“Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions

Joshua Feinberg; Cindy Cen; Freya Schnabel; Sylvia Adams; Magdalena Plasilova; Janet Yeh; Marleen Meyers; James Speyer; Elliot Belenkov; Maryann Kwa; Yelena Novik; Elena Katz; Amber Azniv Guth

doi:doi:10.11648/j.ijcocr.20210601.16

“Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions

Joshua Feinberg, Cindy Cen, Freya Schnabel, Sylvia Adams, Magdalena Plasilova, Janet Yeh, Marleen Meyers, James Speyer, Elliot Belenkov, Maryann Kwa, Yelena Novik, Elena Katz, Amber Azniv Guth

Published in International Journal of Clinical Oncology and Cancer Research (Volume 6, Issue 1)

Received: 24 January 2021 Accepted: 23 February 2021 Published: 4 March 2021

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Abstract

Background: The COVID-19 pandemic presented a unique challenge to our healthcare system and rapidly changed the delivery of cancer care. During the height of the pandemic in New York State, non-emergent surgery, including cancer surgery, was postponed. For patients with hormone receptor positive breast cancer, “bridge” neoadjuvant hormonal therapy was initiated until surgery could be safely performed. Objective: We present our institutional experience with this approach and lessons learned, including oncologic outcomes and factors which may lead to increased medication compliance. Method: This is a single institution, retrospective, observational chart review. Using data from the NYU Perlmutter Cancer Center, we created a database of patients who were diagnosed with ER+ stage 0, I, or II breast cancer and were offered preoperative endocrine therapy (tamoxifen or aromatase inhibitors) between March 12, 2020 and June 1, 2020. Variables collected included demographics, tumor characteristics, as well as the rates of medication uptake and compliance. Patients eligible for review were adult (age>18) males and females who had initial visits at our two cancer centers between March 12, 2020 and June 1, 2020, during the height of the COVID-19 pandemic in New York. Results: Of 192 newly diagnosed breast cancer patients seen at the NYU Perlmutter Cancer Center during the study time period, 136 (71%) patients had early stage ER positive breast cancer. Forty-five patients (23%) had not yet undergone surgery, and were recommended to receive presurgical hormonal therapy as a bridge. Average age: 60.5 +/- 13.8 years old (range 31-89). Thirty-four patients (75.6%) had invasive cancer, 8 had DCIS (17.8%), 3 had DCIS with microinvasion (6.7%). There were 9 patients (20%) who did not take the medication. Thirty-six patients (80%) took medication for an average of 43.6 +/- 27.3 days (range 9-101 days) prior to surgery. Twenty-eight patients (77.8%) took an aromatase inhibitor, and 8 (22.2%) took tamoxifen. Forty-two patients have now undergone surgery (93.3%) – the remaining patients include one who is refusing all treatment, one patient who relocated out of state, and another patient who has not yet scheduled surgery, but is still taking an aromatase inhibitor. Conclusion: Despite traditionally low uptake and adherence to endocrine therapy, acceptance of neo-adjuvant bridge therapy during the COVID-19 pandemic was high (80%). We plan to investigate our patient population further, especially psychosocial and behavioral factors that influence willingness to take endocrine therapy – and apply these lessons to management of early-stage ER positive breast cancer.

Published in	International Journal of Clinical Oncology and Cancer Research (Volume 6, Issue 1)
DOI	10.11648/j.ijcocr.20210601.16
Page(s)	38-41
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Early Stage Breast Cancer, COVID-19, Neoadjuvant Endocrine Therapy

