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Systemic Review: Condition Of Breast Cancer's Patients In Corona

Introduction - Condition Of Breast Cancer Patients In Corona

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“Breast cancer “is referred to as the condition where the breast grows abnormally due to the formation of tumours. These tumours can develop in any part of the breast and these parts are lobules, connective tissues, or ducts. There are various types of “breast cancer “and these include “Invasive ductal carcinoma” and “Invasive lobular carcinoma”. In the first case, the cancer cells first develop in the ducts and after that, they grow outside the duct and then spread to other parts of the tissue. On the other hand, in the case of “Invasive lobular carcinoma”, the cancer cells first develop in the lobules and after that, it spreads to breast tissues. In the UK, the total number of cases of “breast cancer” from 2016 to 2018 was approximately 55920 and approximately 11,547 people died due to “breast cancer”(Cancerresearchuk, 2021). Among all these cases, 23% cases were preventable. Moreover, it has been found that “breast cancer” is considered to be second highest cause of death among females in the UK and males as well, it is quite a significant problem as 95 deaths occurred due to “breast cancer “in 2018 (Cancerresearchuk, 2021). During the “COVID-19”pandemic, a worldwide medical crisis happened and due to a lack of timely treatment, many people died. The primary reason for that condition was that the health systems were overburdened due to excessive loads of critical Covid patients (Zaniboni et al. 2020). In this systematic review, a critical analysis will be done to evaluate the conditions of “breast cancer” patients during “Covid-19”.


Search strategy

In order to find the relevant journals on the condition of “breast cancer” patients during a pandemic, the electronic databases that were considered include “Google Scholar”, “PubMed” and “Proquest”. Emphasis was given to selecting only peer-reviewed journals and for systematic review, the journals that considered only “breast cancer” patients were taken into consideration. The language selected was English and in order to facilitate the searching strategies, key terminologies such as “Novel Coronavirus”, “Covid-19 pandemic”, ““breast cancer” patients”, “Clinical characteristics”, “comorbidities”, “Epidemiology”, and so on were used. Other than that, boolean connectors such as “AND”, “OR” and “NOT” were used to make the searches more relevant to the research topic. Therefore, searching statements for this research were “Condition of “breast cancer” patients during COVID”, ““breast cancer” “AND”“covid-19”, “breast cancer” patients OR effect of “Covid-1”9 on “breast cancer” patients” and so on. In addition, the PRISMA model was used to select the journals following the guidelines of a systematic review.

Inclusion criteria

The studies that conducted primary research such as “case-control studies” or “cross-sectional studies”, “cohort studies”, and “prospective” or “retrospective studies” where the researchers conducted surveys or interviews were considered and excluded in this research. The studies that considered patients of all age groups and sex who had “breast cancer “and might or might not infect with the “SARS-CoV-2” virus were covered in the journals for meta-analysis. Moreover, journals published in the English language and not in any other language were considered as well. In addition, In order to discuss the results, references will also be taken from official government websites in order to make this study valid, reliable, as well as authentic.

Exclusion criteria

The studies where systematic review or meta-analysis, secondary qualitative research etc. were done were excluded from this study. In addition, there were certain research papers, which were duplicated or selected more than once, and they were excluded as well. Certain research papers were not in the English language and so they were excluded as well. Moreover, the research papers that did not consider “breast cancer” and any other type of cancer were excluded from this study. On the other hand, genetically related “SARS-CoV” as well as “MERS-CoV” was excluded also from this systematic review. 


In this study, the mental and physical conditions of “breast cancer” patients during “Covid-19” were considered. In addition, changes in the management, treatment, and surgical procedures during these crises were also considered. In addition, the studies that took interviews or surveys on the “breast cancer” patients who were admitted to the health care institutions due to Covid-19 infections were considered as well for systematic review.

Statistical Analysis

No statistical analysis was directly performed; however, the results that were obtained from the statistical analysis of the researchers were analysed and then evaluated in this study. Most of the research papers considered for critical analysis considered any one type of primary study such as retrospective study, prospective study, cohort study and interviewed for a survey on the cancer patient or surgeons of “breast cancer “were considered for interpretation of the result.

Quality assessment

In order to conduct this systematic review, the quality appraisal given by yolk guidelines has been maintained.

