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Is Breast Cancer Treatment Safe During COVID-19?

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Published on August 17, 2020

What's My Risk of COVID-19 Exposure When I Have Breast Cancer Treatments?

Patient Power host, Megan-Claire Chase brings together Shonte Drakeford, patient advocate and a representative from the Tigerlily Foundation, and experts Dr. Shaveta Vinayak, Seattle Cancer Care Alliance, Dr. Catherine Park, UCSF Helen Diller Family Comprehensive Cancer Center, and Dr. Freya Schnabel, NYU Lagone Health to discuss breast cancer treatment during the very early days of the COVID-19 pandemic and to discuss the precautions taken to ensure that patients are able to safely continue breast cancer treatment.

This is Part 1 from our Breast Cancer Answers Now Live Program. Watch the other parts below:

This program is supported by an educational grant from Daiichi Sankyo. This organization has no editorial control. It is produced by Patient Power and Patient Power is solely responsible for program content.

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Transcript | Is Breast Cancer Treatment Safe During COVID-19?

Megan-Claire Chase:
Hi, I am Megan-Claire Chase, and I'm a breast cancer survivor and advocate. Welcome to our breast cancer Answers Now program. Today, we are talking about breast cancer care during the COVID-19 pandemic. Just because there's a pandemic, breast cancer diagnosis and treatment doesn't stop.

Let me introduce you to our distinguished panel. Dr. Shaveta Vinayak, breast cancer oncologist from Seattle Cancer Care Alliance, Dr. Catherine Park, radiation oncologist from UC San Francisco, Dr. Freya Schnabel, Director of Breast Cancer Surgery from NYU Langone Perlmutter Cancer Center. And then we have Shonte’ Drakeford, metastatic breast cancer patient and a nurse practitioner from Washington, D.C., and an advocate from the Tigerlily Foundation.

So, Dr. Vinayak, let's start with you. This is a two-part question. How is COVID affecting the breast cancer community, and what's going on with your patients and COVID? And Shonte’ feel free to chime in with your own questions or ones from your community.

The breast cancer community and how COVID-19 is affecting treatment.

Dr. Vinayak:
COVID has greatly impacted the cancer community, 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-19 pandemic into the mix has obviously increased significant distress and anxiety, which is understandable. So, the way we are helping patients is lots of institutions, major cancer centers around the country. Came up with certain guidelines sort of during the peak of the pandemic to try to figure out if there's a better sequence of treatments we can use to keep patients out of the hospital, outside of the infusion.

And of course, keeping in mind that we're not impacting their long-term outcomes from the cancer itself. That's kind of like the general way that we adapted; screening patients as they're coming in, limiting the number of caregivers who are coming to the appointments into the infusions, and then just thinking about the best way to sequence treatments. For example, if patients were newly diagnosed and they needed to get surgery first, we thought about doing chemotherapy or hormone-blocking treatment upfront, if that was appropriate for patient care. So, those were some of the ways that we adapted.

Megan-Claire Chase:
And Shonte’?

Shonte’ Drakeford:
Yes. So, I noticed there was a delay, me myself, I never was staged for metastatic breast cancer. So, treatment for me is ongoing, and there are some things that have changed with myself, especially with fear. Have any of you guys noticed that it's been an increase of fear as far as getting screened, coming in for treatment? Has there been a big delay with that due to the fear factor?

Any delays for breast cancer treatment due to COVID-19?

Dr. Park:
Maybe comment a little bit here too. I think it's remarkable that, as Dr. Vinayak said, early on, we came up with some best practices. So, a lot of us are actually using the same approaches and strategies that she mentioned such as giving chemo first if surgery… the doors are closed for a while early on when we were anticipating a big surge. And so the elective surgeries were put off. And so there are those kinds of things that were really out of our hands. But just to speak more to the fear especially in radiation oncology, where sometimes you have to visit the clinic every day to get your radiation treatment. And we found there was early on, especially when we didn't know as much and didn't have as much experience the anxiety levels were very, very high.

We did not have universal masks and we didn't have those tools that we have now to really understand how it's likely for a virus to be spread and what kinds of PPE are most appropriate in the different situations. So, we have learned a lot and I feel that with collaboration with our infectious disease specialists and the environmental specialists in the hospital, that we really do understand the risk from both symptomatic patients and asymptomatic and testing and all of that. So, I believe our environment today is very, very safe. And so 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.

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 because of that. But we continue to reach out to them and we continue to say, "Let's have another conversation in a couple of weeks," to see how they're feeling. And we try to provide some resources with social work and other kinds of support.

Dr. Schnabel:
I would echo some of those sentiments from the other panelists, and what I would also say, and this is certainly true in New York, as I'm sure it's true around the country that we have processes in place right now that are really, really helpful for patients to understand, to allow them to feel more comfortable about accessing healthcare. And they include very, very basic things, such as universal masking, temperature checks at the door, limiting additional visitors and caregivers as was already mentioned. And also the faculty and staff have all been COVID tested and have access to testing at any point when that becomes necessary along with doing our own temperature checks and symptom checks all the time. And I think that that can be very reassuring to our patients. What we've experienced on the surgical end in New York at least was a very brief pause in surgery.

We had about a three-week pause in doing non-emergency surgery. I think the word elective when we talk about cancer... Dr. Park is smiling, I think that word really doesn't apply appropriately. It's not an emergency surgery, but of course, it's urgent to us and to the patients. So, we had about a three-week pause, and that was very fortunate because when that three-week pause was over, the health systems had the resources that they needed to be able to not just keep the patients safe but to make sure that we weren't using resources that were needed elsewhere to treat patients who are affected by COVID.

So, we had a very brief pause and as everyone else has alluded to, we all have tried to formulate treatment plans for our patients that would allow them to get effective and meaningful treatment while we were then thinking about how to limit the number of visits that they needed to make, and to keep them safe and really shepherd our resources where they were otherwise needed. But happily, that was a brief pause, and we are now really back up to doing surgery at our pre-COVID levels.

Dr. Vinayak:
And then we are also utilizing the telehealth visits and that's a new thing, so patients who don't need to come to infusion and they're doing overall well and have been on the same medications sort of as a long-term thing, and they don't necessarily need an exam where we can skip one exam. I think they're very appropriate for the telehealth visits where we can use the video conferencing. And I would say I was definitely skeptical of how these would go, but I've had a very positive experience, so have our patients.

Dr. Schnabel:
Although, I have to say as a surgeon, the one point I always make is that I can't examine anyone by telehealth, so it will have a place but it will be a little bit limited, but in all fairness, at this point, I tell my patients that our offices are safer than the grocery store. So, if everybody's comfortable at going out to get groceries, they should know that coming into the cancer center is safer than that.

This has been an unprecedented event in our lifetimes, this COVID pandemic, and I would not trivialize or decrease the meaning of this. But I want to remind everybody that this is not 1918, this is 2020. We are a lot smarter. We have much better technology, and heaven knows that we have so much better ways of collaborating and sharing information. And that's what's allowed all the treatments to really go forward so quickly and gain momentum and learn so much about the virus so quickly, and going towards a vaccine and better treatments and so on and understanding that we can continue to treat our patients safely through this. So please, everybody, 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, we'll work with you on this. And we will all of us get through this together.


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