References

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[2]	Jill R. Dietz; • Meena S. Moran; Steven J. Isakoff. Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID 19 pandemic. the COVID 19 pandemic breast cancer consortium. Breast Cancer Research and Treatment (2020) 181: 487–497.
[3]	Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 2014; 384: 164–172.
[4]	Morgan J, Wyld L, Collins KA, Reed MW. Cochrane Database of Systematic Reviews: Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus) (Review). Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD004272.
[5]	Semiglazov V. F., Semiglazov V. V, Dashyan G. A, et al. Phase 2 Randomized Trial of Primary Endocrine Therapy Versus Chemotherapy in Postmenopausal Patients With Estrogen Receptor-Positive Breast Cancer. Cancer 2007; 110, 2: 244-255.
[6]	Spring, L. M., Gupta, A., Reynolds, K., et al. Neoadjuvant Endocrine Therapy for Estrogen Receptor-Positive Breast Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. 2016 November 01; 2 (11): 1477–1486.
[7]	Chiba A., Hoskin T. L., Heins C. L., et al. Trends in Neoadjuvant Endocrine Therapy Use and Impact on Rates of Breast Conservation in Hormone Receptor Positive Breast Cancer: A National Cancer Data Base Study. Ann Surg Oncol. 2017 February; 24 (2): 418–424.
[8]	Minami C. A., Kantor O., Weiss A., et al. Association Between Time to Operation and Pathologic Stage in Ductal Carcinoma inSitu and Early-Stage Hormone Receptor-Positive Breast Cancer. JACS. Vol. 231, No. 4, October 2020 pages 343-347.
[9]	Hunt K, et al. Local-regional Recurrence (LRR) Following Neoadjuvant Endocrine Therapy (NET): Data from ACOSOG Z1031 (Alliance). SSO, Virtual Meeting August 17, 2020.
[10]	Buonomo OC, Materazzo M, Pellicciaro M, Caspi J, Piccione E, Vanni G. Tor Vergata University-Hospital in the Beginning of COVID-19 Era: Experience and Recommendation for Breast Cancer Patients. In Vivo 2020; 34 (3 Suppl): 1661-1665.
[11]	Marti C, Sanchez-Mendez JI. Neoadjuvant endocrine therapy for luminal breast cancer treatment: A first-choice alternative in times of crisis such as the COVID-19 pandemic. ecancer 2020; 14: 1027.
[12]	Gasparri ML, Gentilini OD, Lueftner D, Kuehn T, Kaidar-Person O, Poortmans P. Changes in breast cancer management during the Corona Virus Diease 19 Pandemic: An international survey of the European Breast Cancer Research Association of Surgical Trialists (EUBREAST). The Breast 2020; 52: 110-115.
[13]	Bickell NA, Wang JJ, Oluwole S, Schrag D, Godfrey H, Hiotis K, Mendez J, Guth AA. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol. 2006 Mar 20; 24 (9): 1357-62. doi: 10.1200/JCO.2005.04.5799. PMID: 16549830.
[14]	Barbie T. U., Ma C., Margenthaler, JA. Management of Premenopausal Women with Neoadjuvant Endocrine Therapy: A Single-Institution Experience. Ann Surg Oncol. 2015 Nov; 22 (12): 3861-5.
[15]	Masuda N, Sagara Y, Kinoshita T, et al. Neoadjuvant anastrazole versus tamoxifen in patients receiving goserelin for premenopausal breast cancer (STAGE): a double-blinded, randomized phase 3 trial. Lancet Oncol. 2012; 13: 345-352.
[16]	Thompson CK, Lee MK, Baker JL, Attai DJ, DiNome ML. Taking a second look at neoadjuvant endocrine therapy for the treatment of early stage estrogen receptor positive breast cancer during the COVID-19 outbreak. Ann Surg. 2020; 272: e96-e97.

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Joshua Feinberg, Cindy Cen, Freya Schnabel, Sylvia Adams, Magdalena Plasilova, et al. (2021). “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions. International Journal of Clinical Oncology and Cancer Research, 6(1), 38-41. https://doi.org/10.11648/j.ijcocr.20210601.16

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Joshua Feinberg; Cindy Cen; Freya Schnabel; Sylvia Adams; Magdalena Plasilova, et al. “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions. Int. J. Clin. Oncol. Cancer Res. 2021, 6(1), 38-41. doi: 10.11648/j.ijcocr.20210601.16

