MANAGING BREAST CANCER TREATMENT PATHWAYS IN THE COVID-19 ERA

Background and importance Over the last 2 years the COVID- 19 pandemic (C-19) has severely impacted the diagnosis and treatment of patients suffering from cancer. Considering breast cancer (BC) as a case study;fewer women than expected have been diagnosed, predicting a backlog of cases that could overwhelm the current infrastructure. In addition, measures directed at reducing viral spread such as social distancing or increased sanitary practices limit current resource utilisation. Targeted measures are advised to offset these constraints to assure that affected women are effectively cared for in a timely manner, despite health care budgets that have been severely impacted by the pandemic, for example, by managing treatment toxicity to limit emergency hospital attendance or admissions. Aim and objectives To identify evidence of possible interventions that could favourably impact (1) treatment capacity, (2) planned and unplanned attendance at hospitals and clinics and (3) the overall costs of treatment. Material and methods The key steps in the patient journey through BC systemic adjuvant therapy were identified. At each step a systematic and structured literature search using PubMed, Clinical Trials Registries and Google Advanced Search was conducted to identify candidate interventions, the level of evidence, quantifiable risks and benefits and statistical significance. Results Safer care during C-19 requires increased separation of patients and staff, impacting treatment capacity. A broad range of possible effective interventions were identified including validated patient preassessment tools, shortened treatment schedules, rapid infusion delivery, dose-banding, enhanced toxicity monitoring and prevention, the subcutaneous and coadministration of therapeutics, home delivery of treatments and wider use of cost-effective treatment options created by generic and biosimilar products. Each step is identified on the patient pathway map of the poster. Conclusion and relevance Hospital pharmacists have a catalogue of targeted, evidence-based measures at their disposal to assure that women with breast cancer can be effectively cared for in a timely manner despite the impact of C-19 and resulting challenges in treatment capacity and health care budgets.

Supportive care in patients with cancer during the COVID-19 pandemic.

Cancer care has been profoundly impacted by the global pandemic of severe acute respiratory syndrome coronavirus 2 disease (coronavirus disease 2019, COVID-19), resulting in unprecedented challenges. Supportive care is an essential component of cancer treatment, seeking to prevent and manage chemotherapy complications such as febrile neutropenia, anaemia, thrombocytopenia/bleeding, thromboembolic events and nausea/vomiting, all of which are common causes of hospitalisation. These adverse events are an essential consideration under routine patient management, but particularly so during a pandemic, a setting in which clinicians aim to minimise patients' risk of infection and need for hospital visits. Professional medical oncology societies have been providing updated guidelines to support health care professionals with the management, treatment and supportive care needs of their patients with cancer under the threat of COVID-19. This paper aims to review the recommendations made by the most prominent medical oncology societies for devising and modifying supportive care strategies during the pandemic.