In a large, heavy-bottomed skillet set over medium-high heat, warm the olive oil. Add the Italian sausage and crushed red pepper flakes. Cook for approximately 5 minutes, breaking the sausage into small pieces, until it is fully cooked and no longer pink.

Add the chopped onion and minced garlic to the skillet. Continue cooking for 3 minutes, stirring frequently, until the onion becomes tender and translucent.

Add the crushed tomatoes and heavy whipping cream to the skillet. Reduce the heat to low and allow the mixture to simmer gently for approximately 3 minutes, or until the sauce begins to thicken slightly. Season with kosher salt and freshly ground black pepper to taste.

Meanwhile, bring a large pot of generously salted water to a rolling boil. Add the farfalle pasta and cook until al dente, according to package instructions. Reserve 1 cup of the pasta cooking liquid, then drain the pasta.

Return the drained pasta to the pot and add the sausage and tomato cream sauce. Toss gently over medium-low heat until the pasta is evenly coated. If the sauce appears too thick, add the reserved pasta water in ¼-cup increments until the desired consistency is reached.

Transfer the pasta to a serving dish. Garnish with chopped fresh basil and freshly grated Pecorino Romano cheese before serving.