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AMA Style

Joshua Feinberg, Cindy Cen, Freya Schnabel, Sylvia Adams, Magdalena Plasilova, et al. “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions. Int J Clin Oncol Cancer Res. 2021;6(1):38-41. doi: 10.11648/j.ijcocr.20210601.16

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@article{10.11648/j.ijcocr.20210601.16,
  author = {Joshua Feinberg and Cindy Cen and Freya Schnabel and Sylvia Adams and Magdalena Plasilova and Janet Yeh and Marleen Meyers and James Speyer and Elliot Belenkov and Maryann Kwa and Yelena Novik and Elena Katz and Amber Azniv Guth},
  title = {“Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions},
  journal = {International Journal of Clinical Oncology and Cancer Research},
  volume = {6},
  number = {1},
  pages = {38-41},
  doi = {10.11648/j.ijcocr.20210601.16},
  url = {https://doi.org/10.11648/j.ijcocr.20210601.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20210601.16},
  abstract = {Background: The COVID-19 pandemic presented a unique challenge to our healthcare system and rapidly changed the delivery of cancer care. During the height of the pandemic in New York State, non-emergent surgery, including cancer surgery, was postponed. For patients with hormone receptor positive breast cancer, “bridge” neoadjuvant hormonal therapy was initiated until surgery could be safely performed. Objective: We present our institutional experience with this approach and lessons learned, including oncologic outcomes and factors which may lead to increased medication compliance. Method: This is a single institution, retrospective, observational chart review. Using data from the NYU Perlmutter Cancer Center, we created a database of patients who were diagnosed with ER+ stage 0, I, or II breast cancer and were offered preoperative endocrine therapy (tamoxifen or aromatase inhibitors) between March 12, 2020 and June 1, 2020. Variables collected included demographics, tumor characteristics, as well as the rates of medication uptake and compliance. Patients eligible for review were adult (age>18) males and females who had initial visits at our two cancer centers between March 12, 2020 and June 1, 2020, during the height of the COVID-19 pandemic in New York. Results: Of 192 newly diagnosed breast cancer patients seen at the NYU Perlmutter Cancer Center during the study time period, 136 (71%) patients had early stage ER positive breast cancer. Forty-five patients (23%) had not yet undergone surgery, and were recommended to receive presurgical hormonal therapy as a bridge. Average age: 60.5 +/- 13.8 years old (range 31-89). Thirty-four patients (75.6%) had invasive cancer, 8 had DCIS (17.8%), 3 had DCIS with microinvasion (6.7%). There were 9 patients (20%) who did not take the medication. Thirty-six patients (80%) took medication for an average of 43.6 +/- 27.3 days (range 9-101 days) prior to surgery. Twenty-eight patients (77.8%) took an aromatase inhibitor, and 8 (22.2%) took tamoxifen. Forty-two patients have now undergone surgery (93.3%) – the remaining patients include one who is refusing all treatment, one patient who relocated out of state, and another patient who has not yet scheduled surgery, but is still taking an aromatase inhibitor. Conclusion: Despite traditionally low uptake and adherence to endocrine therapy, acceptance of neo-adjuvant bridge therapy during the COVID-19 pandemic was high (80%). We plan to investigate our patient population further, especially psychosocial and behavioral factors that influence willingness to take endocrine therapy – and apply these lessons to management of early-stage ER positive breast cancer.},
 year = {2021}
}

