key: cord-0965821-wb91o49w
authors: Tan, Su-Ming; Melissa Seet, Yert Li; Mok, Chi Wei
title: COVID-19 pandemic: The New Normal in breast cancer management - Prioritization of care from a breast surgical Unit's experience in Singapore
date: 2020-10-10
journal: Asian J Surg
DOI: 10.1016/j.asjsur.2020.08.020
sha: ebac160408954b3b28afd0cc4f9052f0c33ef7d1
doc_id: 965821
cord_uid: wb91o49w

The overwhelming COVID-19 pandemic has forced healthcare institutions around the world to direct resources to manage the pandemic. This has resulted in a sudden acute limitation of resources to care for non-COVID patients with critical conditions. In Singapore, the escalating situation has necessitated swift reaction in the Division of Breast surgery to develop strategies to support the battle against COVID-19 and yet deliver care to our breast cancer patients. By combining our experience with existing guidelines, we present our rationale for a prioritisation aid based on DORSON level and availability of resources. It is our fervent hope that this article will serve as a guide for physicians with similar allocation of resources who are managing breast cancer patients amidst this pandemic.

Singhealth Duke-NUS Breast Centre, Singapore E-mail: mok.chi.wei@singhealth.com.sg

The overwhelming COVID-19 pandemic has forced healthcare institutions around the world to direct resources to manage the pandemic. This has resulted in a sudden acute limitation of resources to care for non-COVID patients with critical conditions. By the end of January 2020, Singapore had the highest number of reported cases outside China 1 .

Despite the initial containment strategies, the number of COVID-19 positive cases rose significantly. Hence, the Singapore Government implemented the Circuit Breaker measures on 7 April 2020, to last through to 1 June 2020 1 . The aim was to reduce community spread and flatten the curve. Hence, hospitals were required to reduce our non-essential patient activities viz non-critical outpatient appointments and surgeries.

In Singapore, significant amount of healthcare resources is directed at the management of COVID-19 positive patients, isolation and testing of high-risk groups. Our challenge is to deliver a standard of care (as in non-COVID times) to non-COVID patients when resources are limited. Concurrently, steps need to be taken to minimise the patients' risk of contracting SARS-CoV-2 when receiving treatment. To achieve this, we looked at available guidelines 2-5 , and drew from our experience (Supplementary Data).

We developed an aid, describing the prioritisation of care based on the DORSON level (Yellow and Orange) and resource availability. Delivery of care was divided into 5 categories along with their respective prioritization principles as follows (Table 1) In conclusion, The COVID-19 pandemic has caused healthcare services worldwide to rush to deal with this highly unpredictable and continually evolving disease. As the situation varies in each country, so do their resources. Singapore is no different, as we grapple with the relentless pace of the virus. While adapting to cope with measures required to battle COVID-19, we also strive to not compromise on the delivery of care to our breast cancer patients.

This requires a tailored strategy, crafted within a multidisciplinary team framework. Treatment delivery may be affected by the severity of the pandemic, availability of healthcare resources, and the need to balance the risks of unnecessary exposure of patients and healthcare personnel. Adding our experience to existing guidelines, we hope that our prioritization aid may assist others in similar circumstances to adapt to the New Normal. Post-treatment visits for complications.

Limited resources Acute spinal cord compression and brain/ leptomeningeal metastases Post-operative radiation therapy for high risk patients

Updates on COVID-19 (Coronavirus Disease 2019) Local Situation. moh.gov.sg

Suggested Treatment Modifications in Multidisciplinary Breast Cancer Management in the Setting of COVID-19

OncologyES for M. ESMO MANAGEMENT AND TREATMENT ADAPTED RECOMMENDATIONS IN THE COVID-19 ERA: BREAST CANCER

Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic

Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic: Executive Summary