The COVID-19 pandemic has created unique circumstances and challenges for cancer care. These challenges can be further compounded by variables such as geography and a variety of health setups.
Challenges for Cancer Patients
Due to their immunocompromised situation, cancer patients are more susceptible to infection. They typically require repeat visits to the hospital for care and receive a variety of potential immunosuppressive treatments such as surgery, radiotherapy, and chemotherapy. The risk incurred is significant, with one study suggesting that cancer patients are 3.5 times more likely to be infected than the general population. According to the WHO, they are 5 times more likely to die.
As such, specialists in the field of oncology must prepare swiftly for the reality of different treatment decisions, even involving rationing care to some of their patients.
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In response, several cancer centers around the globe have implemented guidelines and protocols to reduce these risks, while still providing quality continuous cancer care.
Their efforts revolve around one central question: whether delaying care or bringing their patients into the hospital environment presents the greater risk to their patients.
In a recent article, Dr. Masumi Ueda and her colleagues draw conclusions from their own experience in Seattle, while considering a number of challenges such as infection and environmental control, outpatient care and treatment decisions, inpatient care, as well as ethical implications and the physical well- being of the medical staff.
With that in mind, I would like to present several effective ways hospitals have responded that are worthy of consideration:
Reorganizing the Hospital’s Physical Space
A critical challenge for hospitals is keeping patients and staff safe in what is a naturally crowded environment. Due to the unique aspects of the hospital setting, it is worthwhile to install the infrastructure necessary for quality virtual consultations. Now is a great time for hospitals to explore the various technological solutions for telehealth, something that could provide a long-term benefit. This should also be considered a way to allow for the early discharge of patients in order to free up beds for COVID-19 patients.
When virtual consultations are impossible, all patients, staff, and visitors should be screened for symptoms and a high temperature at specific entry points to outpatient and inpatient facilities. For those patients receiving intravenous chemotherapy, infusion chairs need to be separated by 2 meters.
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Delay of Care
The most difficult decision to make is when to delay care in order to keep patients at home. Below are a few key guidelines:
- All treatments and procedures unlikely to adversely impact the patient’s outcomes should be considered for delay.
- Patients receiving adjuvant treatments with curative intent should probably continue with treatment, while following the recommended preventative infection care steps.
- Patients with hematological cancers, requiring stem cell transplantation and other chemotherapy and biological treatments with curative potential, should continue and not delay their treatments, if possible.
- Cancer surgery requires prioritization over all elective surgery, but in some instances, cancer surgeries may be delayed, and the patient may first undergo their other recommended treatments (hormonal, chemotherapy) before surgery can be scheduled.
- Patients receiving treatments for advanced or metastatic disease could be considered for a delay in treatment. However, this might cause the patient’s status to worsen, losing the window period for treatment. Therefore, this needs to be balanced, taking into consideration the patient’s general condition, as well as their possible need for hospital admissions, stressing further inpatient resources.
Rationing of Care
A tragic outcome of the new stress that the COVID-19 pandemic has placed on the medical system is that an already limited number of resources must now be stretched across a wider population. Some medical systems must confront the fact that they may not be able to provide sufficient care for all their patients and attempts to do so will cause more harm. Hospitals must now have discussions about when and whether to discuss with cancer patients who are COVID-19 infected about end-of-life and palliative care. Ignoring this terrible subject will lead to difficult and harmful results when the decisions need to be made.
We must accept that COVID-19 is a severe infection and that cancer patients are at high risk. Stringent and dedicated interventions are necessary, as this represents a major healthcare challenge for humanity. It is upon the oncological community to work together to develop the best possible operating procedures to maximize patient outcomes and reduce risk.
Dr. Daniel Vorobiof is the Medical Director of Belong.Life, the world’s largest social network and navigator app for cancer patients, caregivers and medical professionals. He is the founder and former medical director of the Sandton Oncology Centre in Johannesburg and has published more than 100 peer reviewed articles in international medical journals. He formerly served as an executive board member of the International Committee of ASCO.