The impact of the COVID -19 pandemic on the treatment of patients with newly diagnosed breast cancer in Clinical Hospital Dubrava

UVOD: Karcinom dojke je najčešći karcinom u ženskoj populaciji u svijetu i uzrokuje oko 20% smrti žena od karcinoma. Svake godine se u Hrvatskoj dijagnosticira oko 2800 novih slučajeva karcinoma dojke. Iznimno je važno dijagnosticirati karcinom dojke u ranom stadiju zbog boljeg ishoda liječenja. ----- CILJ: Cilj ovog istraživanja je retrospektivno evaluirati utjecaj COVID-19 pandemije na liječenje pacijentica s novootkrivenim karcinomom dojke u Kliničkoj bolnici Dubrava, kroz usporedbu 2019. godine, u kojoj nije bilo COVID-19 pandemije i 2020. godine. ----- MATERIJALI I METODE: Istraživanje je uključilo 319 pacijentica kojima je karcinom dojke dijagnosticiran biopsijom širokom iglom (core biopsijom) ili kirurškom biopsijom u Kliničkoj bolnici Dubrava. Podatci su skupljeni pretragom bolničkog informatičkog sustava. Uspoređivali smo broj pacijentica, veličinu tumora, vrijeme čekanja na operaciju, te udio radikalnih i poštednih zahvata na dojci, kao i udio limfadenektomije pazušnih limfnih čvorova i biopsije limfnog čvora čuvara (sentinel limfni čvor). ----- REZULTATI: U istraživanje je uključeno 319 pacijentica, od toga 213 pripada skupini 2019. godine, a 106 pacijentica 2020. godini. Razlika u broju pacijentica bila je statistički značajna, a uvjetovana je i opsegom rada bolnice zbog COVID-19 pandemije. Iako je 2020. godine liječen manji broj pacijentica, vrijeme čekanja na operativne zahvate bilo je kraće. Razlika u vremenu čekanja na operaciju u 2019. i 2020. godini bila je statistički značajna. Medijan dužine čekanja na operaciju u 2019. godini iznosio je 28 dana, a u 2020. godini 19 dana. Nije bilo značajne razlike u godinama između udjela radikalnih i poštednih zahvata na dojci i udjela limfadenektomije pazušnih limfnih čvorova i biopsije limfnog čvora čuvara. Prosječna veličina tumora bila je veća u 2019. godini (1,82 cm) u usporedbi sa 2020. godinom (1,71 cm), ali je udio tumora većih od 3 cm bio veći u 2020. Nije utvrđena statistički značajna razlika u veličini tumora. ----- ZAKLJUČAK: Ovo istraživanje je pokazalo da je COVID-19 pandemija imala značajan utjecaj na smanjenje broja pacijentica koje su dijagnosticirane i/ili liječene u KB Dubrava u 2020. godini, što je moguće uvjetovano i smanjenim opsegom rada bolnice zbog COVID-19 pandemije. Prosječna veličina tumora u 2020. godini u usporedbi s 2019. godinom bila je manja, ali je udio tumora većih od 3 cm bio veći. Udio radikalnih i poštednih operacija, te udio limfadenektomije pazušnih limfnih čvorova i biopsije limfnog čvora čuvara nisu pokazale značajne razlike. Za skupinu pacijentica koje su u kraćem vremenskom intervalu 2020. godine obrađivane i liječene u KB Dubrava pružena je pravovremena i kvalitetna skrb. Usporedbom s 2019. godinom vidljivo je da nije bilo kašnjenja s dijagnostikom i liječenjem što se vidi kroz usporedbe veličine dijagnosticiranih karcinoma i vremena čekanja na operativno liječenje. Štoviše, primjetno je da se zbog organizacije rada usmjerene samo prema najhitnijim oblicima liječenja, vrijeme čekanja na zahvate čak i smanjilo. Nažalost ovdje ne možemo vidjeti ishode liječenja za pacijentice u periodu 2020. godine kada je Klinička bolnica Dubrava bila isključivo organizirana za rad s COVID-19 pacijentima, odnosno jesu li pacijentice koje su u to vrijeme bile preusmjerene na druge medicinske ustanove u Republici Hrvatskoj morale duže čekati na dijagnostiku i liječenje.BACKGROUND: Breast cancer is the most common cancer in women worldwide and the cause of 20% of deaths from cancer in women. Every year about 2800 new cases of breast cancer are diagnosed in Croatia. It is very important to diagnose breast cancer at an early stage for a better treatment outcome. ----- AIM: The purpose of this study is to retrospectively evaluate the impact of COVID-19 pandemic on the treatment of patients with newly diagnosed breast cancer in Clinical Hospital Dubrava. Comparison of 2019, before COVID-19 pandemic and 2020. ----- MATERIALS AND METHODS: The retrospective study included 319 women with core needle biopsy or surgical biopsy proven malignant breast tumour in Clinical Hospital Dubrava whose data were extracted from the hospital database . We compared the number of patients, tumor size, waiting time for surgery, and the proportion of radical and conserving breast surgeries, as well as the proportion of axillary lymph node lymphadenectomy and sentinel lymph node biopsy. ----- RESULTS: The study included 319 patients, of which 213 belonged to the group 2019, and 106 patients 2020. The difference in the number of patients was statistically significant, and was conditioned by the extent of the hospital's work due to the COVID 19 pandemic. Although fewer patients were treated in 2020, they had shorter waiting times for surgical procedures. The difference in waiting times for surgery in 2019 and 2020 was statistically significant. The median length of waiting for surgery in 2019 was 28 days, and in 2020 it was 19 days. There was no significant difference between the proportion of radical and conserving breast surgeries and the proportion of axillary lymph node lymphadenectomy and sentinel lymph node biopsy. The average tumor size is higher in 2019 (1.82 cm) compared to 2020 (1.71 cm), but the proportion of tumors larger than 3 cm was higher in 2020. No statistically significant difference in tumor size was found. ----- CONCLUSION: This study showed that the COVID-19 pandemic had a significant impact on reducing the number of patients diagnosed and / or treated at Clinical Hospital Dubrava in 2020, which may be due to the reduced scope of clinical practice in the hospital due to the COVID-19 pandemic. The average tumor size in 2020 was smaller compared to 2019, but the proportion of tumors larger than 3 cm was higher. The proportion of radical and conserving operations, as well as the proportion of axillary lymph node lymphadenectomies and sentinel lymph node biopsies (SLNB) showed no significant differences. Group of patients who were treated in the Clinical Hospital Dubrava in a shorter interval in 2020 got timely and quality medical care. A comparison with 2019 shows that there were no delays with diagnosis and treatment, which can be seen through comparisons of the size of diagnosed cancers and the waiting time for surgical treatment. Moreover, it is noticeable that due to the organization of work focused only on the most urgent forms of treatment, the waiting time for surgical procedures has even decreased. Unfortunately, we cannot see the outcomes of treatment for patients in the period 2020 when the Clinical Hospital Dubrava was exclusively organized to work with COVID-19 patients, namely whether patients who were referred to other medical institutions in the Republic of Croatia had to wait longer for diagnosis and treatment