chemotherapy before surgery.
In places like Boston, she said cancer treatment returned to normal in late fall.
According to King, many patients who started preoperative endocrine therapy at the center were already candidates for breast mass removal and would continue treatment as usual if the goal was to shrink the tumor. It wasn’t.
Although this treatment change was temporary, King said he would require researchers to think more broadly about which patients might benefit from NET in the future. It shrinks the tumor as well as chemotherapy, but it takes more time to do so, she said.
“But certainly, neoadjuvant endocrine therapy has far fewer side effects and far less toxicity than chemotherapy,” King said. “If the patient is not a candidate for chemotherapy, I think it will drive us to consider using it more widely when trying to shrink the ER + tumor.”
Wilke added that it could take three to five years to fully understand the full impact of the pandemic-induced changes. Some of the new protocols may continue.
For more information
More American Cancer Society breast cancer..
Source: Lee Wilke, MD, Professor, Surgery, University of Wisconsin School of Medicine and Public Health, and Director of the UW Health Breast Center in Madison. Dr. Tali King, MD, Breast Surgery, Dana-Farber / Brigham and Women’s Cancer Center, Professor, Surgery, Harvard Medical School, and Vice President of Interdisciplinary Oncology at Brigham and Women’s Hospital in Boston. American Society of Breast Surgeons, Annual Meeting, May 2, 2021, Online Presentation
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