ESMO Management and treatment adapted recommendations in the COVID-19 era: Breast Cancer

Abstract

The global preparedness and response to the rapid escalation to severe acute respiratory syndrome coronavirus (SARS-CoV)-2-related disease (COVID-19) to a pandemic proportion has demanded the formulation of a reliable, useful and evidence-based mechanism for health services prioritisation, to achieve the highest quality standards of care to all patients. The prioritisation of high value cancer interventions must be embedded in the agenda for the pandemic response, ensuring that no inconsistency or discrepancy emerge in the health planning processes.The aim of this work is to organise health interventions for breast cancer management and research in a tiered framework (high, medium, low value), formulating a scheme of prioritisation per clinical cogency and intrinsic value or magnitude of benefit. The public health tools and schemes for priority setting in oncology have been used as models, aspiring to capture clinical urgency, value in healthcare, community goals and fairness, while respecting the principles of benevolence, non-maleficence, autonomy and justice.We discuss the priority health interventions across the cancer continuum, giving a perspective on the role and meaning to maintain some services (undeferrable) while temporarily abrogate some others (deferrable). Considerations for implementation and the essential link to pre-existing health services, especially primary healthcare, are addressed, outlining a framework for the development of effective and functional services, such as telemedicine.The discussion covers the theme of health systems strategising, and why oncology care, in particular breast cancer care, should be maintained in parallel to pandemic control measures, providing a pragmatic clinical model within the broader context of public healthcare schemes.

Recommendations for skin cancer consultation and surgery during COVID‐19 pandemic

“…In the last months, proposals for triage in several health conditions have been published especially in oncology including skin cancer. [4][5][6][7][8][9] BADO developed recommendations to prioritize dermato-oncological care on a national level in Belgium. In the circumstances of the COVID19 pandemic, the approval and refunding of tele/videoconsultations by the government was accelerated but for skin cancer treatment and follow-up teleconsultations are often suboptimal.…”

A tripartite approach can seek to optimize breast cancer management during a pandemic – Real‐Time experience of a developing breast oncology unit in Singapore

“…Professional societies have led the unenviable challenge of clarifying recommendations on management prioritization for breast cancer during this COVID‐19 pandemic 1‐6 . Triage recommendations estimate the risk of delay‐related outcome compromise.…”

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

“…4 Undeniably, surgery for breast cancer brings the most significant benefits for patients, especially in the curative setting leading to significant gains in survival. 5 Though the many initial guidelines prohibited performing surgery for breast cancer, it was soon realized that surgery cannot be postponed indefinitely. 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.…”