Impact of the COVID-19 pandemic on breast cancer care in Romania: a cohort analysis from the Oncological Institute of Bucharest.

The coronavirus disease 2019 (COVID-19) pandemic profoundly disrupted healthcare systems worldwide, raising concerns regarding delays in cancer diagnosis and treatment. How these disruptions affected breast cancer care during and after the pandemic remains incompletely understood, particularly in Eastern European oncology centers. We conducted a retrospective cohort study of newly diagnosed breast cancer cases treated at the Oncological Institute of Bucharest (IOB), comparing a pandemic cohort (n = 73) with a post-pandemic cohort (n = 99) with respect to age at diagnosis, tumor laterality, location, stage, grade, receptor subtype, human epidermal growth factor receptor 2 (HER2) status, and intervals across the diagnostic and treatment pathways. We measured the intervals between: General Practitioner (GP) referral and the patient's first presentation to the surgery unit; imaging diagnosis (ultrasound, mammogram, or MRI) and the date of biopsy or surgery; biopsy result and initiation of neoadjuvant treatment; the end of neoadjuvant treatment and surgery; surgery and adjuvant treatment; and consecutive chemotherapy sessions. Between the two cohorts, the median age was similar (56 [47-67] vs. 59 [50-68] years). Similarities were also found in tumor laterality and quadrant location. In the post-pandemic cohort, 31.3% of patients were diagnosed with advanced-stage disease, compared with 20.5% in the pandemic cohort, although this difference did not reach statistical significance. Our study showed that chemotherapy delivery was more efficient post-pandemic, with shorter intervals between treatment sessions (18 [17-19] vs. 21 [21-22] days). Referral-to-presentation times were also shorter post-pandemic (3 [1-8] vs. 6 [2-10] days). In contrast, during the post-pandemic year, the interval between the end of neoadjuvant therapy and surgery remained prolonged. During the COVID-19 pandemic, breast cancer care at a major Romanian oncology center was preserved through adapted clinical pathways. We also found that delays in surgical treatment occurred in the post-pandemic period, and a higher percentage of advanced-stage cases were diagnosed. Our findings suggest that pre-hospital delays and residual system constraints, rather than deficiencies in oncology care, contributed to stage migration in the post-pandemic group.