NCCN Offers Strategies and Best Safety Practices During the COVID-19 Pandemic

In an article published by the Journal of the National Comprehensive Cancer Network (JNCCN), researchers reviewed strategies and provided information on the best safety practices during the coronavirus disease 2019 (COVID-19) pandemic. 

“Undoubtedly, healthcare providers have had to rapidly alter care delivery models while simultaneously acknowledging the crucial unknowns of how these changes may affect clinical outcomes,” the authors wrote. “At a time when terms such as social distancing and flattening the curve have become a part of our vernacular, it is essential that we understand what measures can be implemented to protect patients and healthcare workers.” 

Many facilities have already implemented interventions to prescreen and screen patients for symptoms suggestive of COVID-19 infection. In some cancer centers, prescreening efforts have even begun to be performed via phone or digital applications. 

In the cancer population, a unique challenge has been presented in that many patients undergoing cytoreductive therapy, especially those with lung disease, may experience similar symptoms as a consequence of their treatment or as a result of their underlying disease process. Because of this, it is especially important to ensure patients with cancer are properly assessed for other potential etiologies, including other infections.

Should patients present with mild symptoms, they should be encouraged to stay at home with close monitoring, according to the researchers. If possible, evaluations via telehealth should be coordinated to decrease the risk of exposure to other patients and staff. However, if patients are unstable and are referred to the emergency department (ED), it is suggested that a separate area within or outside the ED be designated for vulnerable populations, including those with cancer. 

“These screening clinics allow for dedicated staff to evaluate and potentially test symptomatic patients for SARS-CoV-2,” the authors wrote. “Some cancer centers have also created off-site testing locations, including drive-throughs, which allow for efficient testing of symptomatic patients without increasing exposure risk.”

If symptomatic patients come into a cancer center for treatment following a negative prescreening assessment, it is recommended that they be proved with a mask and directed to a screening clinic for evaluation and potential testing prior to moving forward with any cancer-directed therapies. Centers should also develop strategies for the management of such patients, including rescheduling nonessential visits. 

For patients who are symptomatic or have tested positive for COVID-19, some cancer centers have created cohorted treatment areas. Additionally, the researchers indicated that patients who are COVID-19 positive or under evaluation for COVID-19 may receive their care in designated units when admitted to the hospital. 

In regard to caregivers, it is important that they are educated on the virus and its symptoms, as though they may not be at a high risk for complications from COVID-19, their close relationship with a patient with cancer could put the patient at risk. As an extension of this ideal, many cancer centers have implemented limited or no visitor policies with exceptions for those with disabilities or for those at the end of life. 

“In an effort to include caregiver support during patient visits and treatments, telephone or video communication with caregivers should be accommodated,” the authors wrote. “Cancer center policies can be communicated to patients and visitors via letters, emails, and at phone screening to set appropriate expectations.”

As individuals on the front-line for COVID-19, healthcare workers have been deemed a high-risk population. The optimal approach to protecting this vital population in the face of a worldwide shortage of PPE has been addressed by various public health agencies. Moreover, the World Health Organization recommends contact and droplet precautions (including eye protection) for the management of suspected or confirmed COVID-19 cases.

However, in addition to PPE use, the researchers outlined several other measures to protect healthcare workers, including the early adoption of travel restrictions, arranging meetings over teleconferences, and establishing clear guidelines on when to stay at home and when to return to work. Further, healthcare workers with any concerning symptoms or history of exposure should self-isolate and not report to work. 

“Institutions should develop COVID-19 hotlines in collaboration with occupational health services to triage symptomatic healthcare workers to screening clinics for rapid testing,” the authors wrote. “If a healthcare worker is exposed to a COVID-19 positive patient without appropriate protection, they should contact the occupational health office of their institution for guidance on local policy. Investigation of exposure history should also be performed by occupational health to identify any other individuals who may be at risk.”

The primary focus overall though, according to the researchers, should be keeping all of the healthcare team members, caregivers, and patients informed during the rapidly evolving situation that is COVID-19. Developing and distributing regular content will not only help inform those in the field but will also provide patients and their families with a sense of ease.

Reference:

Cinar P, Kubal T, Freifeld A, et al. Safety at the Time of the COVID-19 Pandemic: How to Keep our Oncology Patients and Healthcare Workers Safe. JNCCN. doi:10.6004/jnccn.2020.7572.