Open AccessPersonalized Risk–Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID ‐19 Outbreak
Author(s) -
Viale Giulia,
Licata Luca,
Sica Lorenzo,
Zambelli Stefania,
Zucchinelli Patrizia,
Rog Alessia,
Aldrighetti Daniela,
Di Micco Rosa,
Zuber Veronica,
Pasetti Marcella,
Di Muzio Nadia,
Rodighiero Mariagrazia,
Panizza Pietro,
Sassi Isabella,
Petrella Giovanna,
Cascinu Stefano,
Gentilini Oreste Davide,
Bianchini Giampaolo
Publication year - 2020
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2020-0316
Subject(s) - medicine , breast cancer , triage , health care , epidemiology , intensive care medicine , outbreak , risk assessment , pandemic , risk of infection , cancer , family medicine , medical emergency , disease , covid-19 , infectious disease (medical specialty) , pathology , computer security , biology , computer science , economics , genetics , economic growth
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.