Diaceutics reveals the data from an abstract poster discussion presentation, highlighting Changes in Management of Triple Negative Breast Cancer (TNBC) during the Covid-19 pandemic in 2020. The data was presented at the San Antonio Breast Cancer Symposium (SABCS) which took place from December 7 to 10, 2021.
The Covid-19 pandemic has caused nearly 695,000 deaths in the US as of September 29, 2021. An increasing body of evidence demonstrates that the Covid-19 pandemic of 2020 saw large reductions in the number of US patients being diagnosed with a variety of conditions including cancer, ischemic stroke, heart failure and depression.
Screening and diagnosis rates for a number of different cancers dropped in the first quarter of 2020 e.g., coincident with the deployment of measures intended to mitigate the spread of infection and that diagnosis rates had not returned to normal by the third quarter of 2020. There is now real-world evidence that delayed diagnosis of at least some cancers and is translating into excess morbidity and mortality.
A study of changes in levels of diagnosis in patients with different cancers suggested that there may be differences in levels of testing associated with diagnosis and prognosis/management. Therefore, we decided to examine CMS data for the entire year of 2020 and focus on a single sub-group in breast cancer, TNBC. These patients have poor prognosis and are relatively intensively managed; it was therefore reasoned that changes in management might be more apparent in this group than in breast cancer patients as a whole.
Data was gathered from a total of 68,018 patients, 8,131 with a J code treatment and 59,887 without. Office visits, surgical pathology and IHC tests all showed a reduction in numbers of patients around March 2020. There was a substantial decrease in office visits for TNBC patients around March 2020 both for those receiving a J code therapy and those who did not. Office visits for patients with a J code therapy showed a lower reduction than patients with no J code therapy suggesting that those who are more intensively managed were more likely to attend their physician than those who were less intensively managed.
For patients not treated with a J code, numbers of office visits, surgical pathology and IHC tests returned to their pre-Covid levels around June 2020. For patients treated with a J code, the numbers of office visits also returned to their pre-Covid levels around June 2020, but the numbers of surgical pathology and immunohistochemistry tests rose to pre-Covid levels and then fell again in the final quarter of 2020.
The reductions in testing in the J code treatment group are greater than that seen with office visits. These patients are not newly-diagnosed with TNBC, therefore the decrease in test utilization suggests a shift in how these patients are being managed in the Covid era compared to how they were managed pre-Covid. One explanation for this shift is that cancer patients’ management is being indirectly impacted by a shift away from a test-based strategy due to restrictions in capacity for testing caused by the huge ramp up in testing for covid-19 which has led to shortages in basic laboratory supplies and has adversely affected the ability of labs to perform non-covid-19 testing.
Many studies using both real-world data and modeling have demonstrated substantial reductions in the number of patients presenting for, or being given, a diagnosis of cancer due to actions taken to mitigate the Covid-19 pandemic This study presents a further route by which the lives of cancer patients can be adversely affected by the Covid-19 pandemic.
Details of the presentation are as follows:
Title: Changes in Management of TNBC During the Covid-19 Pandemic of 2020
Authors: D. Smart, W. Allen, R. Henderson, S. Munksted, P. Riccelli
Access to the study can be gained via: SABCS 2021 Posters | Poster Control Number 21-A-1939-SABCS
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