Shifts In Cancer Care May Ease Strain On Public-Health System During Pandemic

Clinicians caring for cancer patients during the COVID-19 pandemic must balance the usefulness of any intervention against the risk of exposure to the virus, in the setting of care disruptions and limited healthcare resources, according to a new opinion piece in the Annals of Internal Medicine.

"The combat plan during this battle must involve patience, communication, diligence, and resolve," Dr. Alexander Kutikov and colleagues from Fox Chase Cancer Center in Philadelphia note in the article. "Risks must be balanced carefully, public health strategies implemented thoroughly, and resources utilized wisely."

Older people and those with comorbidities, including cancer, are more vulnerable to COVID-19, while patients may also be more at risk after receiving cancer treatment, Dr. Kutikov and his team note. Some solid tumors and hematologic malignancies require immediate treatment, but others do not, they add.

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

Consensus recommendations on aspects of triage decisions in cancer treatment are already being released, they note. "For persons with advanced oncologic disease, futility of treatment in the context of COVID-19 must be frankly considered and discussed," they add.

Patients who receive traditional oncology care, including those enrolled in clinical trials, during the pandemic can disrupt social distancing and increase the likelihood of viral spread, Dr. Kutikov and his team point out, while the supply of drugs used in clinical trials may also be interrupted.

"The National Cancer Institute and the US Food and Drug Administration have issued preliminary guidance regarding these issues, but there is an urgent need for clear instruction and methods to preserve the integrity of the studies while enhancing patient safety during this period," they write.

Expanded use of telehealth can help preserve social distancing while reducing the burden on the health care system, according to the authors.

"Although most cancer care is not typically considered 'elective,' as resource constraints grow owing to supply chain issues, variations in geographic needs, and reallocation of medical infrastructure to care for infected patients, difficult tradeoffs will need to be made," Dr. Kutikov and colleagues write. "Education of providers and patients can help in this setting. Similarly, many standard postacute treatment strategies that bring patients into care centers and utilize such resources as laboratory testing, imaging, and office visits can also be thoughtfully postponed to reduce burden on the health care system."

—Reuters Staff

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