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Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak.
Oncologist. 2020 07; 25(7):e1013-e1020.O

Abstract

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.

Authors+Show Affiliations

Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy. Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.Breast Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.Radiotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy.Radiotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy. Vita-Salute S. Raffaele University, Milan, Italy.Breast Imaging Unit, IRCCS San Raffaele Hospital, Milan, Italy.Breast Imaging Unit, IRCCS San Raffaele Hospital, Milan, Italy.Pathology Unit, IRCCS San Raffaele Hospital, Milan, Italy.Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.Breast Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.Breast Cancer Group, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32412693

Citation

Viale, Giulia, et al. "Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak." The Oncologist, vol. 25, no. 7, 2020, pp. e1013-e1020.
Viale G, Licata L, Sica L, et al. Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak. Oncologist. 2020;25(7):e1013-e1020.
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, O. D., & Bianchini, G. (2020). Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak. The Oncologist, 25(7), e1013-e1020. https://doi.org/10.1634/theoncologist.2020-0316
Viale G, et al. Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak. Oncologist. 2020;25(7):e1013-e1020. PubMed PMID: 32412693.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak. AU - Viale,Giulia, AU - Licata,Luca, AU - Sica,Lorenzo, AU - Zambelli,Stefania, AU - Zucchinelli,Patrizia, AU - Rognone,Alessia, AU - Aldrighetti,Daniela, AU - Di Micco,Rosa, AU - Zuber,Veronica, AU - Pasetti,Marcella, AU - Di Muzio,Nadia, AU - Rodighiero,Mariagrazia, AU - Panizza,Pietro, AU - Sassi,Isabella, AU - Petrella,Giovanna, AU - Cascinu,Stefano, AU - Gentilini,Oreste Davide, AU - Bianchini,Giampaolo, Y1 - 2020/05/26/ PY - 2020/04/16/received PY - 2020/05/06/accepted PY - 2020/5/16/pubmed PY - 2020/7/21/medline PY - 2020/5/16/entrez KW - Breast cancer KW - COVID-19 KW - SARS-CoV-2 KW - Treatment SP - e1013 EP - e1020 JF - The oncologist JO - Oncologist VL - 25 IS - 7 N2 - 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. SN - 1549-490X UR - https://www.unboundmedicine.com/medline/citation/32412693/Personalized_Risk_Benefit_Ratio_Adaptation_of_Breast_Cancer_Care_at_the_Epicenter_of_COVID_19_Outbreak_ DB - PRIME DP - Unbound Medicine ER -