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TY  - JOUR
T1  - “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions
AU  - Joshua Feinberg
AU  - Cindy Cen
AU  - Freya Schnabel
AU  - Sylvia Adams
AU  - Magdalena Plasilova
AU  - Janet Yeh
AU  - Marleen Meyers
AU  - James Speyer
AU  - Elliot Belenkov
AU  - Maryann Kwa
AU  - Yelena Novik
AU  - Elena Katz
AU  - Amber Azniv Guth
Y1  - 2021/03/04
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcocr.20210601.16
DO  - 10.11648/j.ijcocr.20210601.16
T2  - International Journal of Clinical Oncology and Cancer Research
JF  - International Journal of Clinical Oncology and Cancer Research
JO  - International Journal of Clinical Oncology and Cancer Research
SP  - 38
EP  - 41
PB  - Science Publishing Group
SN  - 2578-9511
UR  - https://doi.org/10.11648/j.ijcocr.20210601.16
AB  - Background: The COVID-19 pandemic presented a unique challenge to our healthcare system and rapidly changed the delivery of cancer care. During the height of the pandemic in New York State, non-emergent surgery, including cancer surgery, was postponed. For patients with hormone receptor positive breast cancer, “bridge” neoadjuvant hormonal therapy was initiated until surgery could be safely performed. Objective: We present our institutional experience with this approach and lessons learned, including oncologic outcomes and factors which may lead to increased medication compliance. Method: This is a single institution, retrospective, observational chart review. Using data from the NYU Perlmutter Cancer Center, we created a database of patients who were diagnosed with ER+ stage 0, I, or II breast cancer and were offered preoperative endocrine therapy (tamoxifen or aromatase inhibitors) between March 12, 2020 and June 1, 2020. Variables collected included demographics, tumor characteristics, as well as the rates of medication uptake and compliance. Patients eligible for review were adult (age>18) males and females who had initial visits at our two cancer centers between March 12, 2020 and June 1, 2020, during the height of the COVID-19 pandemic in New York. Results: Of 192 newly diagnosed breast cancer patients seen at the NYU Perlmutter Cancer Center during the study time period, 136 (71%) patients had early stage ER positive breast cancer. Forty-five patients (23%) had not yet undergone surgery, and were recommended to receive presurgical hormonal therapy as a bridge. Average age: 60.5 +/- 13.8 years old (range 31-89). Thirty-four patients (75.6%) had invasive cancer, 8 had DCIS (17.8%), 3 had DCIS with microinvasion (6.7%). There were 9 patients (20%) who did not take the medication. Thirty-six patients (80%) took medication for an average of 43.6 +/- 27.3 days (range 9-101 days) prior to surgery. Twenty-eight patients (77.8%) took an aromatase inhibitor, and 8 (22.2%) took tamoxifen. Forty-two patients have now undergone surgery (93.3%) – the remaining patients include one who is refusing all treatment, one patient who relocated out of state, and another patient who has not yet scheduled surgery, but is still taking an aromatase inhibitor. Conclusion: Despite traditionally low uptake and adherence to endocrine therapy, acceptance of neo-adjuvant bridge therapy during the COVID-19 pandemic was high (80%). We plan to investigate our patient population further, especially psychosocial and behavioral factors that influence willingness to take endocrine therapy – and apply these lessons to management of early-stage ER positive breast cancer.
VL  - 6
IS  - 1
ER  -

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Author Information

Joshua Feinberg

Department of Surgery, Breast Surgery Section, NYU Langone Health, New York University, New York City, U.S.A
Cindy Cen

Department of Surgery, Hofstra University, Northwell Health, New Hyde Park, New York, U.S.A
Freya Schnabel

Department of Surgery, Breast Surgery Section, NYU Langone Health, New York University, New York City, U.S.A
Sylvia Adams

Department of Medicine, Division of Medical Oncology, NYU Langone Health, New York University, New York City, U.S.A
Magdalena Plasilova

Department of Surgery, Breast Surgery Section, NYU Langone Health, New York University, New York City, U.S.A
Janet Yeh

Department of Surgery, Breast Surgery Section, NYU Langone Health, New York University, New York City, U.S.A
Marleen Meyers

Department of Medicine, Division of Medical Oncology, NYU Langone Health, New York University, New York City, U.S.A
James Speyer

Department of Medicine, Division of Medical Oncology, NYU Langone Health, New York University, New York City, U.S.A
Elliot Belenkov

Department of Medicine, Division of Medical Oncology, NYU Langone Health, New York University, New York City, U.S.A
Maryann Kwa

Department of Medicine, Division of Medical Oncology, NYU Langone Health, New York University, New York City, U.S.A
Yelena Novik

