Impact of the COVID-19 Pandemic on Breast Cancer Care in Romania: A Cohort Analysis from the Oncological Institute of Bucharest

Background: The 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. Methods: We conducted a retrospective cohort study of breast cancer patients treated at the Oncological Institute of Bucharest, comparing a pandemic cohort (n = 73) with a post-pandemic cohort (n = 99) regarding age at diagnose, tumor laterality, tumor location, tumor stage, and time intervals across the diagnostic and treatment pathways. We measured the intervals between: GP referral and the patien’s first presentation to the surgery unit; imaging diagnosis; the date of biopsy or surgery, biopsy result, and initiation of neoadjuvant treatement; the end of neoadjuvant treatement and surgery; surgery and adjuvant treatment; and the interval of time between chemotherapy sessions. Results: 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 stages, 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. Conclusions: During the COVID-19 pandemic, breast cancer care at a major oncology Romanian center was preserved through adapted clinical pathways. We also established that delays in surgical treatment happened in the post-pandemic period and a higher percentage of advanced-stage disease cases were diagnosed. Our findings may suggest that pre-hospital delays and residual system constraints contributed to stage migration in the post-pandemic group rather than deficiencies in oncology care.