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A system for risk stratification and prioritization of breast cancer surgeries delayed by the COVID-19 pandemic: preparing for re-entry
- Source :
- Breast Cancer Research and Treatment
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- Purpose During the COVID-19 pandemic, most breast surgery for benign and malignant conditions has been postponed, creating a backlog of patients who will need surgery. A fair and transparent system for assessing the risk of further delaying surgery for individual patients to prioritize surgical scheduling is needed. Methods Factors related to risk of delaying surgery for breast patients were identified. Scores were assigned to each factor, with higher scores indicating a greater risk from delaying surgery. REDCap and Microsoft Excel tools were designed to track and score delayed patients. Results Published data and multidisciplinary clinical judgement were used to assign risk scores based on patient and tumor factors, length of delay, and tumor response to preoperative therapy. Patients completing neoadjuvant chemotherapy were assigned the highest scores as their options for delaying surgery are most limited. Among patients receiving neoadjuvant endocrine therapy or no medical therapy, higher scores were assigned for low-estrogen receptor or high-genomic risk scores, higher grade, larger tumors, younger age and longer delay. High priority scores were assigned for progression during preoperative therapy. Low scores were assigned for re-excisions, atypical lesions and other benign indications. There was good agreement of the tool’s ranking of sample patients with rankings by experienced clinicians. The tool generates risk-stratified patient lists by surgeon or institution to facilitate assignment of surgery dates. Conclusions This tool generates a clinically consistent, risk-stratified priority list of breast surgical procedures delayed by the COVID-19 pandemic. This systematic approach may facilitate surgical scheduling as conditions normalize.
- Subjects :
- 0301 basic medicine
Prioritization
Scoring system
Cancer Research
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
medicine.medical_treatment
Breast surgery
Pneumonia, Viral
Breast Neoplasms
Review
Surgery scheduling
Risk Assessment
Time-to-Treatment
Betacoronavirus
03 medical and health sciences
0302 clinical medicine
Breast cancer
Surgical scheduling
Pandemic
Surgical priority
medicine
Humans
Pandemics
Mastectomy
Neoplasm Staging
SARS-CoV-2
business.industry
General surgery
COVID-19
medicine.disease
030104 developmental biology
Oncology
030220 oncology & carcinogenesis
Female
Coronavirus Infections
Risk assessment
business
Clinical decision-making
Subjects
Details
- ISSN :
- 15737217 and 01676806
- Volume :
- 183
- Database :
- OpenAIRE
- Journal :
- Breast Cancer Research and Treatment
- Accession number :
- edsair.doi.dedup.....8d353777558c64862fceaaceb2b7b6e6