Objective: To convey categories of cancer patients depending upon their risk stratification that help the physician to prioritize patients during COVID-19 pandemic.
Delayed treatment vs. COVID-19 exposure
Coronavirus disease 2019 (COVID-19) can have fatal effects on cancer patients. The oncology specialists now have a challenging task to 1) outnumber the benefits of delayed cancer diagnosis and/or treatment against the potential risks COVID-19 exposure, 2) reduce the risks for healthcare interruptions due to social distancing, and 3) judicious allocation of limited healthcare resources.
The requirement of intervention must be evaluated against the risk for COVID-19 exposure in the healthcare unit, especially when the risk for viral dissemination remains mysterious and cannot be quantified. Oncologic treatment (surgery, systemic chemotherapy, or radiation therapy) may lead to increased vulnerability to complications from COVID-19.
Prioritizing cancer treatment during the COVID-19 pandemic – general guidelines
The decision of treatment to initiate, continue, or delay cancer care depends on the risk of progression of cancer (low, medium and high risk of progression with cancer care delay) and risk for significant morbidity from COVID-19: low risk (less than 50 years) medium risk (50-70 years) and high (above 70 years) risk group.
- High risk of disease progression from delay of treatment – e.g. Chemotherapy for testicular, rectal, non–low-grade hematologic cancers, non–low-grade sarcomas, small cell lung cancer, head and neck cancers, except thyroid: Immediate treatment is recommended in patients with low and medium risk for significant morbidity from COVID-19, while for patients at high risk for significant morbidity from COVID-19, benefits should be evaluated against risk of morbidity before delivering cancer care.
- Intermediate risk of disease progression from delay of treatment – e.g. Chemotherapy for advanced breast, colon, and lung cancer: Delayed care for up to 3 months is acceptable for patients at high risk for significant morbidity from COVID-19. Potential benefits and risks should be weighed before providing treatment in medium risk group, while immediate treatment is recommended in low-risk group for significant morbidity from COVID-19.
- Low risk of disease progression from delay of treatment – e.g. chronic hematologic cancer: It is safe to delay treatment for > 3 months in patients of all the three risk groups of significant morbidity from COVID-19.
This guidance is general and consensus based. The decision should always include expert opinion of oncologists, each patient’s condition, and current situation of local healthcare system.
Reference: : Kutikov A, Weinberg DS, Edelman MJ, et al. A War on Two Fronts: Cancer Care in the Time of COVID-19. Ann Intern Med. 2020; doi: www.nice.org.uk/guidance/ng161 As Accessed on Apr 29, 2020.