|Year : 2020 | Volume
| Issue : 1 | Page : 1-3
COVID-19 and Cancer Management
Anurag Mehta1, Abhishek Mohanty2, Shalini Agnihotri2
1 Department of Laboratory & Transfusion Services, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India; Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
2 Department of Research, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
|Date of Submission||16-Jun-2020|
|Date of Acceptance||16-Jun-2020|
|Date of Web Publication||08-Jul-2020|
Dr. Anurag Mehta
Director Laboratory & Molecular Diagnostic Services and Research, Rajiv Gandhi Cancer Institute & Research Centre Sector-V, Rohini, Delhi,
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mehta A, Mohanty A, Agnihotri S. COVID-19 and Cancer Management. J Curr Oncol 2020;3:1-3
The raging pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly across 190 countries, affecting more than seven million people (and still counting), causing death, despair, and economic disruption of unparalleled magnitude. As the virus spreads frenziedly, lockdowns and travel restrictions have become commonplace causing delays for patients seeking treatment. Heightened vulnerability of patients with cancer to serious form of COVID-19 due to their immunocompromised state poses a serious challenge in managing their safety during their hospital visit. Early reports show that diagnostic and therapeutic interventions in patients of cancer with COVID-19 may actually worsen the outcomes. This raises the need for a new risk–benefit calculator to answer “whether deferring treatment for cancer till COVID-19 has resolved is a right option in a particular case”? For instance, the type of cancer, its metastatic potential, and biological behavior will be the key determinants to choose between early or deferred intervention.
Besides these concerns for patients, there are concerns for the well-being of care providers who are not trained to deal with a highly transmissible disease with serious pathogenicity such as COVID-19, and they need to be trained, reassured, and psychologically supported. Providing care remotely, prioritizing treatment, and deferring intervention whenever possible, ensuring that patients and care providers are protected from COVID-19 are the new problems that physician will have to handle besides maintaining his own physical and mental well-being.
| Reducing Visits of Patients to Hospital and Providing Care Remotely|| |
Face-to-face interactions need to be minimized. All patients must be registered online or telephonically. All patients seeking treatment should be telephonically screened via a questionnaire for symptoms of COVID-19, and if symptomatic, they should be advised to meet their primary care physician. In confirmed COVID-19 cases, the visit should be rescheduled to post recovery. High priority cases in need of treatment or continuation of treatment should make a shared decision with their physicians after proper risk–benefit explanation. In lesser priority cases, deferring treatment with greater watchfulness by health-care team via telecalling can be a useful strategy. Patients on active outpatient anticancer therapy should be categorized into oral or intravenous therapy, and considerations such as switching intravenous therapy to acceptable oral alternatives, decreasing frequency of regimens, and availing chemotherapy break or holiday on individual basis should be assessed. Other practical approaches toward limiting patient travel are by a home collection of diagnostic samples or utilizing a local diagnostic facility, home infusion of chemotherapy, telephonic or web-technology consultation, and prescription renewal.
| Prioritizing Treatment|| |
Prioritizing treatment on the basis of risk–benefit assessment is necessary given the much higher risk of the patient’s susceptibility to contract SARS-CoV-2 infection and the adverse outcome if the patient develops COVID-19 while on treatment. Nevertheless, some patients either because of the benefit of immediate intervention or for the fear of losing the window of opportunity to administer curative treatment need to be treated. National Health Service England has given excellent guidelines to prioritize patients for cytotoxic therapy and radiotherapy. A detailed organ wise prioritization of management has been formulated by European Society of Medical Oncology.[Figure 1] depicts the risk and need for early or deferred intervention in different cancer types and can be used as a guide; however, clinician’s own reasoning and prudence shall be exercised in each case.
|Figure 1: Recommendations in this figure are to be used as a general guideline only. Expert oncologic opinion should be considered to individual patient. COVID-19 = coronavirus disease 2019, Ca = cancer, H&N = head and neck, PCa = prostate cancer, RT = radiotherapy, Leuk = leukemia, HR+ = hormone receptor-positive, ADT = androgen deprivation therapy|
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| Ensuring Protection of Patients and Health-Care Providers from COVID-19|| |
Foremost, limit access to the facility. Maintain one’s entrance that leads to triage enclosure. Triage should be carried out outside the physical facility. Social distancing, mask wearing, and hand sanitization should be enforced within the hospital premises. Dissuade patients to bring attendants unless necessary for intellectual or physical reasons. The screening and COVID-19 status should be clearly stated before them entering the main facility. Once inside the hospital, efforts should be made to minimize time in the waiting bay by careful scheduling. Crowding in the waiting bay and unnecessary interactions with hospital staff should be discouraged. Social distancing and wearing mask should be supervised. Patients and attendants should be advised to stay in the hospital for minimum time necessary. The health-care personnel (HCP) must always wear medical grade mask when interacting with patients. While visiting patients of cancer with COVID-19, full personal protective equipment (PPE) must be worn. Donning and doffing of PPE should be carefully carried out. It will be good practice to train and retrain HCP in proper wearing and taking off the PPE, especially the latter. Social distancing should be practiced while attending to such a patient as much as possible. All HCP should be screened for fever and flu-like symptoms at the start of the tour of the duty. Any HCP feeling fever or other symptoms, suggestive of COVID-19, should inform the superior and immediately separate themselves from patient care. The hospital should make all efforts to quantify the need of personnel to effectively take care of patients and minimize the staff to optimal number. The patient care in COVID-19 era will need customization and frequent discussions with professional colleagues. Arrangements should be made for all interdisciplinary and intradisciplinary consults through web meeting apps. Any HCP who contracts infection should be isolated or admitted to the designated COVID-19 facility immediately. The contact tracing and testing of contacts should be swift, and all contacts should be strictly advised to home isolate till declared negative. Last but not the least, the surface disinfection, environmental sanitation, and canons of time-tested universal precautions should continue to be practiced stringently.
The HCP is facing enormous challenges in meeting the community expectations of them in line with the tenets of Hippocratic Oath and instincts of safety of self and family. These divergent needs are causing severe mental stress. It should be the responsibility of the health administrators and community to provide them with social support and access to positive mental health.
None of the aforementioned preventive strategies is adequate by itself, but in combination, these can help to provide safer care to patients with cancer in this era of COVID-19.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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