Department of Medicine, Division of Medical Oncology, NYU Langone Health, New York University, New York City, U.S.A
Elena Katz

Department of Medicine, Division of Medical Oncology, NYU Langone Health, New York University, New York City, U.S.A
Amber Azniv Guth

Department of Surgery, Breast Surgery Section, NYU Langone Health, New York University, New York City, U.S.A

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APA Style

Joshua Feinberg, Cindy Cen, Freya Schnabel, Sylvia Adams, Magdalena Plasilova, et al. (2021). “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions. International Journal of Clinical Oncology and Cancer Research, 6(1), 38-41. https://doi.org/10.11648/j.ijcocr.20210601.16

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ACS Style

Joshua Feinberg; Cindy Cen; Freya Schnabel; Sylvia Adams; Magdalena Plasilova, et al. “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions. Int. J. Clin. Oncol. Cancer Res. 2021, 6(1), 38-41. doi: 10.11648/j.ijcocr.20210601.16

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AMA Style

Joshua Feinberg, Cindy Cen, Freya Schnabel, Sylvia Adams, Magdalena Plasilova, et al. “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions. Int J Clin Oncol Cancer Res. 2021;6(1):38-41. doi: 10.11648/j.ijcocr.20210601.16

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@article{10.11648/j.ijcocr.20210601.16,
  author = {Joshua Feinberg and Cindy Cen and Freya Schnabel and Sylvia Adams and Magdalena Plasilova and Janet Yeh and Marleen Meyers and James Speyer and Elliot Belenkov and Maryann Kwa and Yelena Novik and Elena Katz and Amber Azniv Guth},
  title = {“Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions},
  journal = {International Journal of Clinical Oncology and Cancer Research},
  volume = {6},
  number = {1},
  pages = {38-41},
  doi = {10.11648/j.ijcocr.20210601.16},
  url = {https://doi.org/10.11648/j.ijcocr.20210601.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20210601.16},
  abstract = {Background: The COVID-19 pandemic presented a unique challenge to our healthcare system and rapidly changed the delivery of cancer care. During the height of the pandemic in New York State, non-emergent surgery, including cancer surgery, was postponed. For patients with hormone receptor positive breast cancer, “bridge” neoadjuvant hormonal therapy was initiated until surgery could be safely performed. Objective: We present our institutional experience with this approach and lessons learned, including oncologic outcomes and factors which may lead to increased medication compliance. Method: This is a single institution, retrospective, observational chart review. Using data from the NYU Perlmutter Cancer Center, we created a database of patients who were diagnosed with ER+ stage 0, I, or II breast cancer and were offered preoperative endocrine therapy (tamoxifen or aromatase inhibitors) between March 12, 2020 and June 1, 2020. Variables collected included demographics, tumor characteristics, as well as the rates of medication uptake and compliance. Patients eligible for review were adult (age>18) males and females who had initial visits at our two cancer centers between March 12, 2020 and June 1, 2020, during the height of the COVID-19 pandemic in New York. Results: Of 192 newly diagnosed breast cancer patients seen at the NYU Perlmutter Cancer Center during the study time period, 136 (71%) patients had early stage ER positive breast cancer. Forty-five patients (23%) had not yet undergone surgery, and were recommended to receive presurgical hormonal therapy as a bridge. Average age: 60.5 +/- 13.8 years old (range 31-89). Thirty-four patients (75.6%) had invasive cancer, 8 had DCIS (17.8%), 3 had DCIS with microinvasion (6.7%). There were 9 patients (20%) who did not take the medication. Thirty-six patients (80%) took medication for an average of 43.6 +/- 27.3 days (range 9-101 days) prior to surgery. Twenty-eight patients (77.8%) took an aromatase inhibitor, and 8 (22.2%) took tamoxifen. Forty-two patients have now undergone surgery (93.3%) – the remaining patients include one who is refusing all treatment, one patient who relocated out of state, and another patient who has not yet scheduled surgery, but is still taking an aromatase inhibitor. Conclusion: Despite traditionally low uptake and adherence to endocrine therapy, acceptance of neo-adjuvant bridge therapy during the COVID-19 pandemic was high (80%). We plan to investigate our patient population further, especially psychosocial and behavioral factors that influence willingness to take endocrine therapy – and apply these lessons to management of early-stage ER positive breast cancer.