Impact of the COVID-19 pandemic on systemic anti-cancer therapy in patients with breast cancer: a systematic review and meta-analysis

Karasneh, D., Patel, M., Hasan, S. S., Conway, B. R., Sadeq, A. A. and Al Deyab, M. A. (2026) Impact of the COVID-19 pandemic on systemic anti-cancer therapy in patients with breast cancer: a systematic review and meta-analysis. Journal of Pharmaceutical Policy and Practice, 19 (1). 2684148. ISSN 2052-3211 doi: 10.1080/20523211.2026.2684148

Abstract/Summary

Background: The COVID-19 pandemic led to major disruptions in oncology services, resulting in delays and alterations in treatment pathways. Breast cancer care, which requires carefully timed and well-organised treatment pathways, was particularly impacted. Understanding how systemic therapies changed during the pandemic is essential for evaluating the quality of care and planning future crisis responses. This review specifically evaluates changes in systemic anti-cancer therapy (SACT), including chemotherapy, endocrine therapy, targeted therapy, and immunotherapy. Secondary outcomes included treatment delays, short-term mortality, and hospital admissions. Methods: We conducted a systematic review and meta-analysis adhering to PRISMA guidelines, and a protocol was registered with PROSPERO (CRD42024542702). We searched PubMed, Scopus, Web of Science, and CINAHL (March 2020–August 2024). Observational studies comparing systemic anti-cancer therapy (SACT) in breast cancer patients before and during the COVID-19 pandemic were also included. Studies comparing adult (≥18 years) breast cancer patients of any stage and sex treated before and during the pandemic were also included. The risk of bias was assessed using Risk of Bias in Non-randomised Studies - of Exposure (ROBINS-E) Version 24. Random-effects meta-analyses generated pooled proportions and odds ratios (ORs) with 95% confidence intervals (CIs). Results: Forty-eight studies were included in the review, and 35 in the meta-analysis. Chemotherapy use increased from 35% pre-pandemic to 42% during the pandemic, mainly driven by a rise in neoadjuvant chemotherapy (18% to 22%), while adjuvant chemotherapy remained stable. Endocrine therapy increased from 35% to 42%, with neoadjuvant endocrine therapy rising from 2% to 10% and adjuvant endocrine therapy declining slightly (46% to 43%). Targeted therapy and immunotherapy showed minimal change. The pooled OR for short-term mortality was 0.81 (95% CI: 0.56–1.15), with wide confidence intervals observed for hospital admissions, reflecting heterogeneity and limited precision. Conclusion: The COVID-19 pandemic led to significant adjustments in the administration of systemic anti-cancer treatment in patients with breast cancer, specifically, the increased use of neoadjuvant endocrine treatment and altered approaches to chemotherapy in an attempt to preserve treatment continuity. Though there were no significant differences in short-term mortality between periods, there is variation across studies that should be interpreted with caution. These findings underscore the importance of robust pharmaceutical policies, effective triage systems, and resilient frameworks for medicine access to ensure continuity of cancer treatment during future health crises.

Item Type	Article
URI	https://centaur.reading.ac.uk/id/eprint/130806
Identification Number/DOI	10.1080/20523211.2026.2684148
Refereed	Yes
Divisions	Life Sciences > School of Chemistry, Food and Pharmacy > School of Pharmacy > Pharmacy Practice Research Group
Publisher	Taylor & Francis
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