ESMO management and treatment adapted recommendations in the COVID-19 era: colorectal cancer

Abstract

COVID-19 pandemic challenges health system capacities in many countries. National healthcare services have to manage unexpected shortage of healthcare resources that have to be reallocated according to the principles of fair and ethical prioritisation, in order to maintain the highest levels of care to all patients, ensure the safety of patients and healthcare workers and save as many lives as possible. Beyond that, cancer care services have to pursue restructuring, following the same evidence-based dispositions. In this article, we propose guidance to the management of colorectal cancer during the pandemic, prioritised according to a three-tiered framework, based on expert clinical judgement and magnitude of benefit expected from specific interventions. Since the availability of resources for diagnostic procedures, surgery and postoperative care, systemic therapy and radiotherapy may differ, authors did separate prioritisation analyses. The impact of postponing or abrogating cancer interventions on outcomes according to a high, medium or low priority scale, is outlined and discussed. The implementation of healthcare services using telemedicine is explored: it reveals itself as functional and effective for limiting patients’ need to travel to centres and thereby has the potential to reduce diffusion of severe acute respiratory syndrome coronavirus 2. Colorectal cancer demands a considerable amount of medical resources. Therefore, the redefinition of its diagnostic and therapeutic algorithms with a rigorous method is crucial in order to ensure the highest quality of continuum of care in the broader context of the pandemic and the challenged healthcare systems.

Perspectives, fears and expectations of patients with gynaecological cancers during the COVID‐19 pandemic: A Pan‐European study of the European Network of Gynaecological Cancer Advocacy Groups (ENGAGe)

“…Healthcare systems have been challenged on multiple levels across all continents and modifications of care were urgently undertaken in order to adjust to a dynamic rapidly evolving public health emergency 1 . As demands on physical infrastructure and personnel resources were pushed to their limits, the weakest many vulnerable patient groups, such as those with advanced and chronic cancer conditions, have been most affected 1‐5 . The strict rules, introduced by many governments, created priority levels to which patients treatment would have to be modified and in some cases postponed, to facilitate the rapidly developing healthcare restrains and to increase the availability for patients with COVID‐19 6‐13 .…”

The Risk and Prevalence of COVID-19 Infection in Colorectal Cancer Patients: a Systematic Review and Meta-analysis

“…The pandemic has brought great challenges to the important elective screening and diagnostic procedures for colorectal cancer (CRC) [16,22]. During the pandemic, the ability of colorectal surgeons has been affected to offer care to the CRC patients globally [22,23]. To date, some studies have been performed to evaluate the risk and prevalence of COVID-19 in CRC patients, but the results of these studies were inconsistent due to limited sample sizes.…”

Restoration of Colorectal Services in the Recovery Phase of the COVID-19 Pandemic: A view from Oxford

“…Much of the literature has focussed on guidelines and strategies to maintain services for colorectal cancer throughout the pandemic. (8)(9)(10)(11) In the UK, we are now entering the recovery phase of the pandemic, and we are gradually opening up our elective services to meet the clinical needs of all our patients. In this paper, we describe our strategy and the implementation of new patient pathways to help streamline our service.…”