Appropriateness of research design

In order to conduct this systematic review, an observational research design has been selected that helped to gain an in-depth view of the concerned research area. Moreover, directness, as well as compact behaviour, is considered the most helpful and a very essential procedure for meeting all the aims and objectives of the study. According to the guidelines by Yolk, a cohort study emphasizes a particular group of people who have some characteristics in common and that can be anything like age, sex, occupation, socioeconomic status or even a health condition has been done. The cohort group that has been selected for this study had “breast cancer “and some of the other associations with the Covid-19. This “systematic review” will help to identify the effect of “Covid-19” on the people who had been suffering from breast cancer. In order to expand the research largely, the Asian countries as well as European countries and the UK have been considered.

Figure 1: PRISMA Model


In this part, the study from various journals that considered the “breast cancer” patients during the “Covid-19 pandemic” and changes in their strategies of management, care, treatment strategies and even the surgical procedures and their potential effects on the “breast cancer” patients will be considered.

Study characteristics

Study type



Retrospective study


Wei et al. 2021, Filipe et al. 2020, Zhang et al.2020

Cohort Study


Zhao et al. 2019,

Cross-sectional study (Survey and interview)


Chen et al. 2021, Shinan-Altman et al. 2020, Papautsky and Hamlish, 2020, Gasparriet al. 2020, Juanjuanet al. 2020, Rocco et al. 2021,

Table 1: Study characteristics table

Summary of Findings





Limitation (IF any)

Wei et al. 2021

The aim of this research is to evaluate the clinical characteristics of a “breast cancer” patient who had been infected with “Covid-19” infection and to determine the risks associated with “anti-cancer treatment” for these patients

This study has been considered a “multicenter retrospective study" and this retrospective study was conducted in Hubei, China. The researcher's data was from seven hospitals in China and 9559 patients were identified this was done among the 13th to 18th of January of the year 2020.

In order to interpret the result of the study by Wei et al. 2021, the researchers considered Univariate as well as multivariate analyses and the result showed that the chances of getting Severe Covid infections had significantly risen among those patients who received chemotherapy as the treatment of breast cancer. Moreover, those who were 75 years old had severe Covid as well.


Filipe et al. 2020

This study aimed to determine the effect of the Covid-19 pandemic in the Netherlands in the Netherlands on the care after the surgery of breast cancer.

“multicenter retrospective cohort study” has been done where a total of 217 patients who had been suffering from “breast cancer” and underwent the surgical procedures in five hospitals in the Netherland and also aged more than 18 years were part of this “retrospective study”.

According to the result of this study, there was a temporary halt in the breast screening procedures and even in the total number of patients, who underwent the surgical procedures. A noticeable decrease was seen in the T1-2 as well as N0 tumours. However, those who underwent the surgery did not develop any type of postoperative complications and that was the best thing.


Zhang et al. 2020

This research aimed to determine the outcomes as well as clinical characteristics of the “breast cancer” patients during the pandemic

A “retrospective study” was conducted on 35 patients who had been suffering from “breast cancer” and were admitted to the China’s five hospitals in order to receive the treatment

The result showed that there was no noticeable difference in the outcome of the “breast cancer” treatment; however, there was a noticeable change was seen in clinical characteristics.


Zhao et al. 2019

This research aimed to determine the effect of “Covid on breast cancer” treatment and interpret the chances of survival rates in “breast cancer” patients.

A “Multiethnic Cohort study” was conducted where the researchers surveyed 2661, registered in Chicago; however, they only received responses from 1300 patients.

The result showed that the patients felt isolated during the whole pandemic and ? of the patients even experienced some financial challenges also 1/4th of the participants faced problems receiving treatment for their condition.,


Chen et al. 2021

The aim of the study was to determine the prevalence of psychological distress as well as interconnected risk factors among “breast cancer” patients at the time of outbreak of a pandemic.

An online survey conducted on 834 patients from March 14 to March 21, 2020,

Multivariate logistic regression analysis was performed and revealed that 21.6% had depression, 5.5% had anxiety, and 14.7% had insomnia. “breast cancer” treatment was the major reason for such mental distresses.


Shinan-Altman et al. 2020

This research aimed to investigate health-service utilisation factors during the “Covid-19”pandemic among “breast cancer” patients.

An online survey of 151 women who had been suffering from “breast cancer” and A multiple hierarchical regression was done to interpret the result.

