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
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 entity 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