ESMO Addresses COVID-19 and Cancer Care

The European Society for Medical Oncology (ESMO) released answers to key questions regarding the coronavirus disease 2019 (COVID-19) in order to help oncologists continue to manage cancer care during the pandemic. 

“So far, no systematic reports are available about a higher incidence of COVID-19 infections in patients with cancer,” ESMO wrote. “However, available data indicate that older people are more vulnerable, particularly when there are underlying health conditions such as chronic lung disease, cardiovascular disease, diabetes, chronic kidney disease, and active cancer.” 

For patients with cancer, ESMO suggests that the categories at risk include:

• Patients having chemotherapy, or who have received chemotherapy in the last 3 months.

• Patients receiving extensive radiotherapy.

• Individuals who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppressive drugs. 

• People with some types of blood or lymphatic system cancer which damage the immune system, even if they have not needed treatment (ex: chronic leukemia, lymphoma, or myeloma). 

Specific risk groups include patients with cancer who have an impaired immune system, such as those with leukocytopenia, low immunoglobulin levels, and long-lasting immunosuppression (i.e. steroids, antibodies). 

Currently, ESMO indicated that the impact of immunotherapy on a patient’s risk is a matter of debate. There is no clear evidence as of now that would allow the definition of the specific impact of such drugs on the course of COVID-19. 

However, co-infections of the upper airways could increase the risk of an adverse outcome in patients with viral infections, according to ESMO. Additionally, chronic inflammatory and obstructive pulmonary disease may increase the risk of major respiratory complications. Regardless, patients have been advised to discuss their individual risk profiles with their treating oncologist. 

Patients with cancer should pay special attention to:

• Cleaning their hands often.

• Washing their hands with soap and water or, if not available, using an alcohol-based hand sanitizer.

• Avoiding contact with sick people, particularly those who have a cough.

• Avoiding touching the face, nose, and eyes.

• Avoiding meetings, events, and other social gatherings in areas with ongoing community transmission. 

• Practicing social distancing.

ESMO recommends that patients with cancer be able to recognize the first sign of COVID-19 infection, such as fever, coughing, sore throat, difficulty breathing, muscle pain, and tiredness. Moreover, patients should contact their doctor or national health care services when returning from a risk region, after contact with an infected person, or when feeling symptoms related to COVID-19. 

For cancer healthcare professionals, ESMO recommends to:

• Promptly liaise with local administrators to set up proactive action and contingency plans for the provision of cancer care in the setting of the COVID-19 pandemic.

• In coordination with local administrators, explore strategies for splitting cancer healthcare personnel to operating and back-up crews rotating in shifts that are epidemiologically compatible with the disease’s incubation time of 14 days.

• Look into telephonic or web-conferencing capabilities in order to consult stable patients, especially those on oral therapies. 

• Establish strategies for “previous day” telephone triage for identifying patients with flu-like symptoms and for reducing large gatherings of patients in waiting rooms. 

• Discuss the benefits and risks of palliative care in regard to COVID-19 and local constraints, weighing in all relevant factors, such as disease prognosis, patient comorbidities, patient preferences, probability, and risks from infection.

• Discuss the benefits and risks of maintenance therapies and the options of “therapy holidays” during the pandemic. 

• Prioritize adjuvant therapies for patients with resected high-risk disease who are anticipated to derive a significant absolute survival benefit.

• Have conversations with patients regarding options of regimens and schedules that reduce the number of hospital visits during the pandemic, such as visits 2 or 3 weeks apart as opposed to weekly and oral or subcutaneous alternatives for treatment.

• Discuss shorter, accelerated, or hypo-fractionated radiation schemes with radiation oncologists where scientifically justified and appropriate for the patient.

• Use blood product transfusions strictly when necessary, given the risk of shortages. Donors should also be encouraged to continue to donate blood under the appropriate precautions. 

• Cite reliable information from scientifically driven sources, and refrain from using or sharing social media accounts and rumors.

• Gather informative material for cancer patients as well as psychosocial support projects for health care professionals and patients. 

“Many therapeutic approaches are being currently tested, including anti-proteases used in HIV (lopinavir/ritonavir), an anti-malaria drug (chloroquine), a new nucleotide analog (remdesivir), and a monoclonal anti-IL6 antibody (tocilizumab),” ESMO wrote. “Until such treatment and preventive measures are available, the researchers emphasize the importance of the full range of strategies for controlling SARS-CoV-2 – as for the ‘highly effective global public health response’ that led to containment of the SARS epidemic.”

Reference:

ESMO. What should medical oncologists know about COVID-19? ESMO website. Published 2020. esmo.org/newsroom/covid-19-and-cancer/q-a-on-covid-19. Accessed March 25, 2020.