Patients faced difficulties to fix their appointments with oncologists as well as other healthcare professionals that delayed their treatment during Covid-19


Papautsky and Hamlish, 2020

The aim was to determine the treatment of “breast cancer” survivors in the US

Snowball sampling technique for conducting surveys on 690 “breast cancer” survivors and used a logistic regression model for result analysis

The result showed that 44% of participants experienced delayed treatment during the crises.


Gasparri et al. 2020

Providing a snapshot of the worldwide management of breast cancer,

Survey where Questionnaires were sent to 377 breast centres from 41 countries 

Results showed modification in the primary “breast cancer” therapy and a 67% increment in the risks of Covid-19 following chemotherapy. Moreover, there was a significant alteration in the protocol of cancer treatments.


Juanjuan et al. 2020

The aim was to determine the psychological state of “breast cancer” patients during “Covid-19” in China

The online survey of 658 patients

Among the participants, 8.9% experienced Severe anxiety, 9.3% patients experienced severe depression, and 20.8% experienced insomnia


Rocco et al. 2021

The aim was to determine the adaptation of surgical procedures for “breast cancer” by the surgeons during the “pandemic”

A virtual meeting to interview 12 surgeons

In most cases, they tried to stick to traditional methods of cancer; however, in deteriorated situations, they were forced to take an alternative strategy.


Table 2: Summary of Findings


From the result, it can be stated that most of the studies showed two important aspects and these are the risks of having complications and having severe Covid-19 in “breast cancer “patients following chemotherapy significantly enhanced. In addition, many of the patients received delays in the treatment and even in the surgery, which significantly caused mental distress among patients. 


The result of this study showed that patients with “breast cancer” had been a major concern during covid-19 as the severity of the complications significantly enhanced during Covid-19. As per the study by Fortin et al. (2022), it has been found that many “breast cancer” survivors experienced a major mental breakdown during the student halt in their treatment. In addition, Smetherman, (2021) showed that during the crises the healthcare professionals were forced to change the surgical as well as screening procedures for “breast cancer” and a similar result was found in the study by Rocco et al (2021) as well. Moreover, Vázquez Rosas et al. (2021), Covid-19 caused the late diagnosis of “breast cancer”, which significantly increases the expenses of the treatment as well, and that caused major psychological distress among patients. As per the findings of Braunstein et al. (2020), there was a significant increment in the risks of Covid-19 following chemotherapy. Kirkegaard et al. (2021) there was a significant alteration in the protocol of cancer treatments and that was quite similar to the findings of Papautsky and Hamlish, (2020). In addition, Grazioli et al. (2020), as many “breast cancer” patients experienced problems in receiving treatment in the hospitals some of the patients even received home-based treatment for cancer as Patients faced difficulties fixing their appointments with oncologists and other healthcare professionals that delayed their treatment during Covid-19. Cim et al. (2022), some patients faced some major financial issues during covid-19 and that caused psychological distress. However, as per the findings of Zaniboni et al. (2020), in not only the treatment of bresat cancer, but also, the patients who have been suffering from other types of cancer as well, faced similar issues in getting timely treatment. Moreover, in that crisis where all the emergency treatment and medical facilities were halted, the doctors (?acko et al. 2020) repeatedly suggested alternative diagnoses and treatment procedures. Breast cancer, is undoubtedly a major issue worldwide and due to Covid-19, the patients did not even get the scope to get themselves checked or even those who had early-stage “breast cancer” could not undergo surgery (Wang et al. 2021). Moreover, there was a significantly higher risk of “Covid-19” when the patient was treated with chemotherapy as the immunity becomes weaker due to this treatment process (Elghazawy et al. 2020). In other cases, patients have shown extreme panic and fear of even going outside the home and getting treatment (Vanni et al. 2020). Therefore, it can be stated that Covid-19 certainly has affected the physical as well as psychological heath of Breast-cancer patients.


It is worth mentioning that several problems had to be faced by the patient in the hospitals during “Covid-19”. Patients suffering from “breast cancer” had to face different health care problems during “Covid-19” as well. There was a significantly higher risks of “Covid-19” when the patient was treated with chemotherapy as the immunity becomes weaker due to this treatment process. However, during “Covid-19”, there was a lack of health care specialists. For this reason, a delay could be seen in the treatment of “breast cancer” patients. This increased their health risk of them. However, some patients suffered from anxiety during that period as the treatment process was delayed. Besides, fear of infection by coronavirus was the most important reason for anxiety. Besides, if the cancer patient is infected with the coronavirus, the treatment process becomes more complex and the chances for survival of the patient decrease accordingly. Hence, from the above discussion, it can be said that “Covid-19” increases the lifetime risk of “breast cancer” patients. A COVID nursing assignment is an academic task that focuses on the COVID-19 pandemic and its impact on nursing practice.



