EBCC-12 during COVID-19

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Published: 16 Oct 2020
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Prof Etienne Brain - EORTC Breast cancer group chair

Prof Etienne Brain speaks to ecancer about the EBCC-12 virtual conference this year and why EBCC is important in terms of multi-disciplinary research.

He talks about the challenges to screening and treating breast cancer due to the COVID-19 situation and points out how oncologists across the globe had to be careful in treating these patients; especially the older more frail patients.

He then highlights how cancer research was impacted due to the pandemic in different ways.

Finally, Prof Brain explains some of the stand out sessions from the EBCC-12 conference and points out why people should attend EBCC.

He says EBCC is different from other conferences because it concentrates specifically on breast cancer and the different treatment modalities for this cancer.

He winds it up by sharing his hopes for the future conferences and what improvements can be made.

EBCC really, as many conferences, was a bit challenging this year because of the COVID-19 crisis which we face all everywhere and in different countries and cultures. EBCC was challenging but we’ve done it, it was successful. It is just a bit more difficult technically, given this new way to interact today virtually which makes things a bit different compared with past years.

I would say that it is a very important meeting; to have been able to maintain it was really important because it’s one of the rare meetings which is really multidisciplinary and which gathers people or professionals from very different regions compared with what is often dominated by the presence of medical oncologists leading the discussions. So it’s really a place where you can interact with different categories of professionals in a more multidisciplinary way.

What are the challenges to detecting, treating and managing breast cancer during COVID-19?

We have been sharing many, many information across countries and across teams. It is true that the COVID-19 crisis has triggered many consequences in terms of how we manage breast cancer patients today, more in terms of organisation – how we were forced to consider differently some interventions, some surgery, to postpone a few with no emergency indications and to weight a bit better the benefit-risk ratio of most of our treatment decisions, specifically in terms of the adjuvant context and also in patients with a weaker situation, a weaker setting and especially for the older patients for whom there is always this level of frailty which is difficult to assess and on which we can discuss later.

How has the pandemic impacted research?

It has impacted research, not that we forgot it but we remain completely committed to continuing accruing important programmes and academic questions of key importance. But I must say that, yes, the pace of the enrolment and accrual in most programmes has slowed down due to the COVID-19 crisis. Because of the fear of patients to participate in some programmes with randomisation for which they were not completely sure anymore to receive the standard treatment with an investigational arm sometimes with higher risk or a different safety profile. That makes the patients think about their participation. Then mostly because the sponsors taking the responsibility of the programmes suspended the accrual for a while during the lockdown and for a few months.

All that came back after lockdown was closed but since we are about to face a second wave I must say that the situation makes it still a bit difficult in terms of keeping a regular reason of participation. So this has changed greatly the way we consider the participation, it has not changed our commitment to research, that’s very important to stress.

What are some of the stand out sessions from the meeting?

There has been an update on a few important programmes like MINDACT and the long-term results of this key trial which has approached a de-escalation of the indication for systemic treatments which are more aggressive in terms of side effects and consequences for the population. So that was a very important point. Otherwise there is a mix of different interventions, I’m not going to reduce that because I think it was clearly… the programme was extensive, it was contracted on a few days instead of the usual 3-4 days of meeting.

I have been involved especially on sessions on reporting specific safety profiles of systemic treatments for neglected or, I would say, underserved populations. That’s something which is really dear to me and that I find very clearly in the responsibility and in the commitment of the community within EBCC compared with other big meetings, scientific meetings. I speak about the older population which today represent, let’s say, 40-50% of our new breast cancer patients, are 70 or older than 70. That’s a very common situation that we share with any region of the world. So the fact that we can really highlight the difficulty faced by this population which often receive standard treatments based on extrapolations that we develop for younger ones is really important. To be able to report that this population, which is really a large segment of those patients that we treat, need specific attention, adjustments, taking into account what is frailty, what are the potential interactions that occur so easily with all these new drugs and new treatments.

This is also a question on how you pay attention to the personal expectations by these patients. This population is different and this is going to be the major group of patients that we’ll treat in the next two decades because of the aging, the life expectancy increase and the evolution of society.

Why people should attend EBCC?

I would say that attending EBCC is really a bit different from other large scientific meetings. It’s really professionals dedicated to one tumour type, which is breast cancer, and also gathering really different expertise from the different domains – from surgery to prevention to all the therapeutic interventions that we can consider for these patients. It is so different from other large meetings in the way that people are really completely committed to this population. Of course, we have different models of tumour types and we can do some parallels in larger oncology meetings like ESMO or ASCO, but being at EBCC means that we have really the expertise on all of these domains is very present and we have time to discuss that in depth. So that’s an important point.

The second point I would like to make is that it is a different meeting because of the participation of EUSOMA and EUROPA DONNA as well in terms of quality of the care that we provide in Europe, mostly, but well beyond Europe as well and in terms of the participation of patients and patient advocates. So this presence is really essential to understand better what we have as responsibilities as professionals to serve correctly our patients and to much better between what we drive in our discussions and what patients really expect or want to decide or do accept. This gap of discussion is also present in our practice and to be exposed to these kinds of interactions in a scientific meeting is really important.

My last point would be that I mentioned that it is beyond Europe because the participation of other countries and other parts of the world, from Asia, from the US and from other parts, is really important to be able to share the different experiences based on multifarious factors which include cultural factors or spiritual factors, things that we need also to dig into or to tackle because we have different views. All that is the best way to respect the patients wherever the patient is treated.

What are your hopes for the future of the meeting?

My genuine wish is that EBCC keeps a long life in the future. I must say that the situation of the COVID-19 has created such an unprecedented challenge for all these scientific meetings. I trust that the virtuality that we have introduced to maintain this interaction is important, is difficult, because it is something which is different than we’ve done for a long time. It doesn’t represent the same level of humanity in the interactions that we have face to face.

So I truly hope that this situation will not last too long, it is still to see, and that it will not create consequences financially which would make non-sustainable what we’ve done so far and which counts so much for patients. So the ultimate goal of keeping active and alive this meeting is really to serve the patients and that’s the best way to do it. Unfortunately we do not have other means immediately but virtuality and my true hope is that we meet soon again face to face and not completely digitalised.