Pattern of Time-to-Surgery in Patients With Breast Cancer at Different Stages of the COVID-19 Pandemic

BackgroundThe management of cancer surgeries is under unprecedented challenges during the COVID-19 pandemic, and the breast cancer patients may face a time-delay in the treatment. This retrospective study aimed to present the pattern of time-to-surgery (TTS) and analyze the features of breast cancer patients under the different stages of the COVID-19 pandemic.MethodsPatients who received surgeries for breast cancers at West China Hospital between February 15, 2020 and April 30, 2020 (the outbreak and post-peak stages), and between March 10, 2021 and May 25, 2021 (the normalization stage) were included. TTS was calculated as the time interval between the pathological diagnosis and surgical treatment of breast cancer patients. And the pandemic was divided into three stages based on the time when the patients were pathologically diagnosed and the severity of pandemic at that time point. TTS, demographic and clinicopathological features were collected from medical records.ResultsA total of 367 patients were included. As for demographic features, it demonstrated statistically significant differences in insurance type (p<0.001) and regular screening (p<0.001), as well as age (p=0.013) and menstrual status (p=0.004). As for clinicopathological features, axillary involvement (p=0.019) was a factor that differed among three stages. The overall TTS was 23.56 ± 21.39 days. TTS for patients who were diagnosed during the outbreak of COVID-19 were longer than those diagnosed during pandemic post-peak and normalization stage (p<0.001). Pandemic stage (p<0.001) and excision biopsy before surgery (OR, 6.459; 95% CI, 2.225-18.755; p=0.001) were markedly correlated with the TTS of patients.ConclusionsTTS of breast cancer patients significantly varied in different stages of the COVID-19 pandemic. And breast cancer patients’ daily lives and disease treatments were affected by the pandemic in many aspects, such as health insurance access, physical screening and change of therapeutic schedules. As the time-delay may cause negative influences on patients’ disease, we should minimize the occurrence of such time-delay. It is vital to come up with comprehensive measures to deal with unexpected situations in case the pandemic occurs.

Factors Predicting Pathological Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer: The Experience of a Single Institution with 269 Patients (STONE-01)

Aims: The aim of this study was to define a potential benefit of pathological complete response rate (pCR) and downstaging rate after neoadjuvant chemoradiotherapy (CRT) in relation to treatment and patient factors in locally advanced rectal cancer. Methods: We performed a retrospective cohort study. Patients were divided according to chemotherapy regimens concurrent to radiotherapy (1-drug vs. 2-drug) and according to the time interval between the end of CRT and surgery (≤8 weeks vs. >8 weeks), as well as in relation to specific relevant clinical factors. Logistic regression was used to estimate the independent factors for pCR and downstaging. Results: 269 patients were eligible for this study. Overall, pCR and downstaging rates were 26% and 75.4%, respectively. Univariate analysis showed that female gender (p = 0.01) and time to surgery >8 weeks (p = 0.04) were associated with pCR; age > 70 years (p = 0.05) and time to surgery >8 weeks (p = 0.002) were correlated to downstaging. At multivariate analysis, interval time to surgery of >8 weeks was the only independent factor for both pCR and downstaging (p = 0.02; OR: 0.5, CI: 0.27–0.93 and p = 0.003; OR: 0.42, CI: 0.24–0.75, respectively). Conclusions: This study indicates that, in our population, an interval time to surgery of >8 weeks is an independent significant factor for pCR and downstaging. Further prospective studies are needed to define the best interval time.

Does time-to-surgery affect mortality in patients with acute osteoporotic vertebral compression fractures?

Introduction Osteoporotic vertebral compression fractures (VCFs) are common. An increase in mortality associated with osteoporotic VCFs has been well documented. The purpose of this study was to assess the impact of time to surgery on 1-year survival in patients with osteoporotic vertebral compression fractures. Methods In a retrospective cohort study with prospective mortality follow-up, consecutive patients aged ≥ 60 years who had operative treatment of a low-energy fracture of a thoracolumbar vertebra and had undergone surgical stabilization between January 2015 and December 2018 were identified from our institutional database. By chart review, additional information on hospitalization time, comorbidities (expressed as ASA - American Society of Anesthesiologists Scale), complications and revision surgery was obtained. Time-to-surgery was defined as the time between admission and surgery. Mortality data was assessed by contacting the patients by phone, mail or the national social insurance database. Results Two hundred sixty patients (mean age 78 years, SD 7 years, range, 60 to 93; 172 female) were available for final analysis. Mean follow-up was 40 months (range, 12 to 68 months). Fifty-nine patients (22.7%) had died at final follow-up and 27/260 patients (10.4%) had died within 1 year after the surgery. Time-to-surgery was not different for patients who died within 1 year after the surgery and those who survived (p = .501). In-hospital complications were seen in 40/260 (15.4%) patients. Time-to-surgery showed a strong correlation with hospitalization time (Pearson’s r = .614, p < .001), but only a very weak correlation with the time spent in hospital after the surgery (Pearson’s r = .146, p = .018). Conclusions In contrast to patients with proximal femur factures, time-to-surgery had no significant effect on one-year mortality in geriatric patients with osteoporotic vertebral compression fractures. Treatment decisions for these fractures in the elderly should be individualized.

