Assessing the Impact of the COVID-19 Outbreak on the Attitudes and Practice of Italian Oncologists Toward Breast Cancer Care and Related Research Activities

PURPOSE: To investigate the impact of the COVID-19 outbreak on the attitudes and practice of Italian oncologists toward breast cancer care and related research activities. METHODS: A 29-question anonymous online survey was sent by e-mail to members of the Italian Association of Medical Oncology and the Italian Breast Cancer Study Group on April 3, 2020. Only medical oncologists (both those in training and specialists) were invited to complete the questionnaire. RESULTS: Out of 165 responding oncologists, 121 (73.3.%) worked in breast units. In the (neo)adjuvant setting, compared with before the emergency, fewer oncologists adopted weekly paclitaxel (68.5% v 93.9%) and a dose-dense schedule for anthracycline-based chemotherapy (43% v 58.8%) during the COVID-19 outbreak. In the metastatic setting, compared with before the emergency, fewer oncologists adopted first-line weekly paclitaxel for HER2-positive disease (41.8% v 53.9%) or CDK4/6 inhibitors for luminal tumors with less-aggressive characteristics (55.8% v 80.0%) during the COVID-19 outbreak. A significant change was also observed in delaying the timing for monitoring therapy with CDK4/6 inhibitors, assessing treatment response with imaging tests, and flushing central venous devices. Clinical research and scientific activities were reduced in 80.3% and 80.1% of respondents previously implicated in these activities, respectively. CONCLUSION: Medical oncologists face many challenges in providing cancer care during the COVID-19 outbreak. Although most of the changes in their attitudes and practice were reasonable responses to the current health care emergency without expected major negative impact on patient outcomes, some potentially alarming signals of undertreatment were observed.

Download Full-text

1740P Assessing the impact of COVID-19 outbreak on the attitudes and practice of Italian oncologists towards breast cancer care and related research activities

Annals of Oncology ◽

10.1016/j.annonc.2020.08.1804 ◽

2020 ◽

Vol 31 ◽

pp. S1017

Author(s):

F. Poggio ◽

M. Tagliamento ◽

M. Di Maio ◽

V. Martelli ◽

A. De Maria ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Care ◽

Breast Cancer Care ◽

Related Research ◽

Research Activities ◽

The Impact

Download Full-text

The Impact of Patient Shifts between Hospitals on Breast Cancer Care: A population based study in The Netherlands

European Journal of Cancer ◽

10.1016/s0959-8049(18)30373-3 ◽

2018 ◽

Vol 92 ◽

pp. S49

Author(s):

E. Heeg ◽

K. Schreuder ◽

P.E.R. Spronk ◽

J.C. Oosterwijk ◽

S. Siesling ◽

...

Keyword(s):

Breast Cancer ◽

The Netherlands ◽

Cancer Care ◽

Population Based ◽

Breast Cancer Care ◽

Population Based Study ◽

The Impact

Download Full-text

Using a disease pathway management approach to improve the quality of breast cancer care in Ontario.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.109 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 109-109

Author(s):

Andrea Eisen ◽

Jasmin Soobrian ◽

Ashley Tyrrell ◽

Clement Li ◽

Derek Muradali ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

Performance Measurement ◽

Quality Indicators ◽

Cancer Care ◽

Evidence Based ◽

Breast Cancer Care ◽

Patient Journey ◽

The Impact

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

Download Full-text

Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review (Preprint)

10.2196/preprints.10930 ◽

2018 ◽

Cited By ~ 1

Author(s):

Chiara Jongerius ◽

Selena Russo ◽

Ketti Mazzocco ◽

Gabriella Pravettoni

Keyword(s):

Breast Cancer ◽

Early Detection ◽

Cancer Prevention ◽

Cancer Care ◽

Care Management ◽

Breast Cancer Prevention ◽

Breast Cancer Care ◽

Prevention And Early Detection ◽

The Impact ◽

Mhealth Apps

BACKGROUND The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. OBJECTIVE The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. METHODS A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions’ features, outcome measures, and results. RESULTS We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. CONCLUSIONS Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations.

Download Full-text

The Feasibility and Performance of the Patient Navigation Programme in Improving Breast Cancer Care in Malaysia

Journal of Global Oncology ◽

10.1200/jgo.18.59500 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 95s-95s

Author(s):

M. Jaganathan ◽

N.H. Zainal ◽

N. Rajaram ◽

T. Soo Hwang ◽

M.Y. Abdul Wahab

Keyword(s):

