A practical approach to the management of breast cancer in the COVID-19 era and beyond

Abstract

The COVID-19 pandemic has resulted in a major shift in how breast services are being utilised and managed. The guidelines relating to this have been published by recognised medical associations from the UK, Europe and the USA, addressing many aspects of breast cancer care. There is an awareness that there may be limitations in resources during this time, and therefore, prioritisation strategies have been identified to ensure that breast cancer patients are appropriately treated, whilst reducing the risk of infection from COVID-19 to both patients and staff. Equally important is the consideration of how breast cancer services can be safely reintroduced, as infection rates from COVID-19 decline. However, until there is a definite management strategy for COVID-19, such as a vaccine being developed, it is likely that there will still be a significant impact from COVID-19 on breast cancer care. This paper, therefore, aims to highlight the current guidance and evidence regarding breast cancer management in the era of COVID-19, and also aims to look at future management strategies in this period of uncertainty.

Patient Perception of Telehealth Services for Breast and Gynecologic Oncology Care during the COVID-19 Pandemic: A Single Center Survey-based Study

“…Recommendations for breast cancer management during the COVID-19 pandemic published by established medical associations from the United States, United Kingdom and Europe included minimizing in-person appointments to prevent the spread of COVID-19 [ 8 ]. Although the current guidelines from the American Society of Clinical Oncology provide that telemedicine should be utilized to expand service capabilities, telemedicine has, historically, rarely been utilized in providing oncologic care [ 9 ].…”

Cancer surgery in the era of COVID‐19 pandemic: Changing dynamics

“…6 Patients with breast cancer who have completed neoadjuvant chemotherapy or have salvageable progression on chemotherapy or patients with malignant breast sarcomas cannot be denied surgery for long as we grdually learn to coexist with COVID-19. 7,8 With the COVID-19 pandemic still on run, many modifications are being made in the patient management strategies in the hospital so as to minimize the effect of COVID-19 on the perioperative outcomes. Table 1…”

Wie sollte eine Strahlentherapie des Mammakarzinoms in den gegenwärtigen Zeiten der Pandemie verändert werden?

“…Einheitlich empfehlen alle Arbeiten eine umfassende Aufklärung, falls aufgrund der Coronakrise vom normalen Standardvorgehen abgewichen wird, insbesondere von der aktuellen Leitlinie des Mammakarzinoms [5]. Dies ist dann auch umfassend zu dokumentieren.…”

“…Dieser Empfehlung folgen auch andere Autoren, inklusive der erwähnten Leitlinie. Im Gegensatz zu Simcock erwähnen sie aber das Fehlen von 5-Jahres-Ergebnissen zur lokalen Kontrolle für das FAST-Forward-Protokoll [3,5].…”

“…Auch beim Verzicht auf eine Strahlentherapie bei älteren Patientinnen mit prognostisch günstigem Brustkrebs sind die Autoren mit einer Altersschwelle von 70 Jahren eher vorsichtig. Luther et al plädieren dagegen für einen Verzicht auf eine Strahlentherapie bei diesen Patientinnen mit einem Alter über 65 Jahre [5]. Als Beleg führen sie den PRIME 2 Trial an, der keinen Vorteil durch die Strahlentherapie im 5-Jahres-Überleben erbrachte.…”