The American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Cancer Network® (NCCN®), the Commission on Cancer (CoC) of the American College of Surgeons, and the American College of Radiology (ACR) have released new joint recommendations for the prioritization, treatment, and triage of patients with breast cancer during the COVID-19 pandemic.
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“As hospital resources and staff become limited, it is vital to define which [patients with] breast cancer require urgent care and which can have delayed or alternative treatment without changing survival or risking exposure to the virus,” said Jill R. Dietz, MD, FACS, President of the ASBrS.
“The COVID-19 pandemic presents unprecedented challenges. These guidelines can help modify patient care to minimize exposure risk and preserve resources for patients with the most immediate need for care,” said Lawrence N. Shulman, MD, Chair of the CoC.
Recommendations
The new recommendations categorize patients into priority levels (A, B, and C) for urgency of care across all specialties and provide treatment recommendations for each category.
- 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 for which treatment can be safely deferred until the pandemic is over.
“Implementation of these recommendations, based on the highest level of available evidence, must be adapted to current resource availability and COVID-19 pandemic severity in that region,” said Scott H. Kurtzman, MD, FACS, Chair of the NAPBC.
“The risk of disease progression and worse patient outcomes should be weighed against risk of patient and staff exposure to the virus,” said Debra Monticciolo, MD, FACR, President of the ACR.
“Doctors should use the recommendations to prioritize care for these patients and adapt treatment recommendations to the local context at their hospital,” said William J. Gradishar, MD, Chair of the NCCN Breast Cancer Panel.
The authors concluded the recommendations with, “This information should be used to organize a process of structured decision-making for the care of patients with breast disease during the COVID-19 pandemic. However, as the pandemic rapidly evolves, we are increasingly learning about viral transmission and its impact on the health system, thus, these recommendations will evolve over time with continued updates. This consortium will continue to adapt these recommendations to the current pandemic severity including future waves of the COVID-19 pandemic. It is our hope that these current 16 recommendations will help clinicians provide the highest quality care for their patients during this evolving pandemic.”