Factors Affecting Time to Surgery in Breast Cancer Patients

Background We sought to determine factors affecting time to surgery (TTS) to identify potential modifiable factors to improve timeliness of care. Methods Patients with clinical stage 0-3 breast cancer undergoing partial mastectomy in 2 clinical trials, conducted in ten centers across the US, were analyzed. No preoperative workup was mandated by the study; those receiving neoadjuvant therapy were excluded. Results The median TTS among the 583 patients in this cohort was 34 days (range: 1-289). Patient age, race, tumor palpability, and genomic subtype did not influence timeliness of care defined as TTS ≤30 days. Hispanic patients less likely to have a TTS ≤30 days ( P = .001). There was significant variation in TTS by surgeon ( P < .001); those practicing in an academic center more likely to have TTS ≤30 days than those in a community setting (55.1% vs 19.3%, P < .001). Patients who had a preoperative ultrasound had a similar TTS to those who did not (TTS ≤30 days 41.9% vs 51.9%, respectively, P = .109), but those who had a preoperative MRI had a significantly increased TTS (TTS ≤30 days 25.0% vs 50.9%, P < .001). On multivariate analysis, patient ethnicity was no longer significantly associated with TTS ≤30 ( P = .150). Rather, use of MRI (OR: .438; 95% CI: .287-.668, P < .001) and community practice type (OR: .324; 95% CI: .194-.541, P < .001) remained independent predictors of lower likelihood of TTS ≤30 days. Conclusions Preoperative MRI significantly increases time to surgery; surgeons should consider this in deciding on its use.

Abstract 1122‐000038: Anticoagulation Versus Antiplatelet Alone in Acutely Symptomatic Carotid Artery Stenosis

Introduction : Acutely symptomatic carotid artery stenoses carry a significant risk of early ischemic recurrence. Timely initiation of effective antithrombotic therapy and revascularization interventions are necessary to reduce the risk of recurrent events. While antiplatelet agents are widely used, there is some limited evidence supporting short term anticoagulation as well. Moreover, most patients require early revascularization with carotid endarterectomy (CEA) which is almost exclusively performed with anticoagulant protection. Thus, we sought to determine the potential safety and efficacy of short term pre‐operative anticoagulation in the secondary prevention of stroke/TIA from acutely symptomatic carotid stenosis. Methods : A prospective single institution registry of carotid revascularization was queried retrospectively. We included all CEA patients who presented to the hospital with acute ischemic strokes or TIAs attributed to the ipsilateral stenotic lesion of the internal carotid artery. Treatment arms were assigned based on exclusive use of antiplatelet agents (AP) or use of anticoagulant (AC) with or without additional antiplatelet agents. Results : 443 patients were identified; 342 treated with anticoagulation (97.7 % IV Heparin) and 101 with antiplatelets alone (95.1% aspirin, 23.8% clopidogrel and 24.8% aspirin and clopidogrel). Baseline characteristics for the antiplatelet and anticoagulation groups were similar except for mean age (73±9.5 vs 71±10.5), premorbid mRS (1.4±1.3 vs 1.0±1.2) and stroke as presenting symptom (53.5 vs 65.8%). Notably the stroke severity (admission NIHSS), degree of stenosis, presence of intraluminal thrombus or median time to surgery was balanced between treatment arms. Patients treated with anticoagulation had significantly lower incidence of recurrent TIA/Stroke (10.9 vs 3.8%, p = 0.006). Symptomatic ICH was only observed in 1 patient in the AC arm and none of the AP group and postoperative bleeding was similar (2 vs 2.3%, p = 0.83). AC appeared to be protective with OR 0.30 (p = 0.007) for incidence of the primary outcome when controlling for degree of stenosis, presence of intraluminal thrombus, stroke severity, premorbid mRS, age, gender and time to surgery. Conclusions : Our findings suggest short term pre‐operative anticoagulation in patients with acutely symptomatic carotid stenosis awaiting revascularization is a potentially safe and effective alternative to antiplatelet agents alone. Confirmatory prospective studies are warranted.