Clinical data on the impact of COVID-19 is not adequate. It is still evolving. However, there is evidence to suggest that people with chronic diseases like cancer have higher risk of infection than others. The infected cancer patients can also develop more serious complications.
Hence, global organisations of oncology professionals like American Society for Clinical Oncology have already issued guidelines to help cancer patients and oncology professionals to cope with the impact of COVID-19, while still continuing cancer management. But most of them relate to guidelines for infection control and prevention in the context of current pandemic.
Home is the new hospital
Patients should opt for home care when it is medically feasible, and logistically feasible for medical team and caregivers. Patients who are not on active cancer treatment do not have to visit doctors for routine follow-ups. Hospital visits for palliative therapy can be postponed, unless it is an emergency.
Even for patients with fever or other symptoms of infection, routine lab samples can be collected from home, instead of making them visit the clinic.
Embrace technology
This is also the right time to make full use of telemedicine for consultations and patient-doctor interactions. Patients who are on follow-up or oral drugs or on maintenance therapy in remission can consult their oncologists using phone, WhatsApp or email, and avoid unnecessary hospital visits.
Screen patients, donors and visitors
Doctors should screen patients for COVID-19 prior to the initiation of treatments that are scheduled and cannot be postponed. It is better to get the screening done one day in advance.
Screening is important for blood donors as well, though there is no evidence that the infection spreads with blood transfusions. As a general precaution, hospitals should make strict restrictions on visitors and visiting hours – and screen all visitors.
When to continue the treatment
Clinical care must be delivered to all serious or emergency cancer cases — including oncological emergencies for radiation, as done routinely. And any medication (involving prophylactic antibiotics) or procedures of preventing diseases should continue because they may be of potential value in maintaining the overall health of the patient and make them less vulnerable to potential COVID-19 complications.
When to postpone treatment
But with patients diagnosed with COVID-19, it would be better to postpone active anti-cancer treatments. Chemotherapy can be stopped altogether for the infected patients when cancer is in deep remission and when it is given only as maintenance therapy. All major elective cancer surgeries and procedures can be delayed.
Another option is modifying treatments. Some patients may be able to switch chemotherapy from IV to oral therapies, which would decrease the frequency of clinic visits.
But doctors should make decisions on a case-to-case basis. As there is no specific evidence or published guidance either to support or delay cancer treatments like chemotherapy. In some settings delays or modifications of treatments may pose a higher risk of compromised disease control. They may affect the long-term survival rate of patients. Hence, withholding critical anti-cancer treatments is not recommended.
However, if the absolute benefit of the treatments is small, the potential of exposure to COVID-19 is high, and if the situation is not an emergency, it is advisable to postpone the treatment.
Doctors should consider all the risks and benefits, and the factors like patient’s age, general medical condition, and the stage of the disease, before deciding whether to continue with the treatments as usual or postpone it during the ongoing COVID-19 pandemic.
