Delays and disruptions in breast cancer care due to coronavirus disease-2019 pandemic: Real-World data from India

PURPOSE: This study aimed to identify and categorize the delays and disruptions in breast cancer care and its impact on disease outcome during the first wave of the coronavirus disease-2019 (COVID-19) pandemic. METHODS: Patients with newly diagnosed or relapsed breast cancer who were treated between May 2020 and March 2021 were evaluated. Patients who had experienced COVID-19 related delays in cancer diagnosis or treatment initiation and/or disruption in ongoing treatment were included for analysis. All delays in cancer diagnosis, surgery, or a delay/disruption in radiotherapy or systemic therapy for each patient were identified. The reasons for delays and disruptions were evaluated. Any modification (s) in ongoing treatment, failure to complete planned treatment, and the effect on disease status were noted. RESULTS: Of the 415 eligible patients with breast cancer, we identified 70 (15.5%) patients who experienced COVID-19-related delay in diagnosis, or a delay or disruption in cancer-directed therapy. Forty (57.1%) patients experienced delays in initiation of their breast cancer treatment and ongoing treatment was disrupted in 30 (42.9%) patients. Majority of the delays (17, 42.5%) and disruptions (17, 60%) were noted in chemotherapy. The median duration of treatment delays was 156 days (interquartile range [IQR] 82–209 days) and that of treatment disruptions was 90 days (IQR 48–261 days). Logistic constraints were responsible for majority of the delays and disruptions. Overall, 32 (45.7%) patients suffered cancer upstaging or progression. CONCLUSION: We observed significant rates of disease progression among patients with breast cancer who suffered treatment delays and disruptions during the first wave of the COVID-19 pandemic. It is critical to identify and characterize these unprecedented delays and their impact to alienate them in the present and future surges, and to inform strategies to overcome the long-term oncological consequences of the pandemic.