Cancer Center Recommendations to Mitigate COVID-19 Impact in Patients With Cancer: Low-Resource Settings Version

Abstract

Liang et al 1 described a Chinese cohort of patients with cancer during the COVID-19 outbreak. The clinical characteristics and outcomes were relevant to our clinical practice. As a whole, patients with cancer have a higher risk for severe events (39% v 8%; P = .0003), including death. Outcomes are even worse in patients who received active treatment in the first month before infection (75% v 43%; odds ratio, 5.34). These patients also had a faster evolution to deterioration (13 v 43 days; P = .0001).

SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression

“…Multiple recommendations and guidelines have been generated around the use of immunosuppressors or cytostatics in the oncology field, 100 such as cyclophosphamide, doxorubicin, cytarabine, vinblastine, as well as immunotherapy and the use of biological drugs in the context of cancer, according to the type of neoplasm in the context of risk or presence of COVID-19 infection, suggesting in general a decrease in dose, but always balancing individual cases according to the type of neoplasm, stage and immunosuppressive scheme proposed. 58 …”

A Review of Clinical Practice Guidelines and Treatment Recommendations for Cancer Care in the COVID-19 Pandemic

“…In an attempt to help cancer centers in low-resource settings, authors from Colombia created some adjusted recommendations such as (1) assuring social containment; (2) moving tumor boards and scientific meetings to virtual modalities; (3) changing of immunotherapy to 4 or 6 week schedules for selected patients, switching to oral therapies for advanced cases with intravenous treatments, and temporarily discontinuing noncritical therapies, such as bisphosphonates or denosumab; (4) using strict selection criteria for in-hospital chemotherapy. According to these authors, only potentially curative chemotherapy with severe toxicity profile should be delivered to inpatients for acute leukemias, high-grade lymphomas or soft tissue sarcomas [ 20 ].…”

“…We conducted a literature search using PubMed to identify articles published in English language that reported on cancer patient care recommendations during the COVID-19 pandemic from inception up to 1st June 2020, using the terms “(cancer or tumor) AND (COVID-19)” ( Table 1 ) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , ...…”

Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: More relevant than ever before in the COVID era

“…In head-neck cancer, hyperfractionated RT [11] , [12] appears to be the best form of altered fractionation and is associated with an 8% improvement in overall survival compared to conventionally fractionated RT. However, hyperfractionation is more resource-intensive (delivering 2 fractions per day with no reduction in overall treatment time) that makes it impractical and undesirable, particularly in the current context of the COVID-19 pandemic, wherein the underlying principle is to reduce the number of fractions/visits to the hospital to reduce the risk-exposure to patients and staff, as well as to allow more efficient utilization of resources [22] , [23] , [24] . The recently published ASTRO-ESTRO consensus statement [25] on practice recommendations for risk-adapted head and neck cancer RT during COVID-19 pandemic turns out to be overly conservative towards altered fractionation schedules.…”