Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of COVID-19 Outbreak.
Open accessAbstract
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.
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Personalised risk-benefit analysis for research participation and concurrent risk minimisation is advocated, while still maintaining the trial integrity.
“Personalised risk-benefit analysis for research participation and concurrent risk minimisation is advocated, while still maintaining the trial integrity [24].”
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Cites
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The Role of Telemedicine in Surgical Specialties During the COVID‐19 Pandemic: A Scoping Review
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- Authors
- 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.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- Breast Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy
- Radiotherapy Unit, IRCCS San Raffaele Hospital, Milan, Italy
- Corresponding author
- Bianchini, Giampaolo
- ORCID
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-05-26
- Volume
- 25
- Issue
- 7
- Pages
- e1013-e1020
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- PMC
- PMC7272798
- OpenAlex
- W3025085972
- Cited by
- 35
- References
- 12
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 10 · 2021: 11 · 2020: 8
- FWCI
- 2.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Oncologist (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Funders
- Associazione Italiana per la Ricerca sul Cancro (ID 21787)
- Topics
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Keywords
- breast cancer, COVID-19 pandemic, risk-benefit assessment, precision oncology, infection risk mitigation, triage, psychological distress, Northern Italy
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Age Factors, Aged, Breast Neoplasms, Clinical Trials as Topic, Continuity of Patient Care, Female, Humans, Italy, Medical Oncology, Middle Aged, Pneumonia, Viral, Research Design, Risk Factors, Infection Control, Telemedicine, Coronavirus Infections, Risk Assessment, Pandemics
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