One of WPH’s cancer experts, and her team, are working hard to make sure women across Westchester and the country are getting the care they need.
When the COVID-19 pandemic exploded in March, calls and messages started coming in nationwide. Physicians reached out to breast cancer experts and to the National Accreditation Program for Breast Centers (NAPBC) for guidance on how to best take care of breast cancer patients. It doesn’t take much imagination to empathize with the woman in the middle of a cancer diagnosis when she is told her treatment is put on hold indefinitely. Many women across the nation have shared this predicament. Women who were already stressed and worried now faced even more uncertainty. With cancer, time can be of the essence for successful treatment, and often, survival.
The National Accreditation Program for Breast Cancers (NAPBC) sprang into action. The NAPBC is a consortium of 19 professional medical organizations and the premiere organization that accredits breast cancer centers across the country: it sets the standards for breast cancer treatment and diagnosis. The NAPBC and its colleagues across the US put together a panel of experts and created the COVID-19 Pandemic Breast Cancer Consortium to develop guidelines for physicians taking care of breast cancer patients. As Director of Radiation Oncology at White Plains Hospital’s Center for Cancer Care, where treatment continued even at the height of the pandemic, Dr. Randy Stevens had the privilege to be one of them.
NAPBC experts spent hundreds of hours and, with lightning speed, published Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. The recommendations help surgeons, radiologists, radiation oncologists and medical oncologists to individually tailor each breast cancer patient’s treatment during the pandemic. The goal was, and still is, to treat the breast cancer as effectively as possible while considering the limitations and risks posed by the pandemic. Later, the task force of breast cancer professionals followed this up with a COVID-19 Pandemic Breast Cancer Consortium’s Considerations for Re-entry, which specifically addressed how to deal with the backlog of cases and the many women who hadn’t been able to get a diagnosis or treatment.
Setting National Standards
These guidelines clearly and specifically laid out for physicians how to prioritize treatment; whose treatment was serious enough to proceed regardless of the pandemic, who might be able to change the order of their treatments and postpone surgery until it was a safer time in their community and any recommended adjustments in chemotherapy or anti-estrogen therapy. Regarding radiation therapy, Dr. Stevens and the task force helped create guidelines to prioritize which patient could not postpone their radiation, and to find creative safe ways to deliver patients’ treatments and maximize their chance of cure.
Every cancer center had to find their proper balance. Depending on where people live in the country, many patients could not get a biopsy or had their diagnosis already but could not have surgery. "Our recommendations helped physicians to take care of their patients in an effective, safe and practical way," explains Dr. Stevens. "NAPBC put together these guidelines in hopes we could help women and physicians all over country, who are living in places at different points in the pandemic. Many clinicians are back to doing business as usual, while others may still be making hard choices."
Recommendations in the papers were immediately e-blasted to cancer centers across the country, published in Breast Cancer Research and Treatment and presented during a series of webinars for cancer center clinicians, list three priority levels:
Priority A, the most severe level, is when the patient’s condition is life-threatening.
Priority B means the patient’s situation is not critical, but a delay of intervention beyond 6-8 weeks could affect the overall success rate and alternate treatment pathways (listed in the Guidelines) may be considered.
In Priority C, the patient’s condition is stable enough that services can be temporized while the pandemic is severe.
In the actual publication, there are multiple situations and treatment guidelines for each priority level.
Here for Our Patients When They Need Us
One of the key recommendations of the Consortium is for Centers to have a multidisciplinary breast conference with all of the relevant clinicians, to discuss each patient’s situation especially if the usual treatment pathway needed to be adjusted due to COVID. "At WPH, we already had a multidisciplinary breast conference started 20 years ago, well before it was a requirement of NAPBC accreditation so the Hospital was well positioned to make sure every patient’s situation was discussed and the best treatment pathway chosen for our breast patients prior to any surgery or treatment," notes Dr. Stevens. "The Consortium’s guidelines provide an additional layer to help them reach the best decision for each patient."
"At WPH, we are trusted and empowered to deliver the highest level of care to our patients," continues Dr. Stevens. "For example, during the height of the crisis, if a patient had an urgent situation and we believed we could perform the surgery safely and the benefits outweighed the risks, we performed the surgery."
During the peak of the pandemic, telemedicine provided many patients with a safe and convenient solution to connect with their physicians, allowing them to get the care and guidance they needed while staying as safe as possible at home. Currently, with active COVID-19 cases at low levels in New York State, the WPH Center for Cancer Care physicians continue to deliver top level care to the patients, and is fully functional, while following the New York State and CDC guidelines to keep everyone as safe as possible.
"As we continue on the road to recovery, our job is to continue to make sure that all patients get the medical care and support they need, wherever they are on their breast cancer journey," Dr. Stevens adds. "Virus or no virus, at WPH that will not change."