Breast Cancer Awareness Month: How Covid-19 Impacted Breast Cancer Treatment, Leading To Metastatic Stage

<p><strong>New Delhi:</strong><span style="font-weight: 400;"> On March 11, 2020, the World Health Organization (WHO) said that Covid-19 had become a pandemic &mdash; a disease that has spread across multiple countries. The US declared a national emergency shortly after.&nbsp;</span></p> <p><span style="font-weight: 400;">Shutdowns began and many of us started to learn the term, &ldquo;social distancing&rdquo;.</span></p> <p><span style="font-weight: 400;">While this was important to contain the virus, which had started to claim lives at an alarming rate soon, the measures took a toll on the health of non-Covid patients as many hospitals closed OPDs and put off elective surgeries.</span></p> <p><span style="font-weight: 400;">Early-stage cancer is curable through surgery, but the patient&rsquo;s condition could worsen if there is a delay.</span></p> <p><span style="font-weight: 400;">And this has happened during the pandemic.</span></p> <p><span style="font-weight: 400;">Covid-19 and its causative virus, SARS-CoV-2, also pose considerable challenges for the management of oncology patients. Covid-19 presents as a particularly severe respiratory and systemic infection in aging and immunosuppressed individuals, including patients with cancer.</span></p> <p><span style="font-weight: 400;">For many breast cancer patients, the disease reached metatastic stage due to delay in treatment.</span></p> <h3><strong>Breast Cancer: How Pandemic Affected Treatment, Follow-Up Care&nbsp;</strong></h3> <p><span style="font-weight: 400;">The pandemic has affected just about every aspect of life, including screening, diagnosis, treatment, and follow-up care for breast cancer patients.</span></p> <p><span style="font-weight: 400;">In India, breast cancer is the most common in women in urban areas, while cervical cancer is still the most common in rural areas. Incidence of breast cancer has increased sharply over the past two decades.</span></p> <p><span style="font-weight: 400;">The approximate number of cases of breast cancer in India in the year 2020 was 1,79,790 and this is about 10 per cent of all cancers. Indian women affected with breast cancer are of younger age group and are normally in advanced stage. Younger patients tend to have aggressive disease, larger size of tumor, worse tumor grade, a greater number of positive lymph nodes, more hormone receptor negative status and early recurrence with poorer prognosis.</span></p> <p><span style="font-weight: 400;">People who have been diagnosed with breast cancer and people who are at high risk for breast cancer have found themselves in a uniquely difficult and sometimes frightening position since the coronavirus crisis began.&nbsp;</span></p> <p><span style="font-weight: 400;">Many of you might be wondering if it&rsquo;s safe to go to certain medical appointments or if you should postpone treatments or screening. Others have already had their treatments delayed or changed.</span></p> <h3><strong>Unique Risks Of Covid-19 For People With Breast Cancer</strong></h3> <p><span style="font-weight: 400;">Most people infected with Covid-19 virus will have mild to moderate respiratory symptoms and</span></p> <p><span style="font-weight: 400;">recover without requiring special treatment or hospitalisation. Some will have no symptoms at all.</span></p> <p><span style="font-weight: 400;">According to the US Centers for Disease Control and Prevention, currently having cancer increases your risk of having serious complications if you do become infected with Covid-19. At this time, it&rsquo;s not known if having a history of cancer increases your risk of serious complications.</span></p> <p><span style="font-weight: 400;">This higher risk for serious complications from Covid-19 for people currently diagnosed with cancer is likely because having cancer puts a strain on the body and because certain treatments can cause people to become immunocompromised (have a weakened immune system) or have lung problems.</span></p> <h3><strong>How Healthcare Is Changing To Keep People Safe From Covid</strong></h3> <p><span style="font-weight: 400;">As anyone who has gone to a clinic or hospital in recent months knows, the pandemic is changing how healthcare is delivered. Healthcare facilities of all types and sizes are taking new steps to keep patients and staff from getting Covid-19.</span></p> <h3><strong>How Covid-19 Has Changed Breast Cancer Care?</strong></h3> <p><span style="font-weight: 400;">The pandemic has affected many aspects of breast cancer care in India and across the globe.</span></p> <p><span style="font-weight: 400;">There were delays in many aspects of breast cancer care, including routine clinical visits,</span></p> <p><span style="font-weight: 400;">surveillance imaging, routine mammograms, reconstruction, radiation therapy, hormonal therapy, mastectomy, and chemotherapy.</span></p> <p><span style="font-weight: 400;">Many patients chose or considered delaying or changing their own treatment plans due to concerns about contracting Covid-19.</span></p> <p><span style="font-weight: 400;">Patients reported feeling some level of anxiety about their care being affected by the pandemic.</span></p> <p><span style="font-weight: 400;">Some breast cancer treatments can weaken the immune system and possibly cause lung problems.</span></p> <p><span style="font-weight: 400;">People who have weakened immune systems or lung problems have a much higher risk of serious complications if they become infected with this virus. For most people, the immune system recovers within a couple of months after completing these treatments. But your immune system&rsquo;s recovery time can vary and depends on several factors. If you have received these treatments in the past, it&rsquo;s not clear if you are at higher risk of serious complications from Covid-19.</span></p> <p><span style="font-weight: 400;">People with breast cancer that has metastasised (spread) to the lungs also can have lung problems that may get worse if they develop Covid-19.</span></p> <h3><strong>Precautions Breast Cancer Patients Should Take During Pandemic&nbsp;&nbsp;</strong></h3> <p><span style="font-weight: 400;">If you are receiving treatment for breast cancer, are immunocompromised, or if you are living with breast cancer that has metastasised (spread) to the lungs, the following extra precautions may help you protect yourself:</span></p> <ul> <li><span style="font-weight: 400;">Be extra vigilant about hand hygiene and not touching your face</span></li> <li><span style="font-weight: 400;">Avoid close contact with friends and family and take precautions if you depend on them for medical care</span></li> <li><span style="font-weight: 400;">Plan with your doctor to monitor for symptoms</span></li> <li><span style="font-weight: 400;">Plan with your caregiver or other loved ones in case you or they get sick</span></li> <li><span style="font-weight: 400;">Plan with your employer to work from home if you&rsquo;re not already doing so</span></li> <li><span style="font-weight: 400;">Stock up on medications</span></li> <li><span style="font-weight: 400;">Ask a friend or family member to shop for groceries or pick up medications for you</span></li> </ul> <p><span style="font-weight: 400;">In general, we agree with recommendations for metastatic breast cancer (MBC) management proposed by the Covid-19 Pandemic Breast Cancer Consortium. We recommend that patients receiving early-line palliative systemic therapy that is likely to improve outcomes continue therapy, but risks and benefits of later-line therapy must be considered carefully.&nbsp;</span></p> <p><span style="font-weight: 400;">As per routine, we assess tumor genomics with next-generation sequencing when indicated. For HER2-positive MBC with minimal disease burden and an extended period of stability, we consider holding therapy with surveillance for progression every 3-6 months.</span></p> <p><em><span style="font-weight: 400;">(Dr Atul Batra is Associate Professor, Department of Medical Oncology, AIIMS, New Delhi.)</span></em></p>

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