Abstract
The rapid progression of the SARS CoV-2 pandemic, a respiratory disease also known as COVID-19, put forth a unique challenge for health care providers of balancing continuous cancer care with prevention of the continued spread of COVID-19 in immunosuppressed breast cancer patients. With these risks, cancer care required modifications as COVID-19 patients began to overwhelm hospitals. The American College Surgeons’ (ACS) COVID Pandemic Breast Cancer Consortium collaborated to form guidelines for interim cancer care therapy, stratifying urgency of care based on severity of diagnosis. NYC Health + Hospitals/Metropolitan (Metropolitan), a hospital located in East Harlem within the Manhattan borough of New York City, was located in the epicenter of the most severe initial outbreak of COVID-19. From March to June 2020, Metropolitan’s Breast Health Center (BHC) suspended cancer services including mammography and other diagnostic testing, chemotherapy treatments, and surgical procedures. Six (6) patients with known breast malignancies were followed closely during this time. The average age of these patients was 64.5 years old (range = 43-76 years), with one case under the age of 50. Two (2) of the patients were triple negative, two were ER/PR positive and HER2 negative, one (1) patient was ER positive and PR/HER2 negative, and one (1) patient was ER/PR positive and FISH negative. In this narrative, we reflect upon Metropolitan’s interim breast cancer care during March to June 2020 and suggest interventions and policies to better equip health systems to provide quality and continuous breast cancer care in future emergency circumstances.
Highlights
The rise of SARS Severe Acute Respiratory Syndrome Coronavirus 2 (CoV-2), a respiratory disease known as COVID-19, presents unique care delivery challenges to cancer patients and their providers
The rapid progression of the SARS CoV-2 pandemic, a respiratory disease known as COVID-19, put forth a unique challenge for health care providers of balancing continuous cancer care with prevention of the continued spread of COVID-19 in immunosuppressed breast cancer patients
The American College Surgeons’ (ACS) COVID Pandemic Breast Cancer Consortium collaborated to form guidelines for interim cancer care therapy, stratifying urgency of care based on severity of diagnosis
Summary
The rise of SARS CoV-2, a respiratory disease known as COVID-19, presents unique care delivery challenges to cancer patients and their providers. As hospitals became overburdened with COVID-19 patients, policies and procedures were created or modified and implemented swiftly (in response to local conditions or due to evolving State or County guidelines) to prevent increased exposure among these patients, interrupting routine cancer screenings and scheduled therapies. 5(2).2020 priority categories based on urgency of medical need: Priority A (life threatening or urgent), Priority B (not urgent but need to start treatment), or Priority C (can be deferred until after pandemic) [4] This is relevant to breast imaging and biopsies, surgeries, radiation, and oncologic therapy. Suspension of routine breast screening is recommended, and imaging is suggested only for those with previous abnormal findings or highly suggestive symptoms These guidelines are dynamic based on local conditions and resource availability. An in-depth analysis of the response of other countries, through national cancer system databases, can provide insights for the establishment of similar government hospitals for continuous cancer care in future emergency circumstances
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