Rising unemployment, mandatory stay at home orders, and an overburdened health care system is causing a perfect storm for breast cancer patients who have questions or need care. Komen recently hosted a panel discussion on Facebook Live to help answer some of the questions that is causing the most anxiety among the breast cancer community.
The discussion featured three oncologists who serve as Komen Scholars and Scientific Advisors, Drs. Julia White, The Ohio State University Comprehensive Center; Antonio Wolff, John Hopkins Sidney Kimmel Comprehensive Cancer Center and Lisa Newman, Weill Cornell Medicine-New York Presbyterian Hospital Network.
During this time of COVID-19 uncertainty and concern, Komen will continue to bring patients information and tips so that, together, will all get through this.
Below are excepts from the live event on topics that patients were asking about.
Elective surgery – what is it and how does it affect patients?
Dr. Newman: “The general concept of an elective surgery is that we’re referring to a procedure that can be postponed or rescheduled with a reasonable expectation that the postponement will not pose an imminent threat to the life of that patient.
“COVID-19 is obviously an extraordinarily abnormal situation, and we are unable to perform breast surgery for breast cancers in many individual situations. We’re being forced to postpone the surgical management whenever possible so that we can limit patient exposure, and also be cautious about how we utilize our sterile supplies.
“Postponing surgery for breast cancer absolutely does not mean that we’re saying that the cancer is not important and that the surgery is not important. We are simply trying to balance all of the factors in the midst of this public health crisis so that we deliver safe cancer care while still mitigating the risk of the COVID-19 infection and pandemic.”
Is radiation treatment still happening?
Dr. White: Patients who need radiation are still getting radiation. If [able], we can shorten it by using technology that allows us to give certain portions of the radiation simultaneously. [We] can shorten it by a few visits or do a partial breast instead of full breast radiation. So, we’re being very mindful, but we’re making sure the breast cancer treatment is appropriate.
“In general, patients on radiation are not immune compromised. We know that if a patient has had chemotherapy first we will see her white [blood cell] counts come up during her course of radiation. She rebuilds her immune system while she’s in radiation. We say that now to our patients that if you come in for radiation treatment and you have a cough and you otherwise past screening, we will ask you to wear a mask, but you can get your radiation treatments. We will not generally see a shift in your blood count as you’ll continue to repair them.”
Are patients going through chemotherapy at risk of catching COVID-19?
Dr. Wolff: “So I think chemotherapy [patients] is the only one, especially after completing adjuvant chemotherapy patients, that may be at a slightly greater risk [of developing covid-19].
“For patients who recently are receiving adjuvant chemotherapy or recently received chemotherapy, now we’re talking about trying to protect them from others, from other issues, so they need to make sure that they are up-to-date with their vaccines. Hopefully they all are getting their flu shots. Patients may have received their pneumonia vaccines, especially if you’re over the age of 60, and all of those issues can help protect them from producing the risk of being exposed and developing diseases.”
How are doctors balancing treating patients with risk of exposure to COVID-19?
Dr. Wolff: “Everything that we’re doing, we don’t think that we are jeopardizing their chances of success for patients with early stage disease; we’re also not jeopardizing the chances of controlling the disease of patients with advanced breast cancer. So at the end of the day, I really think that this is forcing us to work in even more smart ways than ever before, taking advantage of our multidisciplinary team and simply trying to reduce the need for patients to leave home and come to the clinic, so that they can focus on taking care of themselves, their loved ones, their communities and families.”
Dr. White: “We are really trying to make sure we take care of our active breast cancer patients and our new diagnosis patients in a way that is appropriate for their breast cancer, because this if often still their biggest risk, as opposed to the coronavirus, but at the same time protecting them as much as possible from exposure when they come to see us.”
Are clinical trials still happening?
Dr. White: “There are a couple of clinical trials taking place right now asking important questions in the neoadjuvant setting – it may even allow us to give less treatment, less chemotherapy – and those are the types of studies that I actually expect we will continue to enroll patients in clinical trials… because it gives us the opportunity to give less chemotherapy and that could be for some patients a good thing in terms of lesser impact in their immune system.
“We are really focusing on patients who are metastatic patients – sometimes the standard of care is not their best option – and making sure that we’re continuing clinical trials.
Dr. Newman: “In New York, similarly, in the spirit to minimize those hospital visits, clinic visits and exposures, we have pretty much put on hiatus accrual to trials unless it’s a trial where the patient will have the access to some treatment that is expected to be live-saving or life-altering.”
What is important for patients to know as we make our way through this difficult period of time?
Dr. Wolff: “The most important message to a patient is: Before you start believing everything you read online, do reach out to your physicians, your nurses, practitioners and there are a couple of good resources out there. The American Society of Clinical Oncology at its website cancer.net has a very nice summary with educational material for patients, Komen is putting on their website information as well, and The American Society of Breast Surgery today released some general guidance also related to all the treatments of the patients we’re going through.
“We are oncologists – by definition we are optimists.”
Screening mammography has been delayed for most women, but when would it be essential?
Dr. Newman: “The American College of Radiology has issued guidance to breast images that screening mammography programs should be on hold and patients should postpone their usual screening and imaging evaluations. Diagnostic imaging, especially for lesions that are clinically highly suspicious where the patient has danger signs of breast cancer like suspicious lumps, bloody nipple discharges, those types of diagnostic evaluations and image guided needle biopsies are still occurring.”
**Dr. Newman is member of Komen’s Scientific Advisory Board and a surgical oncologist. She is the Chief of the Division of Breast Surgery and Director of the Interdisciplinary Breast Disease Program for the Weill Cornell Medicine New York Presbyterian Hospital Network.
**Dr. White is a Komen Scholar and radiation oncologist. She is Professor and Vice Chair of Radiation Oncology, Klotz Sisters Chair for Cancer Research, and the Breast Disease Specific Leader at The Ohio State University Comprehensive Cancer Center and The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
**Dr. Wolff is a Komen Scholar and medical oncologist. He is Professor of Oncology at Johns Hopkins University and a member of the Johns Hopkins Kimmel Cancer Center.