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Protecting Cancer Patients Against SARS-CoV-2

Objective: To convey recommendation on how to prevent COVID infection in cancer patients.

Cancer patients represent a vulnerable cohort related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or Coronavirus Disease 2019 (COVID-19) and are at an increased risk of severe respiratory complications, and even death.

The guidelines are designed and adopted to protect cancer patients against SARS-CoV-2. The recommendations are applicable for adult patients with solid tumors. For general population, these guidelines should be considered complementary to the standard rules.

Guidance on Protection of Cancer Patients against COVID-19

  • Close Monitoring: Cancer patients are at an increased risk of infection with COVID-19 and more prone to severe respiratory complications requiring admission to intensive care unit (ICU) compared to those without cancer. Hence, cancer patients should be carefully monitored.
  • Minimizing Exposure to COVID-19: In oncology or radiotherapy departments, contact between cancer patients and COVID-19 patients should be minimized as much as possible. COVID-19 patients should be isolated from cancer patients and referred to specialized departments for COVID-19. Open-space chemotherapy outpatient centers should incorporate separation measures such as minimum space between seats, mobile walls, and wearing of masks by patients and healthcare staff.
  • Limiting Inpatient Care: Hospital admission of cancer patients without COVID-19 should be minimized and management at home should be encouraged.
  • Discontinuing Systemic Treatment: Cancer patients with COVID-19 should discontinue the systemic anticancer treatments until their symptoms resolve at the doctor’s discretion.
  • Promoting At-home Management: Measures like encouragement of telemedicine and phone calls, switching from intravenous drugs to oral drugs (chemotherapy and hormone therapies), where possible, and allowance of at-home administration of intravenous and subcutaneous anticancer agents should be encouraged. Frequency of hospital admissions should be reduced by adjusting dosing schedules (e.g. from weekly administration to every 3 weeks or hypofractionated radiotherapy) or using treatment breaks in patients with slowly evolving metastatic cancer, at the discretion of the oncologist.

References Benoit, et al. The official French guidelines to protect patients with cancer against SARS-CoV-2 infection. Lancet Oncol. 2020. doi: 10.1016/S1470-2045(20)30204-7