National Accreditation Program for Breast Centers, Chicago, IL, USA.
American Society of Breast Surgeons, Columbia, MD, USA.
Breast Cancer Res Treat. 2020 Jun;181(3):487-497. doi: 10.1007/s10549-020-05644-z. Epub 2020 Apr 24.
The COVID-19 pandemic presents clinicians a unique set of challenges in managing breast cancer (BC) patients. As hospital resources and staff become more limited during the COVID-19 pandemic, it becomes critically important to define which BC patients require more urgent care and which patients can wait for treatment until the pandemic is over. In this Special Communication, we use expert opinion of representatives from multiple cancer care organizations to categorize BC patients into priority levels (A, B, C) for urgency of care across all specialties. Additionally, we provide treatment recommendations for each of these patient scenarios. Priority A patients have conditions that are immediately life threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country. Additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to SARS CoV-2 (virus associated with the COVID-19 pandemic). Physicians should use these recommendations to prioritize care for their BC patients and adapt treatment recommendations to the local context at their hospital.
COVID-19 大流行给临床医生管理乳腺癌 (BC) 患者带来了一系列独特的挑战。随着 COVID-19 大流行期间医院资源和人员变得更加有限,确定哪些 BC 患者需要更紧急的护理,以及哪些患者可以等到大流行结束后再接受治疗变得至关重要。在本次特别交流中,我们使用来自多个癌症护理组织的代表的专家意见,将 BC 患者分为优先级别 (A、B、C),以确定所有专业的护理紧迫性。此外,我们还为这些患者情况提供了治疗建议。优先 A 患者的病情立即危及生命或有症状,需要紧急治疗。优先 B 患者的病情不需要立即治疗,但应在大流行结束前开始治疗。优先 C 患者的病情可以安全地推迟到大流行结束后。这些患者分诊建议的实施,是基于现有最高水平的证据,必须适应每个地区当前医院资源的可用性和 COVID-19 大流行的严重程度。此外,还需要权衡患者和员工接触 SARS-CoV-2(与 COVID-19 大流行相关的病毒)的风险与疾病进展和患者结局恶化的风险。医生应该使用这些建议为他们的 BC 患者确定护理优先级,并根据他们所在医院的当地情况调整治疗建议。