Recommendations and resources for those diagnosed with breast cancer amid a health pandemic. 

There's a lot we still do not  know about the novel coronavirus that's shutting down the world. But we do know that the sick, the elderly and the immune-compromised are particularly at risk.  We do not want to diminish the gravity of this pandemic, but I feel reassured that our breast cancer community is well prepared. We have experience managing a compromised immune system while undergoing treatment. We know how to remain isolated at home, limit contact, and avoid crowds. 

While there is an increased risk, there are a lot of precautions we can take. The information below is a synthesis to answer questions and provide you with information and resources. 

What is social distancing and why is it important?

Social distancing refers to actions taken to stop or slow down the spread of a contagious disease. For an individual, it refers to maintaining enough distance (recommended 6 feet or more) between yourself and another person to avoid getting infected or infecting someone else.  The COVID-19 virus primarily spreads when one person breathes in droplets that are produced when an infected person coughs or sneezes. In addition, any infected person, with or without symptoms, could spread the virus by touching a surface. Typically a person can carry the virus for up to 14 days without showing any signs of symptoms.  Because the coronavirus could remain on that surface and someone else could touch it and then touch their mouth, nose or eyes it is recommended that people clean surfaces regularly and wash their hands for a minimum of 20 seconds using warm water and soap.  

Adapting to social distancing. Social distancing certainly has an impact on our day to day living. Schools are closed/closing and people have been encouraged to work from home. Furthermore, restaurants and bars have completely closed in some areas. So how can we adapt? 

If you need to get food, staples, medications or healthcare, try to stay at least six feet away from others, and wash your hands thoroughly after the trip, avoiding contact with your face and mouth throughout.

  • Prepare your own food rather than going to a restaurant or even getting takeout.

  • It's best to avoid the gym.  Instead try at home workouts that you can stream from your computer or smartphone. 

  • While challenging for our children, avoid play dates, parties, sleepovers, having friends or family over for meals or visits, and going to coffee shops — basically any nonessential activity that involves close contact with others.

  • Wash your hands often.

  • Use warm water and soap or hand sanitizer with at least 60% alcohol if soap and water are not available. 

  • Avoid touching your eyes, nose and mouth. 

  • The virus spreads mainly from person to person. Be sure to cover your mouth and nose if you cough or sneeze. 

  • Maintain at least 6 feet distance between yourself and others. 

  • Clean and disinfect surfaces regularly. This includes tables, doorknobs, light switches, phones, computers, tablets etc. 

Understanding Symptoms

According to the CDC, confirmed coronavirus disease 2019 (COVID-19) cases have ranged from mild symptoms to severe illness and potentially death. 

The following symptoms may appear 2-14 days after exposure.

  • Fever

  • Cough

  • Shortness of breath

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

  • Difficulty breathing or shortness of breath

  • Persistent pain or pressure in the chest

  • New confusion or inability to arouse

  • Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

Managing Stress and Anxiety

Remember to allow yourself space and be gentle with yourself during this time.  If the weather is nice, it's ok to get some fresh air and take a walk (remembering to keep at least 6 ft of distance between yourself and others and wear a facial covering). Enjoy the sunny days.  This is also a great time to learn a new skill. There are a variety of free online courses you can take via EdX or teach yourself to knit. Take this time to call old friends and catch up with family by phone. 

We will be offering weekly meetups online so we can all stay connected and support each other through this time. 

On Thursdays Thrivers Meet Up

7:00 p.m. ET

Masks vs. Respirators

The CDC and NIOSH have published a helpful handout to inform the public on the critical differences between masks and respirators.

Guidelines and Resources

 

Please note that this information is not meant to substitute professional medical advice nor supersede individual physician judgement, institutional policy or guidelines

 

The American College of Surgeons suggest recommendations as follows based on priority categories:

  • Priority A: Patient condition is immediately life threatening, clinically unstable.

  • Priority B: Patient situation is noncritical but delay beyond 6–8 weeks could potentially impact overall outcome.

  • Priority C: Patient’s condition is stable enough that services can be delayed for the duration of the COVID-19 pandemic.

 

The Society of Surgical Oncology has provided these guidelines specific to breast cancer. What I find fascinating about the guidelines and the disruption to the typical sequence of treatment is that endocrine therapy is now being offered in a neoadjuvant setting. That is to say, if your tumor is estrogen driven, you may be asked to take Tamoxifen or an Aromatase Inhibitor in advance of your surgery. This is to protect you from needing to come to the hospital; yes, it will delay surgery, but given the situation, would you really want to expose yourself to COVID-19 when endocrine therapy could be a benefit? What excites me about this opportunity is that I am hopeful studies will emerge to investigate the effectiveness of endocrine therapy vs chemotherapy in the adjuvant setting and could potentially decrease the need for chemo for those diagnosed with breast cancer. (Of course, may other factors would need to be considered, but still a win in my book!) According to the American College of Surgeons, there are of course situations that need immediate attention:

  • Neoadjuvant patients finishing treatment

  • Clinical Stage T2 or N1 ERpos/PRpos/HER2 negative tumors*†

  • Triple negative or HER2 positive patients*†

  • Discordant biopsies likely to be malignant

  • Excision of malignant recurrence

*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.

 

According to ASTRO, "patients with rapidly progressing, potentially curable tumors may outweigh the risks of COVID-19 exposure/infection, but patients receiving radiation for symptom control or at low risk of harm due to alteration of schedule for radiation treatment visits could potentially be safely delayed. 

 

Patients should check with their radiation oncologist to determine the most appropriate course of action for their treatment."

Please note that this information is not meant to substitute professional medical advice nor supersede individual physician judgement, institutional policy or guidelines

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