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Showing content from https://pubmed.ncbi.nlm.nih.gov/32712878/ below:

A system for risk stratification and prioritization of breast cancer surgeries delayed by the COVID-19 pandemic: preparing for re-entry

Review

Affiliations

• ¹ Division of Surgical Oncology, Massachusetts General Hospital, MGH Center for Breast Cancer, Yawkey 9A, 55 Fruit St, Boston, MA, 02114, USA. blsmith1@mgh.harvard.edu.
• ² Division of Surgical Oncology, Massachusetts General Hospital, MGH Center for Breast Cancer, Yawkey 9A, 55 Fruit St, Boston, MA, 02114, USA.
• ³ Department of Hematology Oncology, Massachusetts General Hospital, Boston, MA, USA.

• PMID: 32712878
• PMCID: PMC7382558
• DOI: 10.1007/s10549-020-05792-2

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Review

Barbara L Smith et al. Breast Cancer Res Treat. 2020 Oct.

• ¹ Division of Surgical Oncology, Massachusetts General Hospital, MGH Center for Breast Cancer, Yawkey 9A, 55 Fruit St, Boston, MA, 02114, USA. blsmith1@mgh.harvard.edu.
• ² Division of Surgical Oncology, Massachusetts General Hospital, MGH Center for Breast Cancer, Yawkey 9A, 55 Fruit St, Boston, MA, 02114, USA.
• ³ Department of Hematology Oncology, Massachusetts General Hospital, Boston, MA, USA.

• PMID: 32712878
• PMCID: PMC7382558
• DOI: 10.1007/s10549-020-05792-2

Item in Clipboard

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.

Keywords: Breast surgery; COVID-19; Clinical decision-making; Scoring system; Surgical priority; Surgical scheduling.

PubMed Disclaimer

The authors report no conflict of interest relevant to this publication. Drs. Smith, Nguyen, Specht, Gadd, Moy and Ms. Korotkin and Ms. Kelly declare they have no conflict of interest. Dr. Spring reports consulting (Novartis), travel (Tesaro), and research funding to the institution (Tesaro, Merck). Dr. Isakoff reports consulting (Abbvie, OncoPrep) and research funding to institution (Abbvie, AstraZeneca, Genetech, Merck, OncoPrep, Pharmamar).

Impact of histology and treatment…

Impact of histology and treatment factors on risk score assignments

Impact of histology and treatment factors on risk score assignments

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