COVID-19 positivity rates are declining. Schools and restaurants are re-opening. And while most people are anxious to get back to “normal,” if you’re in active treatment for breast cancer now is not the time to let your guard down. The caution comes from breast cancer experts at Miami Cancer Institute who stress that those with weakened immune systems ― which can be a side effect of treatment or the result of cancer itself ― are particularly vulnerable.
The good news, doctors say, is that treatment for most patients continued with precautions during the pandemic at Miami Cancer Institute. In addition, those who delayed care can confidently come to the Institute as safety guidelines are still strictly followed.
The Institute never closed to patients during the COVID-19 pandemic, but it did implement stringent safety precautions, from a no visitor policy and mandatory mask wearing to daily screening of patients, staff and physicians, the reconfiguration of spaces and providing telehealth virtual visits when possible.
Before determining if a patient should come in for treatment or for surgery, their individual circumstances are studied ― even now as COVID-19 numbers are decreasing. A decision is based on the type of cancer and how aggressive it may be, the patient’s risk factors and the treatment options available.
In the COVID-19 era, some young, otherwise healthy patients opt to go home from the hospital the same day as mastectomy surgery if their pain is controlled and they are doing well rather than staying overnight, which is more typical, said Starr Mautner, M.D., breast surgical oncologist. “This is now the new normal for us,” she said. “We don’t know when this pandemic will be over. We’re discovering how we can best care for our patients as we deal with it.”
Some patients undergoing radiation therapy are experiencing changes to their treatment schedules, said radiation oncologist Maria-Amelia Rodrigues, M.D., who added that studies showing excellent clinical outcomes with adapted treatments may result in permanent changes in the delivery of care. To minimize in-person contact as much as possible, radiation courses are sometimes able to be shortened or delayed, or the frequency changed, again depending upon the location, type and stage of the patient’s breast cancer.
“Patients who are committed to radiation therapy have a treatment planning simulation appointment,” she said. The appointment is designed to make the most of the time the patient is in the radiation treatment area, precisely coordinating every move of their visit. And patients who have tested positive for COVID-19 may continue radiation therapy when it’s crucial, with plenty of extra precautions in play, including special appointment times, additional room sterilization and more.
Medical oncologist Grace Wang, M.D., stresses the importance of continuing care when possible and of scheduling regular mammography screenings and other testing so that cancer can be caught early when it is most treatable. “We know that screening helps improve survival,” she said. “When you weigh your risks and benefits, it’s safer to be screened than not be screened.”
The doctors agree that patients in treatment should be extra cautious. For example, a newly diagnosed patient about to begin chemotherapy who has school-age children, might want to consider schooling options. “if you have a choice, it would be nice if they could be virtual,” Dr. Wang said.
Cancer survivors with healthy immune systems should take the same precautions as the general public. The physicians recommend mask wearing, social distancing and avoiding crowds, washing hands frequently, getting a flu shot, exercising and eating a healthy diet.
The doctors, Starr Mautner, M.D., breast surgical oncologist; Maria-Amelia Rodrigues, M.D., radiation oncologist; and Grace Wang, M.D., medical oncologist, provided advice and answered questions recently as part of a live panel presentation hosted by the Institute’s Cancer Patient Support Center. The Zoom program, How Has the Coronavirus Pandemic Affected Care of Patients with Breast Cancer, was moderated by Siddhartha Venkatappa, M.D., medical oncologist. It may be viewed in its entirety here.
Dr. Venkatappa left the audience with one last piece of advice. “Be careful what you read,” he said. “There is a lot of fluff out there. Science should be the basis for every decision we make.”