Survey Finds COVID-19 Pandemic Caused Practice and Endocrine Therapy Changes for ER Positive Breast Cancer

Research presented at the 2020 SABCS found providers planned to use neoadjuvant endocrine therapy for as little as possible until surgery was available for patients with estrogen receptor positive breast cancer.

Despite evidence that a therapeutic effect requires a minimum administration time of 3 months, most breast cancer care providers planned to use neoadjuvant endocrine therapy (NET) for as short a time period as possible until surgery was available, according to a study presented at the 2020 San Antonio Breast Cancer Symposium (SABCS).

The stakeholder survey study also found no difference in the planned duration of NET according to provider characteristics including years in practice, percentage of providers who practice in breast cancer, region of the United States, overall practice, and geographic setting.

“This study demonstrates key patterns and provider preference and attitudes regarding practice changes during the initial phase of the pandemic,” corresponding author of the study, Ko Un Park, MD, FACS, explained in a virtual presentation at SABCS 2020. “Endocrine therapy use was low, consistent with prior reports.”

Prior to the initial COVID-19 outbreak, 46% of survey respondents reported rarely using NET for early-stage breast cancer, with only 12% of respondents claiming they used NET often prior to the pandemic. More, because of the pandemic, 46% of respondents said they would be willing to delay surgery up to 2 months to avoid potential exposure to the virus. Twenty one percent said they would be willing to delay surgery up to 3 months.

The research also found that 66% of respondents admitted to changing their practice based on a “multidisciplinary team discussion” because of the pandemic rather than changing due to an explicit mandate from their institution, which accounted for 25% of respondents. A total of 9% of respondents claimed they did not need to change their practice due to the pandemic.

“The management of the axilla and low volume axillary disease after NET varied widely, indicating a need for future evaluation,” explained Park.

In terms of the planned duration of therapy, 53% of respondents planned to use NET for as little time as possible. Specifically, 34% of medical oncologists, 75% of radiation oncologists, and 62% of surgeons who responded planned to use NET for as little as possible. Meanwhile, 39% of medical oncologists responded that they would vary their practice based on patient risk factors.

The researchers sought to determine both the attitude and treatment preferences of care providers regarding NET and surgical management of the axilla after NET for patients with early stage, estrogen receptor positive breast cancer during the initial surge of the coronavirus disease 2019 (COVID-19) pandemic in the United States.

The data was compiled from 114 survey respondents consisting of medical oncologists, radiation oncologists and surgeons from May 8 to June 12, 2020.

“The Society of Surgical Oncology and the American Society of Breast Surgeon specifically recommended short-term delay of surgery in early stage, estrogen receptor positive breast cancer,” said Park. “As a consequence, the use of endocrine therapy during deferment of surgery was recommended in many instances. Historically, neoadjuvant endocrine therapy use in ER positive breast cancer in the United States has been only around 3%.”


Park KU. Emerging from COVID-19 pandemic: Provider perspective on use of neoadjuvant endocrine therapy (NET) in early stage hormone receptor positive breast cancer. Presented at: 2020 San Antonio Breast Cancer Symposium; December 8-11, 2020; Virtual.