Turkish national consensus on breast cancer management during temporary state of emergency due to COVID-19 outbreak
Atakan Sezer1,2, İrfan Cicin3, Güldeniz Karadeniz Çakmak1,4, Sibel Özkan Gürdal1,5, Gül Başaran1,6, Başak Oyan6, Yeşim Eralp6, Bahadır M. Güllüoğlu1,7 with Turkish National Breast Oncology Specialists Task Force for COVID-198
1 SENATURK Senology Academy-Turkey, Istanbul, Turkey
2 Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey
3 Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
4 Department of General Surgery, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
5 Department of General Surgery, Namik Kemal University School of Medicine, Tekirdag, Turkey
6 Department of Medical Oncology, MAA Acibadem University SchooI of Medicine, Istanbul, Turkey
7 Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
8 Turkish National Breast Oncology Specialists Task Force for COVID-19 consists of Müfide Nuran Akçay, Erol Aksaz, Kemal Atahan, Semih Baskan, Betül Bozkurt, Neslihan Cabioğlu, N. Zafer Cantürk, Hasan Şenol Coşkun, Murat Çalıkapan, Bülent Çitgez, Orhan Demircan, Lütfi Doğan, Mustafa Emiroğlu, Özlem Er, Serap Erel, Ali İlker Filiz, Ertuğrul Gazioğlu, Sadullah Girgin, Sema Sezgin Göksu, Semih Görgülü, Mehmet Ali Gülçelik, Semra Günay, Günay Gürleyik, Veysel Haksöyler, Abdullah İğci, Hasan Karanlık, Abut Kebudi, Saadettin Kılıçkap, Belma Koçer, Hande Köksal, Fatih Köse, Bekir Kuru, Semra Paydaş, Ayfer Kamalı Polat, Serdar Özbaş, Necati Özen, Vahit Özmen, Gürhan Sakman, Aykut Soyder, Özlem Sönmez, Mehmet Ali Nahit Şendur, Cemalettin Topuzlu, M. Ümit Uğurlu, Hilal Ünal, Levent Yeniay, Cem Yılmaz, İdris Yücel.
Objective: Cancer care is excessively influenced by the COVID-19 outbreak for various reasons. One of the major concerns is the tendency for delayed surgical treatment of breast cancer patients. The outbreak has urged clinicians to find alternative treatments until surgery is deemed to be feasible and safe. Here in this paper, we report the results of a consensus procedure which aimed to provide an expert opinion-led guideline for breast cancer management during the COVID-19 outbreak in Turkey.
Material and Methods: We used the Delphi method with a 9-scale Likert scale on two rounds of voting from 51 experienced surgeons and medical oncologists who had the necessary skills and experience in breast cancer management. Voting was done electronically in which a questionnaire-formatted form was used.
Results: Overall, 46 statements on 28 different case scenarios were voted. In the first round, 37 statements reached a consensus as either endorsement or rejection, nine were put into voting in the second round since they did not reach the necessary decision threshold. At the end of two rounds, for 14 cases scenarios, a statement was endorsed as a recommendation for each. Thirty-two statements for the remaining 14 were rejected.
Conclusion: There was a general consensus for administering neoadjuvant systemic therapy in patients with node-negative, small-size triple negative, HER2-positive and luminal A-like tumors until conditions are improved for due surgical treatment. Panelists also reached a consensus to extend the systemic treatment for patients with HER2-positive and luminal B-like tumors who had clinical complete response after neoadjuvant systemic therapy.
Keywords: COVID-19, breast cancer, breast surgery, consensus
Concept - A.S., B.M.G., G.K.C., G.B., B.O., Y.E.; Design - A.S., B.M.G., S.O.G.; Supervision - A.S., B.M.G., I.C., G.B.; Resource - A.S., B.M.G., S.O.G.; Materials - A.S., B.M.G., I.C.; Data Collection and/or Processing - A.S., B.M.G., G.K.C., S.O.G., Task Force Specialists; Analysis and Interpretation - A.S., B.M.G., I.C., G.B., B.O., Y.E.; Literature Review - A.S., B.M.G., G.K.C., S.O.G.; Writing Manuscript - A.S., B.M.G., G.B., B.O., Y.E.; Critical Reviews - A.S., B.M.G., I.C., G.K.C., B.O., Y.E.
The authors declared no conflict of interest
The authors declared that this study has received no financial support.