TY - JOUR
T1 - Personalized Risk–Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak
AU - Viale, Giulia
AU - Licata, Luca
AU - Sica, Lorenzo
AU - Zambelli, Stefania
AU - Zucchinelli, Patrizia
AU - Rognone, Alessia
AU - Aldrighetti, Daniela
AU - Di Micco, Rosa
AU - Zuber, Veronica
AU - Pasetti, Marcella
AU - Di Muzio, Nadia
AU - Rodighiero, Mariagrazia
AU - Panizza, Pietro
AU - Sassi, Isabella
AU - Petrella, Giovanna
AU - Cascinu, Stefano
AU - Gentilini, Oreste Davide
AU - Bianchini, Giampaolo
N1 - Funding Information:
We thank Dr. Carmen Criscitiello (European Institute of Oncology, Milan) for the useful comments and suggestions. This work was partially supported by the Associazione Italiana per la Ricerca sul Cancro (IG 2018 ID 21787). The funders had no role in the decision to publish or preparation of the manuscript.
Publisher Copyright:
© 2020 The Authors. The Oncologist published by Wiley Periodicals LLC on behalf of AlphaMed Press.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Northern Italy has been one of the European regions reporting the highest number of COVID-19 cases and deaths. The pandemic spread has challenged the National Health System, requiring reallocation of most of the available health care resources to treat COVID-19-positive patients, generating a competition with other health care needs, including cancer. Patients with cancer are at higher risk of developing critical illness after COVID-19 infection. Thus, mitigation strategies should be adopted to reduce the likelihood of infection in all patients with cancer. At the same time, suboptimal care and treatments may result in worse cancer-related outcome. In this article, we attempt to estimate the individual risk–benefit balance to define personalized strategies for optimal breast cancer management, avoiding as much as possible a general untailored approach. We discuss and report the strategies our Breast Unit adopted from the beginning of the COVID-19 outbreak to ensure the continuum of the best possible cancer care for our patients while mitigating the risk of infection, despite limited health care resources. Implications for Practice: Managing patients with breast cancer during the COVID-19 outbreak is challenging. The present work highlights the need to estimate the individual patient risk of infection, which depends on both epidemiological considerations and individual clinical characteristics. The management of patients with breast cancer should be adapted and personalized according to the balance between COVID-19-related risk and the expected benefit of treatments. This work also provides useful suggestions on the modality of patient triage, the conduct of clinical trials, the management of an oncologic team, and the approach to patients’ and health workers’ psychological distress.
AB - Northern Italy has been one of the European regions reporting the highest number of COVID-19 cases and deaths. The pandemic spread has challenged the National Health System, requiring reallocation of most of the available health care resources to treat COVID-19-positive patients, generating a competition with other health care needs, including cancer. Patients with cancer are at higher risk of developing critical illness after COVID-19 infection. Thus, mitigation strategies should be adopted to reduce the likelihood of infection in all patients with cancer. At the same time, suboptimal care and treatments may result in worse cancer-related outcome. In this article, we attempt to estimate the individual risk–benefit balance to define personalized strategies for optimal breast cancer management, avoiding as much as possible a general untailored approach. We discuss and report the strategies our Breast Unit adopted from the beginning of the COVID-19 outbreak to ensure the continuum of the best possible cancer care for our patients while mitigating the risk of infection, despite limited health care resources. Implications for Practice: Managing patients with breast cancer during the COVID-19 outbreak is challenging. The present work highlights the need to estimate the individual patient risk of infection, which depends on both epidemiological considerations and individual clinical characteristics. The management of patients with breast cancer should be adapted and personalized according to the balance between COVID-19-related risk and the expected benefit of treatments. This work also provides useful suggestions on the modality of patient triage, the conduct of clinical trials, the management of an oncologic team, and the approach to patients’ and health workers’ psychological distress.
KW - Breast cancer
KW - COVID-19
KW - SARS-CoV-2
KW - Treatment
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UR - http://www.scopus.com/inward/citedby.url?scp=85085584733&partnerID=8YFLogxK
U2 - 10.1634/theoncologist.2020-0316
DO - 10.1634/theoncologist.2020-0316
M3 - Article
C2 - 32412693
AN - SCOPUS:85085584733
VL - 25
SP - e1013-e1020
JO - Oncologist
JF - Oncologist
SN - 1083-7159
IS - 7
ER -