Chen, X., Wang, L., Liu, L., Jiang, M., Wang, W., Zhou, X. and Shao, J., 2021. Factors associated with psychological distress among patients with “breast cancer”during the COVID-19 pandemic: a cross-sectional study in Wuhan, China. Supportive Care in Cancer29(8), pp.4773-4782.

Filipe, M.D., van Deukeren, D., Kip, M., Doeksen, A., Pronk, A., Verheijen, P.M., Heikens, J.T., Witkamp, A.J. and Richir, M.C., 2020. Effect of the COVID-19 pandemic on surgical “breast cancer”care in the Netherlands: a multicenter retrospective cohort study. Clinical breast cancer20(6), pp.454-461.

Gasparri, M.L., Gentilini, O.D., Lueftner, D., Kuehn, T., Kaidar-Person, O. and Poortmans, P., 2020. Changes in “breast cancer”management during the Corona Virus Disease 19 pandemic: an international survey of the European “breast cancer”Research Association of Surgical Trialists (EUBREAST). The Breast52, pp.110-115.

Juanjuan, L., Santa-Maria, C.A., Hongfang, F., Lingcheng, W., Pengcheng, Z., Yuanbing, X., Yuyan, T., Zhongchun, L., Bo, D., Meng, L. and Qingfeng, Y., 2020. Patient-reported outcomes of patients with “breast cancer”during the COVID-19 outbreak in the epicenter of China: a cross-sectional survey study. Clinical Breast Cancer20(5), pp.e651-e662.

Papautsky, E.L. and Hamlish, T., 2020. Patient-reported treatment delays in “breast cancer”care during the COVID-19 pandemic. ”breastcancer”research and treatment184(1), pp.249-254.

Rocco, N., Montagna, G., Di Micco, R., Benson, J., Criscitiello, C., Chen, L., Di Pace, B., EsguevaColmenarejo, A.J., Harder, Y., Karakatsanis, A. and Maglia, A., 2021. The impact of the COVID?19 pandemic on surgical management of breast cancer: global trends and future perspectives. The Oncologist26(1), pp.e66-e77.

Shinan-Altman, S., Levkovich, I. and Tavori, G., 2020. Healthcare utilization among “breast cancer”patients during the COVID-19 outbreak. Palliative & Supportive Care18(4), pp.385-391.

Wei, J., Wu, M., Liu, J., Wang, X., Xia, P., Peng, L., Huang, Y., Liu, C., Xia, Z., Chen, C. and Zhao, Y., 2021. Characteristics and outcomes of COVID-19 infection in 45 patients with breast cancer: a multi-center retrospective study in Hubei, China. The Breast59, pp.102-109.

Zhang, B., Xie, R., Hubert, S.M., Yu, Y., Zhang, Y., Lei, X., Deng, W., Chen, J. and Li, Y., 2020. Characteristics and outcomes of 35 “breast cancer”patients infected with COVID-19. Frontiers in oncology, p.2059.

Zhao, F., Henderson, T.O., Cipriano, T.M., Copley, B.L., Liu, M., Burra, R., Birch, S.H., Olopade, O.I. and Huo, D., 2021. The impact of coronavirus disease 2019 on the quality of life and treatment disruption of patients with “breast cancer”in a multiethnic cohort. Cancer127(21), pp.4072-4080.

Other articles

Braunstein, L.Z., Gillespie, E.F., Hong, L., Xu, A., Bakhoum, S.F., Cuaron, J., Mueller, B., McCormick, B., Cahlon, O., Powell, S. and Khan, A.J., 2020. Breast radiation therapy under COVID-19 pandemic resource constraints—approaches to defer or shorten treatment from a comprehensive cancer center in the United States. Advances in Radiation Oncology, 5(4), pp.582-588.

