Management of Breast Cancer During the COVID-19 Pandemic: A Stage- and Subtype-Specific Approach.
Jennifer Yeong-Shin ShengCesar A Santa-MariaNeha ManginiHaval NormanRima CouziRaquel NunesMary WilkinsonKala VisvanathanRoisin M ConnollyEvanthia T Roussos TorresJohn H FettingDeborah K ArmstrongEvanthia T Roussos TorresLisa JacobsJean L WrightElissa D ThornerChristine HodgdonSamantha HornAntonio C WolffVered StearnsKaren L SmithPublished in: JCO oncology practice (2020)
The COVID-19 pandemic has rapidly changed delivery of cancer care. Many nonurgent surgeries are delayed to preserve hospital resources, and patient visits to health care settings are limited to reduce exposure to SARS-CoV-2. Providers must carefully weigh risks and benefits of delivering immunosuppressive therapy during the pandemic. For breast cancer, a key difference is increased use of neoadjuvant systemic therapy due to deferral of many breast surgeries during the pandemic. In some cases, this necessitates increased use of genomic tumor profiling on core biopsy specimens to guide neoadjuvant therapy decisions. Breast cancer treatment during the pandemic requires multidisciplinary input and varies according to stage, tumor biology, comorbidities, age, patient preferences, and available hospital resources. We present here the Johns Hopkins Women's Malignancies Program approach to breast cancer management during the COVID-19 pandemic. We include algorithms based on tumor biology and extent of disease that guide management decisions during the pandemic. These algorithms emphasize medical oncology treatment decisions and demonstrate how we have operationalized the general treatment recommendations during the pandemic proposed by national groups, such as the COVID-19 Pandemic Breast Cancer Consortium. Our recommendations can be adapted by other institutions and medical oncology practices in accordance with local conditions and resources. Guidelines such as these will be important as we continue to balance treatment of breast cancer against risk of SARS-CoV-2 exposure and infection until approval of a vaccine.
Keyphrases
- sars cov
- healthcare
- coronavirus disease
- respiratory syndrome coronavirus
- machine learning
- palliative care
- lymph node
- rectal cancer
- stem cells
- breast cancer risk
- deep learning
- combination therapy
- type diabetes
- locally advanced
- clinical practice
- gene expression
- single cell
- adipose tissue
- radiation therapy
- dna methylation
- skeletal muscle
- decision making
- cell therapy
- health insurance