Direct and indirect effects of COVID-19 on short-term mortality of breast cancer patients
Serena Di Cosimo,
Silva Ljevar,
Annalisa Trama,
Alice Bernasconi,
Paolo Lasalvia,
Maria Carmen De Santis,
Vera Cappelletti,
Rosalba Miceli,
Giovanni Apolone
Affiliations
Serena Di Cosimo
Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy; Corresponding author. Biostatistics for Clinical Research Unit Fondazione IRCCS Istituto Nazionale Tumori Via Venezian 1, 20133 Milano Italy.
Silva Ljevar
Biostatistics for Clinical Research Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
Annalisa Trama
Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Alice Bernasconi
Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Paolo Lasalvia
Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Maria Carmen De Santis
Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Vera Cappelletti
Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
Rosalba Miceli
Biostatistics for Clinical Research Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
Giovanni Apolone
Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
We studied the COVID-19 impact in newly-diagnosed breast cancer (7,349 patients in 2019, and 5,563 in 2020). In 2020 there were two diagnostic drops: −37.2% (March–May), −15.8% (October–December). Early-stage at presentation (76.4% vs. 74.4%, p = 0.0013), conserving surgery (71.0% vs. 67.0%, p < 0.0001), chemotherapy (86.2% vs. 53.4%, p < 0.0001), and radiotherapy (65.7% vs. 42.1%, p < 0.0001) decreased in 2020 compared to 2019. COVID-19 occurred in 250 patients (4.49%). The time-dependent COVID-19 effect was associated with mortality (multivariable Cox analysis HR [95% CI] 2.26 [1.35–3.74]; p = 0.0018). Survival within the year of diagnosis was 97.6% in 2020 and 98.3% in 2019; 30-day mortality was 1.13% in 2020 (1.07 in uninfected patients), and 0.61% in 2019. The year of diagnosis lost its prognostic relevance after adjusting for stage and treatment. These findings emphasize the critical role of continuity of care, which was disrupted during the pandemic, and underscore the need for policies minimizing treatment initiation delay in newly diagnosed breast cancer patients.
