Case presentation:
A 50-year-old woman was diagnosed with breast cancer with bone metastasis at a medical institution in her home town, Iwaki City, Fukushima Prefecture, Japan in January 2016. In February 2016, she was referred to a university hospital in Tokyo, Japan, which is approximately 200 km apart from Iwaki City. There, she received hormone therapy with exemestane and goserelin, and treatment for bone metastases with denosumab. Because of the worsening local control, the patient received the mastectomy and axilla dissection in June 2019. In April 2020 she had an enhanced computed tomography (CT), and the results revealed no signs of exacerbation. After that, due to the increasing number of COVID-19 cases in Japan, she could not visit the university hospital in Tokyo from Fukushima.
Instead, she began to receive remote video consultations of the university hospital and were prescribed medications regularly. In this period, treatment with denosumab and goserelin was interrupted, and she and the attending doctor had been looking for a medical institution near her home where she could have regular imaging exams, but six months had passed without finding one.
In November 2020, she was firstly referred to our hospital. She had some mild symptoms with Eastern Cooperative Oncology Group Performance Status of 1 just before visiting our hospital. We detected elevated CA15-3 of 87.2 and CEA of 7.6, and subsequent positron emission tomography revealed multiple liver metastases that had not been previously detected by her previous doctor 7 months ago. She soon started chemotherapy at our hospital with paclitaxel and bevacizumab and restarted denosumab, and as of October 2021, her liver metastases have kept shrunk, fortunately.