In the setting of diminished and dwindling resources for treatment of breast cancer, and in an effort to protect patients from unnecessary exposure to the SARS Covid-19 coronavirus, the American Society of Breast Surgeons, the National Accreditation Program for Breast Centers (NAPBC), the Commission on Cancer of the American College of Surgeons, and the National Comprehensive Cancer Network (NCCN) urgently collaborated to produce general guidelines and thoughts on the management of patients with breast disease in this difficult period of time.
The consortium released an executive summary to help guide physicians involved in the treatment of breast disease and breast cancer with some of the decisions that they are all facing. Of note, these are general guidelines, and nothing is a substitute for the doctor/patient relationship and assessment of the individual patient risk factors in the local context of each breast center.
Here is the link to the Executive Summary that provides the prioritization and recommendations for breast disease focused outpatient visits, Breast disease focused imaging, breast disease focused surgery, medical oncology recommendations, and radiation therapy recommendations in the context of breast disease.
Executive Summary Priority Classification
The COVID-19 pandemic poses unprecedented challenges for patients, clinicians and health care systems. We assembled representatives from multiple cancer care organizations with expertise in the multidisciplinary management of breast disease to provide preliminary recommendations for the triage and treatment of patients with breast disease amidst the COVID-19 pandemic. These are recommendations, and are not intended to supersede individual physician judgement, nor institutional policy or guidelines. These recommendations should be taken in the context of each institution’s resources and prevalence of the COVID-19 pandemic in their region. The consortium highly recommends multidisciplinary discussion regarding priority for elective surgery and adjuvant treatments for your breast cancer patients. The COVID-19 pandemic may vary in severity over time and these recommendations are subject to change with changing COVID-19 pandemic severity.
Recommendations are broken down into the following priority categories based on patient condition (1):
a) Priority A: patient condition is immediately life threatening, clinically unstable,
b) Priority B: patient situation is noncritical but delay beyond 6-8 weeks could potentially impact overall outcome,
c) Priority C: patient’s condition is stable enough that services can be delayed for the duration of the COVID-19 pandemic.
In order to get the information out as quickly as possible prior to publication, we are releasing this executive summary and providing our emails for urgent questions related to treatment of breast cancer patients during this COVID-19 pandemic.
(1) Ontario Health, Cancer Care Ontario, “Pandemic Planning Clinical Guideline for Patients with Cancer”, https://www.accc-cancer.org/docs/document/cancer-program-fundamentals/oh-cco-pandemic-planning-clinical-guidelines (accessed March 23, 2020).