Breast Cancer ◽

Cancer Care ◽

Patient Navigation ◽

Poor Adherence ◽

Adherence To Treatment ◽

Breast Cancer Care ◽

Middle Income ◽

Treatment Delays ◽

And Performance ◽

The Impact

Background: Breast cancer is the most common cancer in Malaysia and it is anticipated that incidence will increase by 49% from 2012 to 2025. Unfortunately, survival remains poor because of late presentation and poor adherence to evidence-based medicine. Barriers to early presentation include inadequate knowledge about the disease, financial issues, negative influence of relatives and perceived poor quality of care and services in state-run hospitals. Poor adherence to treatment is also a common struggle, and is further exacerbated by the use of traditional, alternative healing methods. While patient navigation (PN) programs have been shown to improve breast cancer outcomes in the US, its implementation and performance in low and middle income countries is not well studied. Aim: We sought to determine the impact of a PN program in reducing treatment delays and improving adherence to treatment and patient satisfaction, as well as to evaluate the barriers faced by women seeking breast cancer care in Malaysia. Methods: We established a nurse-led patient navigation center at a secondary government hospital in Klang. This clinical team involved the surgery, pathology, radiology and nursing departments and provided patient-centered care, including patient tracking and call reminder systems, family counseling, health education and decision aids. The community team involved a Patient Navigator Program Coordinator and a Community Navigator. We compared treatment delays and adherence to treatment between navigated patients and patients registered in the year prior to the PN program. We used Student t-tests and Pearson χ2 or Fisher's Exact tests to compare timeliness between navigated patients and patients registered in the year prior. Results: Of the 136 Malaysian women enrolled in the PNP in 2015, 48.9% were diagnosed with advanced disease (stage 3 or 4). Women with advance disease had a lower median monthly household income compared with women with early disease (USD $350 vs $540, P = 0.023). Women with advance disease were also less likely to have personal transportation to the hospital (36.4% vs 56.5%, P = 0.048). Compared with the year before PN, more navigated patients underwent mammography within 7 days of their first visit (96.4% vs 74.4%, P < 0.001) and received their diagnosis within 14 days of their first visit (80.0% vs 58.5%, P < 0.001). The proportion of women who met timeliness to treatment initiation was similar for navigated patients and patients in the year prior. The proportion of defaulters were marginally lesser among navigated patients compared with the year prior (4.4% vs 11.5%, P = 0.048). Conclusion: We found that integrating PN within a breast clinic of a middle income country is feasible, and in the long run, could improve outcomes for breast cancer patients. Long-term follow-up is needed to assess the impact of the PN program on improving treatment completion and survival.

Download Full-text

The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis

Breast Cancer Research and Treatment ◽

10.1007/s10549-016-3887-8 ◽

2016 ◽

Vol 158 (3) ◽

pp. 523-534 ◽

Cited By ~ 14

Author(s):

Tracy A. Battaglia ◽

Julie S. Darnell ◽

Naomi Ko ◽

Fred Snyder ◽

Electra D. Paskett ◽

...

Keyword(s):

Breast Cancer ◽

Research Program ◽

Cancer Care ◽

Patient Navigation ◽

Meta Analysis ◽

Breast Cancer Care ◽

National Patient ◽

The Impact

Download Full-text

Effects of COVID-19 on an academic breast oncology center in New York City.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.51 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 51-51

Author(s):

Jake Prigoff ◽

Grace Hillyer ◽

Fletcher Bell ◽

Melissa Kate Accordino

Keyword(s):

Breast Cancer ◽

Targeted Therapy ◽

Endocrine Therapy ◽

Cancer Care ◽

Management Strategies ◽

Oncologic Outcomes ◽

Patient Access ◽

Breast Cancer Care ◽

Oncology Patients ◽

The Impact

51 Background: The influx of patients to the healthcare system due to COVID-19 impacted healthcare practices including the care of breast cancer patients. Our aim is to describe the impact this pandemic had on breast cancer care delivery at an academic center in NYC to inform policy and procedure for future crises that limit patient access to on-site facilities. Methods: A survey was sent to physicians involved in the care of patients with breast cancer at Columbia University Irving Medical Center in May 2020. Participants were asked about practice structure and changes to breast cancer care. The primary outcome was the degree that providers believed breast oncology patients’ clinical outcomes were significantly impacted by COVID-19. Secondary outcomes included changes in diagnostic and management approaches and advice for future providers faced with a similar pandemic. Results: The response rate was 65.4% (17/26). This included physicians from medical oncology (n = 7), radiology (n = 4), breast surgery (n = 3), radiation oncology (n = 2), and plastic surgery (n = 1). Seventy-six percent of physicians somewhat agreed, agreed, or strongly agreed that oncologic outcomes may be significantly impacted by the COVID-19 pandemic. Nearly half (47%) of respondents reported delays in the workup of patients due to COVID-19 with 50.0% for mammograms, 47.5% for bone scans, 46.0% for ultrasounds, 43.8% for PET scans, and 43.3% for biopsies. Eighty-two percent reported delays in overall oncologic management. Delays to systemic therapy were: intravenous/targeted therapy (37.9%), intramuscular/subcutaneous endocrine therapy (28.3%), oral chemotherapy/targeted therapy (22.9%), and oral endocrine therapy (12.8%). Delays to local therapy were: surgery (64.4%) and radiation therapy (44.6%). Almost two-thirds (64.7%) reported it necessary to use alternative oncologic management strategies. The most common piece of advice our providers offered was to increase testing capacity to all patients, especially when coming to a healthcare facility. Conclusions: The COVID-19 pandemic has caused major disruption to breast cancer practices. Breast oncology physicians reported delays in management in over 80% of patients, and the need to use alternative management strategies in over 60% of patients. Effects of these disruptions on oncologic outcomes are unknown, but over 75% of our physicians believe this will significantly impact breast oncology patients’ outcomes. There's a need for policies and procedures to structure patient care should there be a future crisis that limits patient access to oncologic care.

Download Full-text