publication date: Jun. 12, 2020
Guidance helps select breast cancer patients for urgent surgery or chemotherapy during pandemic
A new approach to better select breast cancer patients in need of urgent surgery or chemotherapy during the COVID-19 pandemic has been developed by researchers at The Royal Marsden and the Breast Cancer Now Research Centre at The Institute of Cancer Research, London, in collaboration with colleagues in the U.K., Germany, and the U.S.
The innovative algorithm, using data from multiple international trials, can identify postmenopausal patients with primary ER+HER2- breast cancer (c.70% of cases) who have less endocrine-sensitive tumours and who should be prioritised for early surgery or neoadjuvant chemotherapy.
The COVID-19 pandemic has led to an international need to prioritize the number of cancer surgeries and chemotherapy treatments to the most urgent patients to protect staff and vulnerable patients. While patients diagnosed with triple negative and HER2-positive breast cancer have still been going forward for urgent surgery or chemotherapy, for a large group of patients deferring these treatments and prescribing neoadjuvant endocrine therapy, i.e. treatment to reduce the stimulation of the disease by estrogen without the surgical removal of the breast tumor, has been identified as the best course of treatment.
Development of the new treatment algorithm was led in the UK by researchers working in the Ralph Lauren Centre for Breast Cancer Research at The Royal Marsden and the Breast Cancer Now Toby Robins Research Centre at The Institute of Cancer Research.
Prof. Mitch Dowsett, head of the Ralph Lauren Centre for Breast Cancer Research at The Royal Marsden and Professor of Biochemical Endocrinology at the ICR, led the collaboration published in NPJ Breast Cancer this week. The work highlighted that while 85% of patients in whom treatment by surgery is deferred would be safe to remain on NeoET treatment for up to six months, 15% can be identified who are resistant to this treatment and risk disease spread.
“NeoET can block the tumor from growing successfully for many women but for one in six who are resistant there is a risk the tumor will continue to grow and spread elsewhere,” Dowsett said in a statement.
“By accessing unpublished results from clinical trials involving thousands of patients, with colleagues here and abroad we have developed a new way of directing patients’ treatment in this global crisis. Using the data on estrogen receptor, progesterone receptor and proliferation from the tumor of newly diagnosed patients, our simple new calculator can be used by fellow clinicians worldwide to immediately identify the best course of treatment for about 80% of their patients.
“Then, by drawing upon our earlier research, we can help the other 20% by measuring Ki67 (a protein that measures the number of cells dividing in the tumor) a few weeks after starting their NeoET. Overall, we can identify the 15% of the women who are most at risk of relapsing on just NeoET treatment and should be prioritised for surgery or neoadjuvant chemotherapy.
ChristianaCare develops COVID-19 symptom monitoring, testing program for businesses and employers
ChristianaCare has developed a virtual telehealth service that provides daily monitoring of employees for COVID-19 symptoms, testing, and care for employees who test positive.
The Employee COVID-19 Symptom Monitoring and Testing Program is designed to increase safety and ease anxiety in the workplace. Employees will have access to a registered nurse to discuss their symptoms and the opportunity for a tele-visit with a provider.
The program relies on ChristianaCare’s COVID-19 Virtual Practice and its CareVio care management program for daily bi-directional, secure text messaging.
Currently, 12 employers in Delaware, Pennsylvania, New Jersey, Louisiana and Arizona are using the ChristianaCare Employee COVID-19 program. All told, the program is monitoring nearly 5,000 people.
Prior to the start of work each day, employees receive a text message in English or Spanish with a few screening questions related to coronavirus symptoms. If employees indicate they have no symptoms, they receive an “All Clear” text that it is safe to report to work. If they indicate they have developed symptoms, they will receive a message that they are “Not Cleared” and should not report to work. A registered nurse from the CareVio team will reach out for further evaluation.
If the nurse identifies positive coronavirus symptoms, employees are urged to see a provider in ChristianaCare’s COVID-19 Virtual Practice through a tele-visit or visit their own primary care provider. If employees choose the COVID-19 Virtual Practice, they may be sent for a test. If the test is positive and they have symptoms of coronavirus, CareVio will monitor them several times each day to make sure they are improving. If symptoms progress, CareVio will arrange for another tele-visit with the COVID-19 Virtual Practice.
The COVID-19 Virtual Practice began mid-March 2020 within ChristianaCare’s Center for Virtual Health. Through June 1, the practice has conducted more than 2,536 virtual visits with more than 2,070 patients.
HealthTree recruits over 1,000 participants for study on impact of COVID-19 on MM
A total of 1,066 patients have joined a HealthTree observational study on COVID-19 and multiple myeloma. All participating patients have filled out a HealthTree profile by contributing their de-identified health data and answered survey questions related to their outcomes during the COVID-19 pandemic.
The aim of the study is to help patients and physicians use real data to drive future medical decisions.
The study was first announced on April 16, 2020. The anonymous answers will be aggregated and analyzed by myeloma researchers to identify recommendations for patients navigating myeloma during the COVID-19 pandemic. Initial study results will be available in July, and more extensive results will be published in December.