Expanded Indications for Neoadjuvant Endocrine Therapy in Early-Stage Breast Cancer During the COVID-19 Pandemic

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• The COVID-19 pandemic prompted the Pandemic Breast Cancer Consortium (PBCC) to issue triage recommendations for breast cancer patients.
• These guidelines suggested neoadjuvant treatment for early-stage cases with surgical delays.
• This study investigated national neoadjuvant treatment patterns aligned with PBCC guidelines.

Purpose of the Study:

• To evaluate national trends in neoadjuvant therapy utilization for breast cancer patients.
• To assess adherence to Pandemic Breast Cancer Consortium (PBCC) triage recommendations during the COVID-19 pandemic.
• To identify patient and hospital factors associated with neoadjuvant endocrine therapy (NET) use.

Main Methods:

• Data from 2018-2020 National Cancer Database for patients undergoing surgery were analyzed.
• Proportions of patients treated per PBCC guidelines in 2020 were compared to 2018-2019 cohorts.
• Logistic regression models assessed associations between patient/hospital factors and NET use.

Main Results:

• In 2020, patients with cT1N0 ER+/PR+/HER2- disease were significantly more likely to receive neoadjuvant endocrine therapy (NET) (OR, 3.08).
• NET use also increased in 2020 for patients with cT2N0 or cT1N1 disease (OR, 1.76).
• Academic centers, Black/Asian race, comorbidities, and specific US regions were linked to higher NET utilization.

Conclusions:

• The COVID-19 pandemic led to increased neoadjuvant therapy adoption for surgical breast cancer patients.
• Healthcare system constraints during the pandemic accelerated neoadjuvant therapy use in early breast cancer.
• Long-term outcomes for patients treated under PBCC recommendations warrant close observation.