In the current era of the COVID-19 pandemic, the management of patients with cancer is a huge problem for healthcare systems. However, maintaining the required level of cancer care while taking the essential steps to ensure the safety of patients and healthcare professionals is necessary. To maintain the balance between patient care and safety, some changes in the medical management of patients with cancer, such as surgical approaches, locoregional and systemic therapies, as well as adjustments in treatment and follow-up regimens are required. Furthermore, determining medical care priorities may be necessary when available health services fall short of the number of patients. Patients with cancer are a diverse group with a variety of symptoms, stages at diagnosis, tumor load, and therapy options, all of which come with their own set of side effects and immune suppression. This could put patients with cancer at risk for COVID-19–related problems.1
COVID-19 infection puts patients with cancer at a higher risk for developing severe illness and death. Case fatality rates recorded among patients hospitalized with COVID-19 are higher than those reported among other patients, with 29.4% versus 10.2%, respectively.1 Even after accounting for age, sex, diabetes, smoking, cardiovascular and pulmonary illness, and other major risk factors for COVID-19 severity, large cohort studies consistently show that patients with cancer have a greater risk for all-cause mortality and intensive care unit admission. These findings emphasize the urgent need to reduce the risk for COVID-19 infection in patients with cancer.2
COVID-19 infection is more common in patients with breast cancer for a variety of causes, including myelosuppression caused by chemotherapy used in neoadjuvant, adjuvant, or metastatic situations; cyclin-dependent kinase 4/6 inhibitors; and palliative radiotherapy to the spine or pelvis.1
Myelosuppression may also be caused by metastatic tumor cells infiltrating the bone marrow. The European Society for Medical Oncology, the American College of Surgeons, and the National Comprehensive Cancer Network all issued suggestions and recommendations addressing possible treatment modifications and precautions in the management of patients with cancer in the era of the COVID-19 pandemic. The fundamental focus of the expert-based advice is to reduce the likelihood and/or length of neutropenia, reduce the frequency of hospital visits and stays, and to avoid drugs that may be dangerous during the current COVID-19 epidemic. The European Society for Medical Oncology recommendations, for example, divide the management of patients with breast cancer into low, medium, and high medical care priorities. Similarly, Cancer Care Ontario, Canada, observed differing priorities for medical care of patients with cancer who were treated with a variety of therapeutic modalities such as surgery, radiation, systemic therapy, and palliative care.1
As a result, during the COVID-19 pandemic, the risk–benefit ratio of various treatment options may need to be reviewed to choose the appropriate therapeutic strategy for each patient. Therefore, multidisciplinary tumor board discussions and assessments of available hospital facilities are vital. Furthermore, it is critical to assess how practicing oncologists respond to these therapeutic modification recommendations and whether they are implemented in real life. Results of a recent web-based survey show what doctors treating patients with breast cancer think about probable changes in breast cancer management during the current COVID-19 epidemic.1
References
- Elsamany S, Elbaiomy M, Zeeneldin A, et al. Suggested modifications to the management of patients with breast cancer during the COVID-19 pandemic: web-based survey study. JMIR Cancer. 2021;7:e27073.
- Garrigós L, Saura C, Martinez-Vila C, et al. COVID-19 in breast cancer patients: a subanalysis of the OnCovid registry. Ther Adv Med Oncol. 2021;13:17588359211053416.
