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Impact of the COVID-19 Pandemic on Breast Cancer Presentation and Treatment Recommendations: A Multi-Hospital Health System Experience
Shiva Niakan, Jesse Casaubon, Aixa Perez-Caraballo, Danielle Lipoff, Holly Mason
Baystate Medical Center, Springfield, Massachusetts, United States

1. Objective
To assess the impact of COVID-19 related restrictions on the diagnosis and treatment of breast cancer in a single health system.

2. Design
Retrospective, cohort investigation using difference-in-difference analysis of breast cancer patients at Baystate Health from March 1, 2019 to December 31, 2020 with two time periods related to the pandemic: Wave 1 (March 1 - June 30) and Wave 2 (July-December 31). 2020 was compared to 2019 to exclude potential differences from temporal or seasonal changes. Variables included demographics, COVID related-deferral, cancer specific data, method of detection, type of treatment recommended and received.

3. Setting
Baystate Health is comprised of Baystate Medical Center (a 720-bed tertiary care center), and three community hospitals (Noble Hospital, Franklin Hospital, Wing Hospital) in western Massachusetts.

4. Patients (or Other Participants)
All female patients with breast cancer who presented from March 1, 2019-December 31, 2020 were included.

5. Interventions (if any)

6. Main Outcome Measure (s)
Rate of breast cancer presentation; differences in method of cancer detection, stage at diagnosis, treatment recommendation.

7. Results
Fewer patients presented with a breast cancer diagnosis during Wave 1 in 2020, however volume increased significantly in Wave 2; total volume of patients seen in 2020 was similar to 2019. Although there was an increase in neoadjuvant therapy during 2020 Wave 1, there was no statistically significant difference overall in stage at presentation, breast conservation rates or type of axillary surgery recommended.

8. Conclusions
Despite limitations on breast cancer screening and surgical treatment imposed by the COVID-19 pandemic, a difference in presenting stage, treatment recommended or treatment provided was not observed.

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