Navigating a breast cancer treatment plan can be overwhelming on its own, but going through it during a pandemic can usher in an entirely new set of fears.
While every person’s treatment plan is individualized, there is some flexibility with timing and the duration of treatments that can help with your safety, without compromising your health.
Oncologist Sara Hurvitz, MD, director of the Breast Cancer Clinical Research Program at the UCLA Jonsson Comprehensive Cancer Center and associate professor of medicine at the David Geffen School of Medicine at UCLA, helps answer some common questions about how to safely continue your cancer care during the COVID-19 crisis.
Should I continue my cancer follow-up appointments?
It is always a good idea to touch base with your oncologist for personal guidance. There are many situations where visits can safely be postponed. This could include a routine follow-up appointment after cancer therapy has been completed in a patient without active cancer. However, if you are on anticancer therapy or have concerning symptoms or issues that need to be discussed with your oncologist, then a visit either in person or via telephone or video is called for. Most oncology clinicians are making themselves available not only in person, but by phone or video as well.
Is it safe to push back my treatment or surgery?
This is an individualized decision that should be made after consultation with a surgeon and medical oncologist (and in some cases a radiation oncologist). For breast cancer that has not spread outside the breast and nearby lymph nodes (stage I-III breast cancer), surgery may be safely delayed by giving systemic anticancer medicine (with drugs that target HER2, the hormone pathway or in some cases chemotherapy) prior to surgery.
On the other hand, sometimes the surgeon and oncologist will evaluate the patient and determine that they would be best served by having surgery first, followed by systemic therapy. If a patient has metastatic breast cancer (cancer that has spread to other parts of the body), the patient and their oncologist will discuss the risks and benefits of continuing or changing therapy. In some cases, a change in therapy (to a lower dose or a different regimen) will be warranted to reduce the risks of immune suppression during the COVID-19 crisis.
I'm due for a mammogram. How do I effectively do screening?
If you have not had a history of breast cancer and do not have any concerning symptoms (breast lump, change in breast skin or nipple, pain, etc), you should be able to safely postpone your screening mammogram by a few months. The decision to postpone should be discussed with your physician who is ordering the mammogram.
If you are scheduling a repeat mammogram to follow up abnormal breast imaging or notice any concerning symptoms, then you would most likely benefit from having an imaging workup. Patients who have a history of breast cancer who are now undergoing screening mammography should consult with their oncologist or surgeon for guidance regarding postponing screening imaging.
What if I feel a lump? Is it ok to wait?
A breast lump should be evaluated by your clinician (for example, physician or nurse practitioner) in person. In some cases, imaging and biopsy will be warranted but a physical exam is the first step. Measures have been taken to reduce the number of patients visiting clinics and to protect the safety of patients coming to clinic.
Does telemedicine work for all my appointments?
Telemedicine is an effective way to communicate with your physician for many needs. However, it does not enable your physician to examine you, to draw bloodwork or to administer therapies that need to be given in the clinic (IV infusions and some injections). Many visits may be converted to telehealth or video visits as long as the patient is comfortable with this format and as long as the physician feels that an in-person visit is not required for them to effectively guide or treat the patient.
Are clinics safe to visit — and are they all open?
All oncology clinics at UCLA are open and have implemented safety measures to protect the wellness and safety of patients and staff. Patients are screened with a phone call prior to coming to clinic to ensure they do not have symptoms suggestive of an infection. Every person entering the clinic has their temperature taken and visitors are generally not allowed. All staff and patients within the clinic wear masks. The volume of patients in the clinic has also been reduced by the use of telemedicine visits for a large number of appointments.