Breast cancer treatment during the coronavirus outbreak
With the attention of people around the world on the threat of COVID-19, the disease caused by the new coronavirus, it can be hard to understand where your breast cancer treatment fits in. COVID-19 presents a threat to people’s lives, but so does breast cancer. If you are diagnosed or getting treatment, how do you balance the known threat of breast cancer against the potential threat of developing COVID-19?
We’re here to connect you with trusted information. Hospitals, treatment centers, healthcare providers, and medical organizations around the country are working to develop plans to make sure you get the best, evidence-based care during this time.
Care continues during the COVID-19 outbreak
Most people already being treated for early-stage breast cancer will continue their treatment as planned, says Julie Gralow, MD, Professor of Breast Medical Oncology at University of Washington School of Medicine and director of breast medical oncology at the Seattle Cancer Care Alliance.
The American Society of Clinical Oncology says there is no evidence to support stopping or changing chemotherapy, and it does not recommend changing treatment during the outbreak. Chemotherapy and certain targeted therapies can affect the immune system, but interrupting treatment can lower its effectiveness against breast cancer returning. Hormonal therapies, tamoxifen, and aromatase inhibitors do not affect the immune system, and people should feel comfortable continuing on those treatments, Dr. Gralow says.
For people who have just been diagnosed, Dr. Gralow says doctors are giving chemotherapy or hormonal therapy before surgery when it’s appropriate for the diagnosis. When surgeries are performed it’s only surgery to remove the cancer, with no reconstruction or preventive mastectomies. This is to protect patients by having fewer brought into the hospital for surgery and fewer admitted overnight where they risk being exposed to the coronavirus, and it saves protective equipment for hospitals need as COVID-19 cases come in.
The ultimate decision of what is right for your situation remains between you and your doctor. The coronavirus outbreak is hitting different regions at different rates, and what is true in your area may not be so in other areas. Work together with your doctors to make decisions that best protect you while making sure you get the treatment you need.
Health care, especially oncology care, continues even during a pandemic.
Protecting you during treatment
The main way to avoid spreading the coronavirus is to keep people from being exposed. This is why businesses across the country have been ordered closed and you have been told to avoid contact with people outside your home. You must go to a treatment center for chemotherapy, radiation therapy, some tests, and some other treatments, but healthcare providers are trying to limit other visits. Checkups, physical exams, and other visits may be cancelled or held over a video or phone call, or what your providers may call telemedicine.
“We're really fortunate that there are several platforms that allow us to keep connected with our patients and offer them support and advice during this extremely challenging time," says Dr. Mahtani, who is associate professor of medicine at Sylvester Cancer Center, University of Miami.
She encourages patients to use video conferences with their doctors. In her experience, these calls can resolve many concerns and questions as well as ease people’s minds of anxiety.
Many healthcare facilities are postponing elective procedures during the outbreak to limit interactions and save resources for COVID-19 care. Some common procedures being delayed are certain types of reconstructive surgeries, screening mammograms, and preventive mastectomies.
For appointments you must attend in-person, such as treatments or blood tests, providers want to keep people who may be infected from coming into the area where those with cancer go for treatment. Every center has its own policies for screening people coming in. They may ask if you have symptoms of COVID-19 before coming in or examine you for symptoms at the door. Those showing symptoms may be referred for a COVID-19 test in a separate area of the hospital.
They may also limit the number of guests allowed with you for appointments. Dr. Gralow says her center allows just one guest for many appointments and no guests for chemotherapy infusions, where people most at risk are gathered.
Whatever the procedures at your cancer center, be sure to follow steps to protect yourself from the coronavirus at home and at the cancer center.
If you are screened out of treatment, you may have to miss your treatment session until you know your COVID-19 test is negative and it is safe for you to return. People who test negative can follow the policy for other infections, such as the flu, which often allow treatment after symptoms end. People who test positive will wait the two weeks in self-quarantine before returning to treatment.
COVID-19 and metastatic breast cancer
People with metastatic breast cancer are under continuous treatment and may make treatment choices that weigh the risk of encountering this coronavirus. Dr. Gralow says ASCO has allowed for people who have had no evidence of disease (NED) for an extended period to discuss a break from treatment. Treatment breaks are commonly used for special events and for relief from side effects, and for some people it can mean staying away from treatment centers during the outbreak. Others may be eligible to move to a chemotherapy that comes as a pill, such as capecitabine (Xeloda).
Keeping up on new developments
Dr. Mahtani says new guidance is being released, sometimes daily, as experts learn more about COVID-19, as discussions continue with doctors who provide treatment, and as the situation changes around the country.
“Everything in medicine, every decision we make, is about balancing risk and benefit,” Dr. Mahtani says, “The coronavirus outbreak has complicated these discussions by introducing a new risk into decision making.” She says it’s important to stay connected to your doctors and to take advantage of things like video calls to have appointments and get answers to your questions.
The other thing to remember is to protect yourself at the treatment center and at home. Wash your hands, stay home, cover coughs and sneezes, and avoid touching your face.
Dr. Gralow stresses that as of April 2020 there are no known treatments to prevent getting COVID-19 but that you can support your immune system by getting sleep, reducing stress, exercising, and eating well. And while you should not have people visit you in person, you can and should connect with loved ones with video calls and other technology that allows you to stay in touch through this outbreak.