Oncology Group Issues Preliminary COVID-19 Triage Guidelines for Breast Cancer

The American Society of Breast Surgeons (ASBrS), the Breast Center’s National Accreditation Program, the National Comprehensive Care Network, the Cancer Board, and the American College of Radiology are working together to issue preliminary guidelines on how to treat patients. I will. Breast cancer 2019 Coronavirus disease (COVID-19) outbreak.

Of particular note is that, according to the organization, resource availability and risk of exposure should be considered in these treatment decisions.

Affects breast cancer patients who are not infected with the virus. The purpose of triage is to maintain scarce medical resources for patients with COVID-19 while not overriding physician decisions or institutional policies.

“As hospital resources and staff are limited, any breast cancer patient needs urgent care and can be given delayed or alternative treatments without altering survival or risking exposure to the virus.” It is important to define Said Jill R. Dietz, MD, FACS, ASBrS Chairman announce new guidance.

After extensive discussion, the consortium of organizations and their representatives stratified breast cancer patients according to three priorities.

1. Patients with priority A are life threatening and require immediate treatment. These patients have the highest priority status.
2. Priority B patients have serious conditions in which treatment is not urgent but should not be delayed until the end of the pandemic. Most patients with breast cancer fall into this category.
3. The stage of Priority C patients can wait for treatment until the pandemic subsides and the outcome is not adversely affected.

“The decision to make a direct visit must be carefully weighed against the risk of viral transmission to patients and health care providers and the need for individualized assessment,” the guidelines emphasize.

By stratifying patients, the organization was also able to address the following areas:

Outpatient visit. In light of the current pandemic, Telemedicine We have seen a wide range of implementations. Therefore, current face-to-face consultations should be scheduled for clinically unstable postoperative patients, including oncology medical emergencies.

Imaging focused on the breast. Most of the diagnostic imaging included in these guidelines include diagnostic imaging, biopsy By rad Lesions in category 4 or 5 and breast magnetic resonance imaging (MRI) can be postponed without postoperative complications. In addition, it is advisable to push all screening tests (mammography, ultrasound, MRI, etc.) during the post-pandemic period.

Surgical oncology. Use of the operating room should be minimized. In addition, patients with invasive disease may be tentatively given preoperative therapy, so treatment teams may need surgery if the risk may include immunosuppression and especially the likelihood of malignancy. The comorbidity of postponed treatment should be evaluated.

Oncology. Again, the goal is Minimization Unnecessary interaction and maximization of resources. This means saving them only in the most important cases. In some patients, this may require modification of the care plan with regular assessments to follow tumor progression, including the introduction of simplified treatment schedules and dose modification regimens.

Radiation oncology. According to the guidance, most patients referred to radiation therapy will be classified as Priority B, so treatment can be postponed. Other suggestions include a 20-week delay in radiation therapy in patients with early-stage estrogen receptor-positive disease, Low division Regimen if possible.

Supportive care. Home administration is an endocrine treatment option such as a luteinizing hormone-releasing hormone agonist. Explanation of side effects is a priority and granulocyte colony stimulating factor is recommended, especially for neutropenia. Bone modification treatment can be postponed.

“We acknowledge that our experience, which is likely to guide these recommendations, is limited. In addition, these recommendations postpone BC treatment without significantly compromising the long-term outcome of individual BC patients.” Is promoted by the common goal of protecting hospital resources for virus-infected patients: “But as pandemics evolve rapidly, we are learning more and more about viral infections and their effects on health systems.” As such, these recommendations will evolve over time with continuous updates. “

reference

Recommendations for prioritization, treatment and triage of breast cancer patients during COVID-19 pandemic such as Dietz JR, Moran MS, Isakov SJ. American College of Surgeons website. www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx. Published April 13, 2020. Accessed April 14, 2020.

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