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2020 ; 25
(7
): e1013-e1020
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Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter
of COVID-19 Outbreak
#MMPMID32412693
Viale G
; Licata L
; Sica L
; Zambelli S
; Zucchinelli P
; Rognone A
; Aldrighetti D
; Di Micco R
; Zuber V
; Pasetti M
; Di Muzio N
; Rodighiero M
; Panizza P
; Sassi I
; Petrella G
; Cascinu S
; Gentilini OD
; Bianchini G
Oncologist
2020[Jul]; 25
(7
): e1013-e1020
PMID32412693
show ga
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.
|Adult
[MESH]
|Age Factors
[MESH]
|Aged
[MESH]
|Betacoronavirus/*pathogenicity
[MESH]
|Breast Neoplasms/*therapy
[MESH]
|COVID-19
[MESH]
|Clinical Trials as Topic/organization & administration/standards
[MESH]
|Continuity of Patient Care/organization & administration/standards
[MESH]