- Delaying Treatment or Accepting Harm of Exposure?
- Many solid tumors (such as lung or pancreatic cancer) and some hematologic cancer (such as acute leukemia or aggressive lymphomas) require immediate diagnosis and treatment, opposed to other common early-stage cancers (breast, prostate, cervical, nonmelanoma skin…) that may not need immediate action and therefore prevent unnecessary exposition.
- For persons with advanced oncologic disease, futility of treatment in the context of this pandemic must be considered and discussed.
- Social Distancing and its Effects on Oncology Care Delivery.
- Implementation of modern information technology platforms (such as telemedicine) offers a good alternative to classic in-clinic medicine, especially for survivorship care patients.
- There are concerns regarding clinical trials, as supply of novel drugs may be compromised. Clear instructions and methods to preserve integrity of the studies while enhancing patient safety are urgently needed.
- Allocation of Limited Resources.
- Difficult tradeoffs will need to be made, as the cancer care supply chain may be in direct conflict with the supply chain needed to treat COVID-19. They both use wards, intensive care unit beds, ventilators, pharmaceuticals, blood products, staffs and basic medical supplies.
- Many standard post-acute treatment strategies that bring patients into care centers (such as imaging studies) can also be thoughtfully postponed.
« My queasy conscience now wrestles with the possibility of a bimodal peak of cancer patients dying: the imminent spike of those with decimated immunity falling victim to Covid-19 and the latent toll on those whose treatments were de-intensified, delayed, or canceled altogether. » – Marc A, Lewis, Oncologist at Intermountain Healthcare, Murray, UT.
This article was written by a group of experts at Fox Chase Cancer Center, Philadelphia, US. Guidelines about specific cancer type timeline of treatment are offered by many associations.
- Kutikov A., Weinberg D., Edelman M., Horwitz E., Uzzo R.G., Fisher R.I. (March 27, 2020).A War on Two Fronts: Cancer Care in the Time of COVID-10. Annals of Internal Medicine. https://doi.org/10.7326/M20-1133
- Lewis M.A. (April 7, 2020). Between Scylla and Charybdis – Oncologic Decision Making in the Time of Covid-19. The New England Journal of Medicine (NEJM). https://www.nejm.org/doi/full/10.1056/NEJMp2006588