Breast Cancer Management During the COVID-19 Pandemic

In a commentary article published in BIO Integration, researchers from Singapore discussed experiences and strategies used by a Singapore breast surgical unit for multidisciplinary breast cancer management during the coronavirus disease 2019 (COVID-19) pandemic.

The first case of COVID-19 in Singapore was reported on January 23, 2020, and by the end of January Singapore had the highest number of reported cases outside China. As a result, the Singapore Ministry of Health (MOH) raised the level of the Disease Outbreak Response System Condition (DORSCON), forcing health care institutions to implement new strategies to try and safely care for patients with cancer amidst the pandemic.

“Despite the COVID-19 pandemic, patients with essential non-COVID conditions still require attention,” the authors wrote. “Hence managing breast cancer patients during the COVID-19 pandemic requires swift and adaptable strategies to cope with the constantly changing demands.”

Early on, routine follow-ups for patients with benign conditions were postponed to a later date and patients with abnormal investigation results or were on follow-up for breast cancer continued to be seen. However, no additional appointments were added unless considered to be urgent, including breast abscess, suspicious mammogram or ultrasound findings of breast imaging-reporting and data system (BIRADS) 4 or 5 categories, suspicious signs and symptoms suggestive of breast cancer, and/or newly diagnosed breast cancer.

As the pandemic continued, a set of essential face-to-face medical services were defined by the MOH, including cancer services. Specifically, all non-essential patient visits to hospitals were to be postponed. Given these new outlines, the commentary authors came up with a list of patients who were not be postponed, including:

• Newly diagnosed patients with breast cancer
• Patients with breast cancer on routine follow-up who were treated within the last 2 years
• Patients without cancer with recent investigations revealing abnormalities
• Patients with recent onset of new symptoms

With regard to other services, such as screening and imaging, screening was deemed a non-essential medical service and suspended. However, those who were recalled for abnormalities previously detected on screening mammogram continued to be evaluated. For those requiring surgery, priority was given to oncological cases or cases that were indeterminate and required diagnostic surgery. Immediate reconstruction options and oncoplastic surgery were also still offered.

Moreover, patients with breast cancer requiring systemic therapy and/or radiation continued to have their treatment. For these patients, the researchers indicated an enhanced effort to ensure social distancing, minimizing immunosuppression and reducing unnecessary visits.

“Multidisciplinary efforts from important stakeholders in breast cancer care, including but not limited to surgeons, radiologists, medical oncologists, radiation oncologists, pathologists, and [breast cancer nurses] cannot be emphasized more and this requires a concerted effort from all to ensure timely delivery of standard of care in the new normal,” the authors noted. “All the measures and prioritization principles adopted by the authors would not have been possible without the cooperation and teamwork from all specialties involved.”

Though some of the restrictions imposed in Singapore have been lifted, the authors highlighted concerns regarding resurgence of community cases. Moving forward, healthcare services, cancer screening, outpatient services and surgery for semi-urgent conditions will be permitted. However, the challenge is now trying to review those whose appointments were postponed and still continue to maintain social distancing measures. Therefore, patients with breast cancer are to be reviewed first, followed by those with image-detected abnormal lesions, patients deemed to be high-risk in need of screening, and finally patients with benign conditions.

“We hope that our experience in adapting to this crisis may assist others in similar circumstances, to prioritize and adapt to the evolving situation, so as to continue to manage essential non-COVID patients,” the authors concluded.

Reference:

Mok CW, Seet YLM, Tan S. Breast Cancer Multidisciplinary Management during COVID-19 Pandemic: Experiences and Strategies Used by a Singapore Breast Surgical Unit. Bio Integration. doi: 10.15212/bioi-2020-0012