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Review
. 2020 May;5(Suppl 3):e000793.
doi: 10.1136/esmoopen-2020-000793.

ESMO Management and treatment adapted recommendations in the COVID-19 era: Breast Cancer

Evandro de Azambuja #  1 , Dario Trapani #  2 , Sibylle Loibl  3 , Suzette Delaloge  4 , Elzbieta Senkus  5 , Carmen Criscitiello  6 , Philip Poortman  7 , Michael Gnant  8 , Serena Di Cosimo  9 , Javier Cortes  10 , Fatima Cardoso  11 , Shani Paluch-Shimon  12 , Giuseppe Curigliano  13
Affiliations
Review

ESMO Management and treatment adapted recommendations in the COVID-19 era: Breast Cancer

Evandro de Azambuja et al. ESMO Open. 2020 May.

Abstract

The global preparedness and response to the rapid escalation to severe acute respiratory syndrome coronavirus (SARS-CoV)-2-related disease (COVID-19) to a pandemic proportion has demanded the formulation of a reliable, useful and evidence-based mechanism for health services prioritisation, to achieve the highest quality standards of care to all patients. The prioritisation of high value cancer interventions must be embedded in the agenda for the pandemic response, ensuring that no inconsistency or discrepancy emerge in the health planning processes.The aim of this work is to organise health interventions for breast cancer management and research in a tiered framework (high, medium, low value), formulating a scheme of prioritisation per clinical cogency and intrinsic value or magnitude of benefit. The public health tools and schemes for priority setting in oncology have been used as models, aspiring to capture clinical urgency, value in healthcare, community goals and fairness, while respecting the principles of benevolence, non-maleficence, autonomy and justice.We discuss the priority health interventions across the cancer continuum, giving a perspective on the role and meaning to maintain some services (undeferrable) while temporarily abrogate some others (deferrable). Considerations for implementation and the essential link to pre-existing health services, especially primary healthcare, are addressed, outlining a framework for the development of effective and functional services, such as telemedicine.The discussion covers the theme of health systems strategising, and why oncology care, in particular breast cancer care, should be maintained in parallel to pandemic control measures, providing a pragmatic clinical model within the broader context of public healthcare schemes.

Keywords: COVID-19; ESMO adapted recommendations; breast cancer.

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Conflict of interest statement

Competing interests: GC has received honoraria from Pfizer, Novartis, Eli Lilly, Roche; fees for expert testimony and medical education from Pfizer and has participated in advisory boards for Pfizer, Roche, Eli Lilly, Novartis, Seattle Genetics, Celltrion. SD reports grants, institutional fees from Roche/Genentech, Pfizer, Puma, AstraZeneca, Novartis, Amgen, Sanofi, Eli Lilly, MSD, BMS, Daichi and non-financial support from Roche/Genentech, Pfizer, AstraZeneca. SDC has received fees for medical education from Novartis and Pierre-Fabre and is the recipient of the IG 20774 of Fondazione AIRC. MG reports personal fees/travel support from Amgen, AstraZeneca, Celgene, Eli Lilly, Invectys, Pfizer, Novartis, Puma, Nanostring, Roche, Medison, LifeBrain, all outside the submitted work; an immediate family member is employed by Sandoz. PP is medical advisor of Sordina IORT Technologies. ES has received honoraria from Amgen, AstraZeneca, Clinigen, Egis, Eli Lilly, Genomic Health, Novartis, Pfizer, Pierre-Fabre, Roche, Sandoz, TLC Biopharmaceuticals and travel support from Amgen, AstraZeneca, Egis, Novartis, Pfizer, Roche. FC has consultancy role for Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi-Sankyo, Eisai, GE Oncology, Genentech, GlaxoSmithKline, Macrogenics, Medscape, Merck-Sharp, Merus BV, Mylan, Mundipharma, Novartis, Pfizer, Pierre-Fabre, prIME Oncology, Roche, Sanofi, Samsung Bioepis, Seattle Genetics, Teva. EdA honoraria and/or advisory board from Roche/GNE, Novartis, SeaGen and Zodiac; travel grants from Roche/GNE and GSK/Novartis; research grant to the institution from Roche/GNE, AstraZeneca, GSK/Novartis and Servier. CC declares consultancy/advisory role/speaker's bureau: Pfizer, Eli Lilly, Roche, Novartis. SP-S discloses honoraria, consultancy and speaker’s bureau: Roche, Novartis, Pfizer, Eli Lilly, AstraZeneca, Nanostring.

Figures

Figure 1
Figure 1
Priority-setting of the health interventions in oncology during COVID-19.
See this image and copyright information in PMC

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