key: cord-1037588-y6ab4as3
authors: Gousis, C.; Tsotra, E.; Russell, B.; Moss, C.; Mera, A.; Van Hemelrijck, M.; Dolly, S.
title: Impact of the COVID-19 Pandemic in Treating Breast Cancer (BC) Patients Receiving Systemic Anti-cancer Treatment (SACT): The Guy's Cancer Centre Experience
date: 2022-04-30
journal: Clinical Oncology
DOI: 10.1016/j.clon.2021.12.031
sha: f3cbb7ea5dd9380a7d4ed4c75323b1fb1e428b2d
doc_id: 1037588
cord_uid: y6ab4as3

nan

Results: Two patients did not have an echocardiogram before starting treatment and an additional two patients had inadequate views to assess left ventricular ejection fraction (LVEF). 39/50 patients (78%) received anthracycline chemotherapy prior to anti-HER2 therapy and 16/39 (41%) had repeat echocardiograms after anthracycline exposure as recommended. 9/50 patients (18%) experienced a reduction in LVEF of 10 points during treatment. One patient was symptomatic and two patients discontinued therapy early. Three patients were discussed at the echocardiogram MDT and six patients had specialist cardiology input. Five patients were prescribed ACE inhibitors and three patients commenced beta blockers. Reduction in LVEF triggered an earlier repeat echocardiogram after 6e8 weeks in one patient. Conclusion: These results demonstrate significant variation and lack of compliance with guidelines in the current baseline cardiac assessment, monitoring and management of patients on anti-HER2 therapy. Together with a consultant cardiologist and senior cardiac physiologist, we plan to present these results locally and develop a dedicated cardio-oncology pathway to standardise patient care. The European Society of Cardiology position paper regarding the role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies will be used as a framework [3] . References [1] Purpose: Due to the COVID-19 pandemic, many oncology appointments became remote [1] . Consequently, consultations to discuss and consent for radiotherapy (RT) adopted a mix of face-to-face (F2F), video (V) and telephone (T) settings [2] . This service evaluation explored patients' appointment and consent process experiences. Methods: Patient perspectives following breast RT consent consultations were prospectively collected using a peer-reviewed anonymised questionnaire provided on RT planning day (5 May to 12 July 2021) in Kent. Views on satisfaction with consultation setting (F2F, V or T), quality and clarity of information, support received and recommendations to future patients were sought. Results: 55 women, aged 39e88 years (median 60.5) participated. F2F consultations predominated (64%) followed by T (31%) and V (4% Purpose: Undergoing radiotherapy treatment for breast cancer can be a daunting and anxiety-provoking experience. Evidence shows that empowering patients with education prior to commencing treatment can have a positive impact on their anxiety levels [1, 2] . We aimed to educate this patient cohort through the development of a video to reinforce information delivered at consultation regarding the treatment process and side-effects of breast radiotherapy. Methods: We created a patient information video in collaboration with breast cancer patients, which is available to view on the Royal Free Hospital Trust website via the following link: https://www.youtube.com/watch? v¼58YtVyVsNlc&t¼38s . Audits were carried out to assess patient satisfaction and anxiety levels in breast cancer patients receiving radiotherapy before and after implementation of the video. [4, 5] were recorded as covariates.

Results: 112 patients were included in the study, with a median age of 44 years (IQR 40e47). 66.1% (74/112) received adjuvant chemotherapy, of whom 59.5% (44/74) were prescribed OFS. Of these, 75% also received an AI and 25% tamoxifen. 10/38 (26.3%) patients who did not receive chemotherapy were prescribed OFS with a similar proportional split between AI and tamoxifen (80% and 20%, respectively). OFS prescribing by age was: <35 years 8/8 (100%); 35e39 years 11/16 (68.8%); 40e44 years 18/37 (48.6%); 45e50 years 16/51 (31.4%). In stage I and II patients, OFS was used in 25.6% (10/39) and 49.0% (25/51), respectively, compared with 81.8% (18/ 22) in stage III (AI use with OFS: 70% (7/10), 92% (23/25) and 61.1% (11/18), respectively). There was little variation in rates of OFS or AI prescribing by HER-2 status.

Conclusion: There was greater prescribing of OFS in pre-menopausal women with higher stage breast cancer. These women were also more likely to have received chemotherapy. The use of OFS and choice of AI or tamoxifen was not affected by HER-2 status. We saw variation in prescribing according to treating physician, highlighting the requirement for local guidelines in the management of these patients.

Tailoring adjuvant endocrine therapy for premenopausal breast cancer

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Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: ASCO Clinical Practice Guidelines Focused Update