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Prioritized and Safe Delivery of Systemic Anticancer Treatment During COVID-19

Objective: To convey amendments in the guidelines on choosing systemic chemotherapy during COVID 19 pandemic.

The National Institute for Health and Care Excellence (NICE) guidelines recommend healthcare professionals, staffs, and commissioners to follow specific treatment regimens for systemic anticancer treatment during the current Coronavirus Disease 2019 (COVID-19) pandemic. The recommendations are based on the existing national and international policies and expert opinions from specialists.

To prioritize systemic anticancer treatment, following factors should be considered:

  • Level of immunosuppression associated with different treatments and types of cancers, and risk factors of patients.
  • Capacity issues: Limited and inadequate resources (facilities, intensive care, facilities, protective equipment).
  • Evaluation of benefits of cancer treatment against the risk of the patient being immunosuppressed and risk of adverse outcomes from COVID-19.

Modifying Care for Delivering Safe Systemic Anticancer Treatments

Modification in delivery of systemic treatment to reduce exposure of cancer patients to COVID-19 and optimum utilization of resources is recommended. This includes different and less immunosuppressive treatments and alternative route of administration, where applicable.

Options for safe systemic anticancer regimen include:

  • Replacing intravenous administration with subcutaneous or oral alternatives, where beneficial
  • Selecting shorter treatment regimens
  • Reducing frequency of immunotherapy regimens (Switching to 4-weekly or 6-weekly regimens)
  • Avoiding patient visits by repeating prescriptions for oral medicines or at-home treatments
  • Postponing treatments to prevent long-term complications (for e.g. bone disease)
  • Promoting home delivery of oral medicines (Resilience of home care providers should be checked first)
  • Using breaks for long-term treatments (if possible, more than 6 weeks)
  • Following interim treatment regimens that allow clinicians to have more flexibility and additional treatment options to manage cancer during COVID-19 pandemic crisis

Policy decisions should be modified at organizational levels. Individual patient should be considered, and patients along with family members and caregivers should be informed about the risks and benefits of changing regimens or treatment breaks.

Reference: The National Institute for Health and Care Excellence (NICE). COVID-19 rapid guideline: delivery of systemic anticancer treatments. 2020. Available at: www.nice.org.uk/guidance/ng161.