A French group of oncologists and radiotherapists, coordinated by You et al, formulated protocols to guide healthcare professionals and cancer patients in the prevention of severe infection by the new coronavirus (COVID-19), a condition that can lead to severe acute respiratory syndrome (SARS-CoV-2), maintaining the possibility of cancer treatment.
The data were published in The Lancet Oncology on March 25, 2020 under the supervision of the French Higher Council for Public Health (Haut Conseil de Santé Publique [HCSP]), at the request of the French Ministry of Health.
The guidelines were developed according to several lines of evidence and considering the following observations:
• Cancer patients have a higher risk of SARS-CoV-2 infection than the general population;
• There is an increased risk of severe respiratory complications with SARS-CoV-2, requiring more time in the intensive care unit in cancer patients versus patients without cancer;
• This risk is associated with a history of chemotherapy or surgery in the month prior to infection (a factor that includes most cancer patients);
• Cancer patients develop serious events in a shorter time than those without cancer;
• The guidelines are only for adult patients with solid tumors and complement the previous guidelines for the general population.
The main recommendations are:
• Prevention measures must be implemented in the oncology and radiotherapy centers, with the objective of avoiding any contact of cancer patients with COVID-19;
• Admission of patients with COVID-19 to oncology or radiation therapy centers should be avoided. If admitted to these centers, infected patients should be isolated from other cancer patients and transferred to specialized COVID-19 sectors as soon as possible;
• The presence of cancer patients in hospitals should be minimized based on susceptibility to SARS-CoV-2. Measures that allow the management of cancer patients at home should be encouraged, including the use of telemedicine and telephone calls. Substitution of intravenous drugs by oral chemotherapy and hormonal therapies is also encouraged within the allowed oncological indications. Measures that allow home administration of intravenous and subcutaneous antineoplastic drugs should be reinforced. Chemotherapy or radiotherapy regimens should be reconsidered in order to reduce the frequency of hospitalizations. Patients with slowly evolving metastatic disease should discuss temporary interruptions and / or prolonged treatment intervals with their oncologists;
• Various measures are proposed for cancer patients who need to be admitted to the hospital for systemic treatment or radiation therapy: healthcare professionals should make daily telephone calls to patients planned for admission to the oncology center the next day, to ensure that patients do not show symptoms of COVID-19 prior to admission to oncology or radiation therapy wards. Those with symptoms should be referred to departments specialized in COVID-19. Outpatient chemotherapy centers that have an open space must integrate patient separation measures, as well as the use of masks by patients and staff;
• If access to hospital cancer treatment is reduced due to the requisition of facilities for the management of patients with COVID-19 or if the probability of viral infection and life-threatening complications are considered to be very high, prioritizing the selection of patients a being admitted to the hospital for cancer treatment may be necessary. Prioritization must take into account the therapeutic strategy with a curative or non-curative intention, the patient’s age, life expectancy, time since diagnosis and symptoms;
• The following order of priority is suggested, but subject to the discretion of the doctor and the patient’s team: (1) cancer patients undergoing treatment with curative intent (favoring patients aged ≤ 60 or with life expectancy ≥ 5 years, or both); (2) cancer patients undergoing non-curative treatment and aged 60 years or less, or life expectancy of 5 years or more, or both, and in the first therapeutic line; and (3) other cancer patients treated with non-curative intent, favoring those whose lesions have progressed or whose symptoms can quickly compromise their life in the event of discontinuation of treatment. Patients who need to be hospitalized for supportive care (for example, pain management, bacterial infection or palliative care before death) can be referred to non-cancer departments, or even home care.
To learn more about the publication, visit: https://www.nejm.org/doi/full/10.1056/NEJMp030078
Liang, W, Guan, W, Chen R et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020; 21: 335-337