Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak
Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak
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DOI：
10.1634/theoncologist.2020-0316
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发表时间：
2020-05-26
期刊：
影响因子：
5.8
通讯作者：
Bianchini, Giampaolo
中科院分区：
文献类型：
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作者：
Viale, Giulia;Licata, Luca;Bianchini, Giampaolo
意大利北部是报告 COVID-19 病例和死亡人数最多的欧洲地区之一。大流行的蔓延给国家卫生系统带来了挑战，需要重新分配大部分可用的医疗保健资源来治疗 COVID-19 阳性患者，从而与包括癌症在内的其他医疗保健需求产生竞争。癌症患者感染 COVID-19 后患危重疾病的风险更高。因此，应采取缓解策略来降低所有癌症患者感染的可能性。与此同时，次优的护理和治疗可能会导致更糟糕的癌症相关结果。在本文中，我们尝试估计个体风险收益平衡，以确定最佳乳腺癌管理的个性化策略，尽可能避免通用的未经定制的方法。我们讨论并报告了我们的乳腺科从 COVID-19 爆发之初就采取的策略，以确保在医疗保健资源有限的情况下，为我们的患者持续提供最佳的癌症护理，同时降低感染风险。对实践的启示 在 COVID-19 爆发期间管理乳腺癌患者具有挑战性。目前的工作强调需要估计个体患者的感染风险，这取决于流行病学考虑和个体临床特征。应根据 COVID-19 相关风险与治疗预期获益之间的平衡，对乳腺癌患者的管理进行调整和个性化。这项工作还为患者分诊方式、临床试验的进行、肿瘤团队的管理以及患者和卫生工作者心理困扰的处理方法提供了有用的建议。
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.