Dr. Anne Moore, medical oncologist and Director of the Breast Cancer Survivorship Program at Weill Cornell and Dr. Leticia Varella, Assistant Professor of Medicine at Weill Cornell Medical College will go over changes in treatment and maintenance care for those with an early stage or metastatic breast cancer diagnosis. They will address your risk level as a cancer patient, provide strategies to minimize risk, discuss how to deal with anxiety, and answer your questions to help you through the COVID-19 pandemic.

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Addressing Your COVID-19 Breast Cancer
Concerns
Leticia Varella, MD
Assistant Professor of Medicine
Weill Cornell Breast Center
Anne Moore, MD
Professor of Medicine
Weill Cornell Breast Center

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COVID19 and Breast Cancer: Outline
• COVID-19
• “Am I at risk for COVID-19?”
• Management of breast cancer during the pandemic
• Lifestyle during the pandemic

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COVID-19

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COVID-19
• “Coronavirus”: SARS-CoV-2 (Severe Acute Respiratory Syndrome
Coronavirus 2).
• COVID-19: Coronavirus Disease 2019.
• First case identified in China in December 2019. First case in NYC
on March 1st 2020.

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COVID-19: Symptoms
• Fever and/or chills
• Dry cough
• Fatigue
• Loss of appetite
• Shortness of breath
• Muscle aches
• Loss of smell and/or taste
• Diarrhea
• Less common: nausea, vomiting, headache, runny nose, sore throat

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COVID-19
• Incubation Period: 1-14 days (most commonly 4-5 days)
• More than 80% of the cases are mild
• Older adults and those with other medical problems are more
likely to have severe disease

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COVID-19: Prevention
www.cdc.gov

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NYC perspective

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NYC perspective
About 140,000 cases
in NYC (4/21/20)
About 9,000 now
being tested every
day – about half of
them tested negative.

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“Am I at risk for COVID-19?”

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Cancer and COVID-19
• Although preliminary data from China suggested that patients
with cancer may have a higher incidence of COVID-19, that was
based on a very small number of patients and details regarding
stage and general health were not available.
• For patients with breast cancer, other preliminary data suggests
that early stage and general good health predict for good
outcome.
• Studies are currently ongoing…

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Cancer and COVID-19:
“Am I immunosuppressed?”
• Lymph node removal should not affect the risk
• Endocrine therapy (tamoxifen, anastrozole, letrozole, exemestane)
does not affect the immune system
• Radiation: unlikely to affect the immune system

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Cancer and COVID-19:
“Am I immunosuppressed?”
• How about our chemotherapy patients?
o Adjuvant and neoadjuvant
o Metastatic

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Chemotherapy and COVID-19:
• Chemotherapy in the past: we do not expect long term
immunosuppression
• Current chemotherapy: case-by-case decisions
- Consideration of delaying or modifying treatments
- Consideration of growth factor support
- Home administration of some medications

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Management of Breast Cancer
During the Pandemic

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Management of Breast Cancer During the Pandemic:
Adapting to the current situation
 Relocate hospital resources and staff to support the front-line care
 Operating rooms are now ICU’s
 Staff is working from home
 Keep patients that absolutely need to come in for testing and treatment
safe
 Keep staff protected from unnecessary exposure
 Adapt our standard breast cancer management while continuing to
provide optimal care

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Treatment of Breast Cancer
• Across the country, our professional organizations (e.g. ASCO,
NCCN) have put together the best evidence based guidelines to
guide us during this time.
• At Weill Cornell, we developed internal guidelines in the beginning
of the pandemic. All cases are being discussed in a
multidisciplinary conference to decide the best choices for
treatment.

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Concerns regarding imaging
• Delay of routine follow-up mammogram
• New lump in the breast should be addressed
• Biopsies are being performed when needed
• Routine CT scans may be safely delayed

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Treatment of Breast Cancer
• Surgery may be delayed when the delay is deemed safe for the patient
o Use of adjuvant hormone treatment before surgery in women with ER
positive early stage breast cancer
• Chemotherapy/immunotherapy: treatment options may be modified at this time
(e.g. chemotherapy before vs. after surgery, oral vs. IV treatment, every 3 weeks
instead of weekly intervals, use of growth factor support to prevent infections)
• Fertility preservation
• Radiation: regimen may be modified in some cases to decrease exposure
(transportation, frequent visits, contact with other patients and staff)

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Lifestyle during the pandemic

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Alcohol and Cancer
National Institute of Alcohol Abuse and Alcoholism
Limit intake to 3-4 drinks
per week

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Body weight and Breast cancer
Decrease caloric intake
Increase physical activity

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Decreasing calorie intake during the pandemic
• Decrease the size of food portions
• Avoid foods and beverages that are
high in calories, fat, and sugars
• Limit between‐meal snacks
• Keep track of food intake

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American Cancer Society:
nutrition recommendations
• Consume a healthy diet, with an emphasis
on plant foods
• Limit processed meat and red meat
• Eat at at least 2½ cups of vegetables and
fruits each day
• Choose whole grains instead of refined
grain products

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Physical Exercise
• 1 minute of vigorous activity = 2 minutes of moderate activity
• Activity below the recommended levels is still beneficial
Center for Disease Control and Prevention

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Physical Exercise
• Vigorous intensity aerobic activity:
 1 h and 15 minutes per week
 Ideal: 2 h and 30 minutes per week!

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Physical Exercise During the Pandemic

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Physical Exercise
• Muscle-strengthening activities:
 Twice a week

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Mental Health
• Meditation and yoga
• Good sleep hygiene
• Virtual meetings with family and friends
• Limit watching the news

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Resources for COVID 19 and Breast Cancer

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Conclusions
• Breast cancer care from diagnosis to
treatment may be modified but not
compromised during the pandemic
• Keep in touch with your medical team to
discuss your concerns
• Use at least 30 minutes every day to take
care of you Breast Center at New York-Presbyterian
Hospital - Weill Cornell Medicine

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