Online March 24, 2020
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Developed by the COVID 19 Pandemic Breast Cancer Consortium (this consortium is made up of representatives from the NAPBC, CoC, ASBrS, and NCCN)
Few COVID 19 patients, hospital resources not exhausted, institution still has ICU vent capacity, and COVID trajectory not in rapid escalation phase
Surgery restricted to patients likely to have survivorship compromised if surgery not performed within next 3 months
Cases that need to be done as soon as feasible (recognizing status of hospital likely to progress over next few weeks):
*In some cases institutions may decide to proceed with surgery versus subjecting a patient to an immunocompromised state with neoadjuvant chemotherapy, these decisions will depend on institutional resources
†Encourage use of breast conserving surgery whenever possible, defer definitive mastectomy and/or reconstruction until after the COVID 19 pandemic resolves provided radiation oncology services are available
†Autologous reconstruction should be deferred
Cases that should be deferred
*These patients can receive hormonal therapy.
†These patients should receive neoadjuvant therapy.
Alternative treatment approaches to be considered (assuming resources permit):
*Many women with early stage, ER positive breast cancers to not benefit substantially from chemotherapy. In general, these include women with stage 1 or limited stage 2 cancers, particularly those with low-intermediate grade tumors, lobular breast cancers, low OncotypeDX scores (<25), or “luminal A” signatures. High-level evidence supports the safety and efficacy of 6 to 12 months of primary endocrine therapy before surgery in such women, which may enable the deferral of surgery.
Many COVID 19 patients, ICU and ventilator capacity limited, OR supplies limited or COVID trajectory within hospital in rapidly escalating phase
Surgery restricted to patients likely to have survivorship compromised if surgery not performed within next few days
Cases that need to be done as soon as feasible (recognizing status of hospital likely to progress over next few days):
*Autologous reconstruction should be deferred
Cases that should be deferred:
Alternative treatment approaches RECOMMENDED (assuming resources permit):
Hospital resources are all routed to COVID 19 patients, no ventilator or ICU capacity, OR supplies exhausted
Surgery restricted to patients likely to have survivorship compromised if surgery not performed within next few hours
Cases that need to be done as soon as feasible (status of hospital likely to progress in hours)
*Autologous reconstruction should be deferred
All other cases deferred
Alternate treatment recommended