ASCO Offers Guidelines to Oncologists on Allocating Resources During COVID-19

The American Society of Clinical Oncology (ASCO) released new recommendations to aid the oncology community, as difficult decisions around the allocation of scarce health care resources must be made during the coronavirus disease 2019 (COVID-19) pandemic. 

“As healthcare institutions make difficult decisions about where and how to deploy their resources during the COVID-19 crisis, they must ensure that allocation approaches don’t unconditionally deny patients with cancer access to resources,” ASCO president Howard A. “Skip” Burris III, MD, FACP, FASCO, said in a press release. “Every person with cancer has inherent worth and dignity. A cancer diagnosis alone should not keep a patient from a fair chance to access potentially life-saving resources, even in a public health crisis.”

The recommendations, which will eventually be published in the Journal of Clinical Oncology,² include suggestions such as:

• Allocation of scarce resources in a pandemic should be based on maximizing health benefits.

• A fair and consistent prioritization and allocation policy should be developed before allocations become necessary.

• Decisions regarding allocation of scarce resources should be separated from bedside decision-making. The oncologist caring for a patient should not make scarce resource allocation decisions about that patient. 

• Oncologists should work with their institutions on how to best utilize scarce resources for the care and support of cancer patients. 

• Oncologists should communicate allocation plans and decisions to their patients with compassion and honesty, and health care institutions should offer support to oncologists in these communications. 

• Oncologists should engage in advance care planning discussions with their patients and carefully document patient preferences for goals of care, particularly end of life care. 

ASCO also indicated that The Hasting’s Center’s Ethical Framework for Health Care Institutions & Guidelines for Institutional Ethics Services Responding to the Coronavirus Pandemic should be used as a model for approaching ethical decision-making regarding resource shortages. 

Additionally, ASCO recommended the use of the University of Pittsburgh’s Allocation of Scarce Critical Care Resources During a Public Health Emergency, which provides guidance for decisions regarding severe shortage. Specifically, the framework recommends that if a policy takes pre-existing life-limiting diseases into account, it should do so consistently across types of disease and should consider evidence-based information regarding life expectancy. 

Moreover, the framework suggests that all cancer diagnosis and prognosis should be considered individually with input from the treating oncologist, and cancer diagnosis alone should not be considered terminal, even for patients living with advanced or metastatic disease. Consideration of cancer as either a major or severely life limiting comorbidity should reflect evidence-based factors including the individual patient’s clinical status and prognosis.

“Oncologists have great skill and expertise in treating the individual patient in front of them, but in a public health emergency like this one, we need to expand our view to also protect the health of the larger patient population,” Jonathan M. Marron, MD, MPH, FAAP, Chair-Elect of ASCO’s Ethics Committee and lead author of the recommendations, said in a press release. “Oncologists have an important role to play to promote resource allocation plans that fairly, objectively, and consistently consider patients with cancer, and to work with their institutions to communicate those decisions clearly to patients, families, and surrogates.”

References:

1. New Guidance Released for Oncology Community on Allocation of Limited Resources During COVID-19 Pandemic [news release]. Published April 9, 2020. asco.org/about-asco/press-center/news-releases/new-guidance-released-oncology-community-allocation-limited. Accessed April 13, 2020. 

2. Marron JM, Joffe S, Jagsi R, Spence RA, Hlubocky FJ. Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID19 Pandemic. Journal of Clinical Oncology. doi:10.1200/JCO.20.00960.