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - “Bridge” Neoadjuvant Endocrine Therapy for Early Stage Breast Cancer Patients During COVID-19 at an Academic Hospital in NYC: Lessons Learned and Future Directions
AU  - Joshua Feinberg
AU  - Cindy Cen
AU  - Freya Schnabel
AU  - Sylvia Adams
AU  - Magdalena Plasilova
AU  - Janet Yeh
AU  - Marleen Meyers
AU  - James Speyer
AU  - Elliot Belenkov
AU  - Maryann Kwa
AU  - Yelena Novik
AU  - Elena Katz
AU  - Amber Azniv Guth
Y1  - 2021/03/04
PY  - 2021
N1  - https://doi.org/10.11648/j.ijcocr.20210601.16
DO  - 10.11648/j.ijcocr.20210601.16
T2  - International Journal of Clinical Oncology and Cancer Research
JF  - International Journal of Clinical Oncology and Cancer Research
JO  - International Journal of Clinical Oncology and Cancer Research
SP  - 38
EP  - 41
PB  - Science Publishing Group
SN  - 2578-9511
UR  - https://doi.org/10.11648/j.ijcocr.20210601.16
AB  - Background: The COVID-19 pandemic presented a unique challenge to our healthcare system and rapidly changed the delivery of cancer care. During the height of the pandemic in New York State, non-emergent surgery, including cancer surgery, was postponed. For patients with hormone receptor positive breast cancer, “bridge” neoadjuvant hormonal therapy was initiated until surgery could be safely performed. Objective: We present our institutional experience with this approach and lessons learned, including oncologic outcomes and factors which may lead to increased medication compliance. Method: This is a single institution, retrospective, observational chart review. Using data from the NYU Perlmutter Cancer Center, we created a database of patients who were diagnosed with ER+ stage 0, I, or II breast cancer and were offered preoperative endocrine therapy (tamoxifen or aromatase inhibitors) between March 12, 2020 and June 1, 2020. Variables collected included demographics, tumor characteristics, as well as the rates of medication uptake and compliance. Patients eligible for review were adult (age>18) males and females who had initial visits at our two cancer centers between March 12, 2020 and June 1, 2020, during the height of the COVID-19 pandemic in New York. Results: Of 192 newly diagnosed breast cancer patients seen at the NYU Perlmutter Cancer Center during the study time period, 136 (71%) patients had early stage ER positive breast cancer. Forty-five patients (23%) had not yet undergone surgery, and were recommended to receive presurgical hormonal therapy as a bridge. Average age: 60.5 +/- 13.8 years old (range 31-89). Thirty-four patients (75.6%) had invasive cancer, 8 had DCIS (17.8%), 3 had DCIS with microinvasion (6.7%). There were 9 patients (20%) who did not take the medication. Thirty-six patients (80%) took medication for an average of 43.6 +/- 27.3 days (range 9-101 days) prior to surgery. Twenty-eight patients (77.8%) took an aromatase inhibitor, and 8 (22.2%) took tamoxifen. Forty-two patients have now undergone surgery (93.3%) – the remaining patients include one who is refusing all treatment, one patient who relocated out of state, and another patient who has not yet scheduled surgery, but is still taking an aromatase inhibitor. Conclusion: Despite traditionally low uptake and adherence to endocrine therapy, acceptance of neo-adjuvant bridge therapy during the COVID-19 pandemic was high (80%). We plan to investigate our patient population further, especially psychosocial and behavioral factors that influence willingness to take endocrine therapy – and apply these lessons to management of early-stage ER positive breast cancer.
VL  - 6
IS  - 1
ER  -

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