Published on August 18, 2020
Is It Safe to Have Breast Cancer Treatment During COVID-19?
The COVID-19 pandemic has disrupted medical care for everything not related to the novel coronavirus, including cancer. Breast cancer patients had treatments and procedures changed, postponed — or canceled altogether, clinical trials halted, and CT scans put on hold.
Even mammograms were suspended.
Now that elective procedures can resume, patients are facing another dilemma: Is it safe?
“There has been fear and anxiety about coming in, undergoing treatment,” said Dr. Shaveta Vinayak, a medical oncologist specializing in breast cancer at Seattle Cancer Care Alliance. “I have had early-stage breast cancer patients wanting to not proceed with chemotherapy or wanting to delay it and that’s really a major point of discussion, balancing the risks and benefits of those delays.”
Breast Cancer Care During COVID-19
On August 4, Dr. Vinayak participated in Patient Power’s Breast Cancer Care During COVID-19 webinar. She was joined by Dr. Catherine Park, a radiation oncologist at UCSF Health; Dr. Freya Schnabel, director of breast cancer surgery at NYU Langone's Perlmutter Cancer Center; and Shonte Drakeford, a nurse practitioner who has stage IV breast cancer.
“COVID has greatly impacted the cancer community,” Dr. Vinayak said, “The way we practice, the way we treat patients and the patients themselves who are already dealing with some difficult decisions regarding treatments. And then throwing the COVID pandemic into the mix has obviously increased significant distress and anxiety.”
People being treated for breast cancer may have a higher risk of severe illness if they get COVID-19, according to breastcancer.org. That’s because treatments, such as chemotherapy, immunotherapy, and targeted therapies, can weaken the immune system. People with a compromised immune system have a much higher risk of complications if infected.
COVID-19 Safety Protocols for Cancer Care
Cancer centers, hospitals and other healthcare settings have implemented safety protocols to protect both patients and staff: asking screening questions, checking temperatures, requiring COVID testing before procedures, limiting the number of care partners who can come to appointments, including infusions, testing employees, and requiring masks and in some cases face shields for workers.
Healthcare providers are also changing the sequence of treatment for patients (i.e. hormone-blocking treatment before surgery) and using telehealth so patients can delay coming into the clinic.
Dr. Park said early on there was a lot of fear and anxiety especially among patients who had to visit the clinic daily for radiation treatments. But she said there is a much better understanding of the virus now — how it is spread and how to reduce the risk — and that the environment is very safe.
“I do try to explain that to patients so that they understand that you don't have to feel so fearful, that we understand the risk and that it's low and here are the ways that we're protecting you and ourselves,” Dr. Park said. “But that being said, I have to say there are a few patients who are so frightened by the prospect of coming in and acquiring something that they really have stayed away and I feel very badly that their oncology care is being compromised in some way.”
Delaying Breast Cancer Treatment Because of COVID-19
Dr. Park said treatments are delayed for those patients who test positive for COVID-19 — not only because of the possibility of spread but also uncertainty over how radiation interacts with the virus. However, there are urgent cases and oncologic emergencies in which someone with COVID-19 cannot wait for treatment. Still, there are protocols set up to protect other patients and staff from being exposed, she said.
In terms of when a breast cancer patient should defer treatment, Dr. Schnabel said that is a complicated question. There are several factors to consider, including the patient’s age, medical history, prognosis, and co-morbidities. The decision is not only patient-specific but also disease-specific.
Someone at high risk of recurrence may be encouraged to start treatment more quickly than someone who has early-stage breast cancer with favorable biological factors and has the luxury of time, Dr. Schnabel said.
At the forefront is what’s going to be the best treatment for the patient, Dr. Vinayak said. That hasn’t changed because of the pandemic.
If You Need Breast Cancer Treatment, Talk to Your Doctor
Dr. Schnabel urged breast cancer patients to not let fear keep them from seeking treatment.
“This has been an unprecedented event in our lifetimes and I would not trivialize or decrease the meaning of this, but I want to remind everybody that this is not 1918,” she said referring to the Spanish Flu pandemic. “This is 2020. We are a lot smarter. We have much better technology and heaven knows we have much better ways of collaborating and sharing information.”
Her message to patients: “Don't give up. Don't feel like you have to stay in your house. We can figure out ways for you to be effectively treated in a safe manner. Contact your doctors. Your treating physicians will work with you on this and we will all get through this together.”
Watch the program to learn more: Is Breast Cancer Treatment Safe During COVID-19?
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