Adapting Management of Sarcomas in COVID-19: An Evidence-Based Review

Gulia, Ashish; Arora, Ramandeep Singh; Raja, Anand; Tiwari, Afy; Bakhshi, Sameer; Salins, Naveen; Goel, Vineeta; Janu, Amit

doi:10.1007/s43465-020-00143-1

Cited by 12 publications

(17 citation statements)

References 45 publications

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“…Both cases needed urgent surgery due to their presentation and aggressiveness of disease and further underline the fact that surgery on cancer patients during the pandemic is associated with risks. In elderly patients with increased co-morbidities, intentional postponement of surgery could be considered especially in endemic areas, as highlighted following initial experience on dealing with cancer cases in China at the start of the pandemic [1] and other recent published guidelines [14,15]. Both patients who died in our series were females, which was different in relation to the earlier reports of male sex being a risk factor for higher mortality following cancer [5,6].…”

Section: Discussioncontrasting

confidence: 58%

Patient safety associated with the surgical treatment of bone and soft tissue tumours during the COVID-19 pandemic—results from an observational study at the Oxford Sarcoma Service

Rajasekaran

Kotecha

Whitwell

et al. 2020

International Orthopaedics (SICOT)

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Purpose Deferring cancer surgery can have profound adverse effects including patient mortality. During the COVID-19 pandemic, departmental reorganisation and adherence to evolving guidelines enabled provision of uninterrupted surgical care to patients with bone and soft tissue tumours (BST) in need of surgery. We reviewed the outcomes of surgeries on BST during the first two months of the pandemic at one of the tertiary BST centres in the UK. Materials and methods Between 12 March 2020 and 12 May 2020, 56 patients of a median age of 57 years (18-87) underwent surgery across two sites: index hospital (n = 27) and COVID-free facility (n = 29). Twenty-five (44.6%) patients were above the age of 60 years and 20 (35.7%) patients were in ASA III and ASA IV category. The decision to offer surgery was made in adherence with the guidelines issued by the NHS, BOOS and BSG. Results At a minimum follow-up of 30 days post-surgery, 54 (96.4%) patients were recovering well. Thirteen patients (23.2%) had post-operative complications which included four (7.1%) patients developing pulmonary embolism. The majority of complications (12/13 = 92.7%) occurred in ASA III and IV category patients. Four (7.1%) patients contracted COVID-19, of which three required escalation of care due to pulmonary complications and two (3.6%) died. Patients < 60 years of age had significantly less complications than those > 60 years (p < 0.001). Patients operated on in the COVID-free facility had fewer complications compared with those operated on at the index hospital (p < 0.027). Conclusion In spite of the favourable results in majority of our patients, our study shows that patients with sarcoma operated at the height of the pandemic are at a risk of contracting COVID-19 and also having associated with mortality. The use of a COVIDfree facility, surgery in patients < 60 60 years and in ASA I & II category are associated with better outcomes. If a second wave occurs, a serious consideration should be given to ways of minimising the risk of contracting COVID-19 in these vulnerable patients either by using COVID-free facilities or delaying treatment until peak of infection has passed.

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Section: Discussioncontrasting

confidence: 58%

Patient safety associated with the surgical treatment of bone and soft tissue tumours during the COVID-19 pandemic—results from an observational study at the Oxford Sarcoma Service

Rajasekaran

Kotecha

Whitwell

et al. 2020

International Orthopaedics (SICOT)

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“…SBRT is a good treatment option for these patients with unresectable or lung metastases from sarcoma. Preoperative RT for Ewing's sarcoma cases can be an option where surgery is not feasible or suitable ( Gulia et al, 2020 ). In specialized and dedicated centers, HDR-BT can be employed for soft tissue cases such as rhabdomyosarcoma.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Siavashpour

Goharpey²,

Mobasheri

2021

Critical Reviews in Oncology/Hematology

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Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.

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“…Prioritization of adjuvant therapy over palliative care for individuals with a high survival rate should continue, while patients with low to no survival rate may be considered a low priority. [23] Terminally ill individuals should be referred to palliative care service and managed at home if possible.…”

Section: Adjuvant and Neo-adjuvant Therapiesmentioning

confidence: 99%

Saudi orthopedic society guidelines for treating patients with bone and soft-tissue tumors during the COVID-19 pandemic

Juhani¹,

Sobeai²,

Alhamdan³

et al. 2021

J Musculoskelet Surg Res

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The coronavirus disease 2019 (COVID-19) pandemic presented a significant challenge to health-care systems globally. The Saudi government took rapid and unprecedented precautionary measures to limit this disease's explosive spread. [1,2] Nevertheless, severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) had infected almost 360,000 patients in Saudi Arabia by early December 2020. [3] This, in turn, jeopardized the ability of the health-care service to provide the required medical care for COVID-19 and non-COVID-19 patients. Cancer patients are more susceptible to infection than individuals without cancer because of the systemic immunosuppressive

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Adapting Management of Sarcomas in COVID-19: An Evidence-Based Review

Cited by 12 publications

References 45 publications

Patient safety associated with the surgical treatment of bone and soft tissue tumours during the COVID-19 pandemic—results from an observational study at the Oxford Sarcoma Service

Patient safety associated with the surgical treatment of bone and soft tissue tumours during the COVID-19 pandemic—results from an observational study at the Oxford Sarcoma Service

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Saudi orthopedic society guidelines for treating patients with bone and soft-tissue tumors during the COVID-19 pandemic

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