Clinicians Discuss Best Approaches for Treating Patients with Cancer During COVID-19 Pandemic

In a paper published in the Annals of Internal Medicine, clinicians advised the best approaches for treating patients who have been diagnosed or are currently under treatment for cancer during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

The clinicians, from Fox Chase Cancer Center, wrote that, “oncology specialists as well as other providers regularly involved in the diagnosis, active treatment, and longitudinal follow-up of patients with cancer must consider how to 1) balance a delay in cancer diagnosis or treatment against the risk for a potential COVID-19 exposure, 2) mitigate the risks for significant care disruptions associated with social distancing behaviors, and 3) manage the appropriate allocation of limited health care resources in this unprecedented time of health care crisis.”

The current findings suggest that a current or past cancer diagnosis appears to put patients infected with COVID-19 at substantially increased risk. Given this, the utility of intervention in patients with cancer must be weighed against the risk for inadvertent COVID-19 exposure in the healthcare system, according to the clinicians, because the risk for viral dissemination cannot be quantified and is still largely unknown. 

“The quality of evidence in some cases is inadequate to support ‘one size fits all’ statements applicable to every patient,” the authors wrote. “However, experienced oncology providers should feel confident exercising judgment regarding which patients need to initiate or continue treatment owing to their tumor's more aggressive biology versus those who can tolerate a delay.”

Taking social distancing into consideration, opportunities to minimize contact with patients who have cancer, such as telehealth options were highlighted in the paper. Moreover, with this need for social distancing even in clinical trials, the clinicians indicated that there is an urgent need for clear instruction and methods to preserve the integrity of the studies while simultaneously enhancing patient safety during this time.

“Implementation of nontraditional care delivery strategies and harnessing of modern information technology platforms, especially for patients who are receiving survivorship care, offers tremendous opportunity to minimize the negative effect of cancer care delivery on public health efforts,” the authors wrote.

During the COVID-19 pandemic, cancer care utilization of ward and intensive care unit beds, ventilators, pharmaceuticals, blood products, staff and other basic medical supplies may directly conflict with the treatment of those with COVID-19. Further, though most cancer care is not traditionally deemed “elective,” as resources become scarcer there will need to be difficult decisions and tradeoffs made.

However, the clinicians suggest that education of providers and patients could help in this setting. Additionally, many standard post-acute treatment strategies that bring patients into cancer care facilities may be able to be thoughtfully postponed, such as laboratory testing and imaging, in order to reduce burden on the health care system. 

“The combat plan during this battle must involve patience, communication, diligence, and resolve. Risks must be balanced carefully, public health strategies implemented thoroughly, and resources utilized wisely,” the authors wrote. “Furthermore, the policies and procedures developed today will serve as the basis for addressing the next outbreak or similar crisis.”

Reference:

Kutikov A, Weinberg DS, Edelman MJ, Horwitz EM, Uzzo RG, Fisher RI. A Ware on Two Fronts: Cancer Care in the Time of COVID-19. Ann Intern Med. 2020. doi:10.7326/M20-1133.