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Ann Surg Oncol ; 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1463293


BACKGROUND: Surgical delays are associated with invasive cancer for patients with ductal carcinoma in situ (DCIS). During the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, neoadjuvant endocrine therapy (NET) was used as a bridge until postponed surgeries resumed. This study sought to determine the impact of NET on the rate of invasive cancer for patients with a diagnosis of DCIS who have a surgical delay compared with those not treated with NET. METHODS: Using the National Cancer Database, the study identified women with hormone receptor-positive (HR+) DCIS. The presence of invasion on final pathology was evaluated after stratifying by receipt of NET and by intervals based on time from diagnosis to surgery (≤30, 31-60, 61-90, 91-120, or 121-365 days). RESULTS: Of 109,990 women identified with HR+ DCIS, 276 (0.3%) underwent NET. The mean duration of NET was 74.4 days. The overall unadjusted rate of invasive cancer was similar between those who received NET ((15.6%) and those who did not (12.3%) (p = 0.10). In the multivariable analysis, neither the use nor the duration of NET were independently associated with invasion, but the trend across time-to-surgery categories demonstrated a higher rate of upgrade to invasive cancer in the no-NET group (p < 0.001), but not in the NET group (p = 0.97). CONCLUSIONS: This analysis of a pre-COVID cohort showed evidence for a protective effect of NET in HR+ DCIS against the development of invasive cancer as the preoperative delay increased, although an appropriately powered prospective trial is needed for a definitive answer.

J Surg Educ ; 78(1): 321-323, 2021.
Article in English | MEDLINE | ID: covidwho-688862


The coronavirus crisis hit at the beginning of the Complex General Surgical Oncology Fellowship (CGSO) and Breast Oncology Fellowship interview cycles. Within 2 weeks, nearly all programs, including ours, switched to a virtual platform for the remainder of the season. Given that social distancing will remain in place for the foreseeable future, it is possible that all residency and fellowship interviews will need to be conducted virtually. Our methods and shared experience can assist other programs faced with this task for their upcoming interview cycle. We recommend using a virtual meeting platform in which staff have the most comfort; we chose Zoom as our platform. Information on the program traditionally included in the welcome packet, research opportunities, details on the institution, hospital and staff, and detailed interview instructions were distributed prior to the interview day. A virtual "happy hour" was conducted to provide an opportunity for candidates and current trainees to interact. Our virtual interview day schedule mimicked our traditional in person interview day, and we always had a back-up plan for completing the interview if the virtual platform became unstable. While many programs would not choose to perform virtual interviews, we felt that by conducting them in the methods we describe, we were able to closely replicate our traditional interview day and appreciate the candidacy of the applicants.

COVID-19/epidemiology , Interviews as Topic , Physical Distancing , Surgical Oncology/education , Videoconferencing , Education, Medical, Graduate , Fellowships and Scholarships , Humans , Internship and Residency , Pandemics , Pennsylvania/epidemiology , SARS-CoV-2
Breast Cancer Res Treat ; 181(3): 487-497, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-116756


The COVID-19 pandemic presents clinicians a unique set of challenges in managing breast cancer (BC) patients. As hospital resources and staff become more limited during the COVID-19 pandemic, it becomes critically important to define which BC patients require more urgent care and which patients can wait for treatment until the pandemic is over. In this Special Communication, we use expert opinion of representatives from multiple cancer care organizations to categorize BC patients into priority levels (A, B, C) for urgency of care across all specialties. Additionally, we provide treatment recommendations for each of these patient scenarios. Priority A patients have conditions that are immediately life threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country. Additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to SARS CoV-2 (virus associated with the COVID-19 pandemic). Physicians should use these recommendations to prioritize care for their BC patients and adapt treatment recommendations to the local context at their hospital.

Breast Neoplasms/classification , Breast Neoplasms/therapy , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Betacoronavirus/isolation & purification , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , COVID-19 , Coronavirus Infections/virology , Female , Health Resources , Humans , Neoplasm Invasiveness , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2 , Telemedicine , Triage