Cim, E.F.A., Torlak, E., Unveren, G., Soybir, G.R., Ozmen, V., Iyigun, Z.E., Tapan, T.K., Yesilova, A., Alco, G., Yilmaz, E. and Eyrenci, A., 2022. Effect of Fear of Covid-19 Infection on Functionality in “breast cancer”Patients in the Pandemic. Iranian Red Crescent Medical Journal, 24(2).

Elghazawy, H., Bakkach, J., Zaghloul, M.S., Abusanad, A., Hussein, M.M., Alorabi, M., Eldin, N.B., Helal, T., Zaghloul, T.M., Venkatesulu, B.P. and Elghazaly, H., 2020. Implementation of “breast cancer”continuum of care in low-and middle-income countries during the COVID-19 pandemic. Future Oncology, 16(31), pp.2551-2567.

Fortin, J., Rivest-Beauregard, M., Defer, C., Leblanc, M., Thamar Louis, L.A., Roy, C.A., Lapierre, I., Brunet, A., Montreuil, M. and Marin, M.F., 2022. The Impact of Canadian Medical Delays and Preventive Measures on “breast cancer”Experience: A Silent Battle Masked by the COVID-19 Pandemic. Canadian Journal of Nursing Research, p.08445621221097520.

Grazioli, E., Cerulli, C., Dimauro, I., Moretti, E., Murri, A. and Parisi, A., 2020. New strategy of home-based exercise during pandemic COVID-19 in “breast cancer”patients: A case study. Sustainability, 12(17), p.6940.

Kirkegaard, P., Edwards, A. and Andersen, B., 2021. Balancing risks: qualitative study of attitudes, motivations and intentions about attending for mammography during the COVID-19 pandemic. Scandinavian Journal of Public Health, 49(7), pp.700-706.

?acko, A., Maciejczyk, A., Kasprzak, P., Dupla, D., Senkus, E., Wysocki, W., Nowecki, Z.I. and Matkowski, R., 2020. Proposals for the modification of diagnostics and combination treatment of “breast cancer”during the COVID-19 pandemic. Nowotwory. Journal of Oncology, 70(3), pp.77-84.

Merz, V., Ferro, A., Piras, E.M., Zanutto, A., Caffo, O. and Messina, C., 2021. Electronic Medical Record–Assisted Telephone Follow-Up of “breast cancer”Survivors During the COVID-19 Pandemic: A Single Institution Experience. JCO Oncology Practice, 17(1), pp.e44-e52.

Sezer, A., Cicin, ?., Çakmak, G.K., Gürdal, S.Ö., Ba?aran, G., Oyan, B., Eralp, Y., Güllüo?lu, B.M., Task, T.N.B.O.S. and for COVID, F., 2020. Turkish national consensus on “breast cancer”management during temporary state of emergency due to COVID-19 outbreak. Turkish journal of surgery, 36(2), p.147.

Smetherman, D.H., 2021. “breast cancer”screening and the COVID-19 pandemic. Journal of Breast Imaging, 3(1), pp.3-11.

Vanni, G., Materazzo, M., Pellicciaro, M., Ingallinella, S., Rho, M., Santori, F., Cotesta, M., Caspi, J., Makarova, A., Pistolese, C.A. and Buonomo, O.C., 2020. “breast cancer”and COVID-19: the effect of fear on patients' decision-making process. in vivo, 34(3 suppl), pp.1651-1659.

Vázquez Rosas, T., Cazap, E., Delgado, L., Ismael, J., Bejarano, S., Castro, C., Castro, H., Müller, B., Gutiérrez-Delgado, F., Santini, L.A. and VallejosSologuren, C., 2021. Social distancing and economic crisis during COVID-19 pandemic reduced cancer control in Latin America and will result in increased late-stage diagnoses and expense. JCO Global Oncology, 7, pp.694-703.

Wang, W., Guo, B., Cui, C., Sun, T. and Liu, S., 2021. Management of early-stage “breast cancer”patients during the coronavirus disease 2019 (COVID-19) pandemic: The experience in China from a surgical standpoint. Journal of Cancer, 12(8), p.2190.

Zaniboni, A., Ghidini, M., Grossi, F., Indini, A., Trevisan, F., Iaculli, A., Dottorini, L., Moleri, G., Russo, A., Vavassori, I. and Brevi, A., 2020. A review of clinical practice guidelines and treatment recommendations for cancer care in the COVID-19 pandemic. Cancers, 12(9), p.2452.