Managing cancer patients during the COVID-19 pandemic: an ESMO multidisciplinary expert consensus

Abstract

We established an international consortium to review and discuss relevant clinical evidence in order to develop expert consensus statements related to cancer management during the severe acute respiratory syndrome coronavirus 2-related disease (COVID-19) pandemic. The steering committee prepared 10 working packages addressing significant clinical questions from diagnosis to surgery. During a virtual consensus meeting of 62 global experts and one patient advocate, led by the European Society for Medical Oncology, statements were discussed, amended and voted upon. When consensus could not be reached, the panel revised statements until a consensus was reached. Overall, the expert panel agreed on 28 consensus statements that can be used to overcome many of the clinical and technical areas of uncertainty ranging from diagnosis to therapeutic planning and treatment during the COVID-19 pandemic.

Synthesis of Recommendations From 25 Countries and 31 Oncology Societies: How to Navigate Through Covid-19 Labyrinth

“…Aiming at immunosuppression risk reduction, many societies [MOGA/AGCA, Bulgarian, Chinese, HDIO, IOL, SEOM, SOF/ RCCC, NHS/NICE, ASCO/NCCN/ACS/CDC, ESMO] recommend the use of prophylactic GCSF +/-antibiotics (2,(9)(10)(11)(12) and also reducing or tapering steroids as anti-emetics or immune-suppressants when appropriate. Dutch Oncology Society (NVMO) is against the prophylactic use of GCSF +/-antibiotics (13).…”

Figure 2 from: Cassetta L, Rodrigues PM, Andreu T, Botta B, Brandau S, Brierley C, Wilson C, Dadeshidze I, Forzi L, Ortelli F, Quintas MA.C (2020) Beating Cancer by 2030: Mission Impossible? Research Ideas and Outcomes 6: e61662. https://doi.org/10.3897/rio.6.e61662

“…Although the importance on investing resources in the fight against COVID-19 is recognised, cancer is still a deadly and economically relevant disease. Moreover, recent studies have highlighted the negative effects of the COVID-19 pandemic on the increase of avoidable deaths in four major tumours (Maringe 2020) and experts have shown the need to prioritizing the various aspects of cancer care to mitigate these negative effects in the management of cancer patients (Curigliano 2020) .…”

Updated general recommendations in cancer management during the COVID-19 pandemic in the Philippines

“…• Restructure the clinic or facility, as applicable, in accordance with the hospital infection control unit and/or safety and health committee recommendations. • Observe proper respiratory/coughing etiquette and disposal of used hygiene materials.• Decontaminate the workplace regularly following hospital and local recommendations.• Provide alternative ways of doing operations (i.e., online platforms for conferences and meetings, telemedicine for patients, as appropriate)[21,22]. • Limit the number of visitors or companions during admissions or clinic visits.2.…”

“…Emerging evidence and evolving guidance should be taken into account. The staff should be provided with the necessary education, training and assessment on the following[21,22]:• Infection control, proper selection and use and disposal of personal protective equipment and proper use of respirators.• Proper use and cleaning of equipment, clinic rooms, chemotherapy infusion facilities, among others.• Proper disposal of potentially infectious wastes.…”

“…includes, but is not limited to, cytotoxic chemotherapy, biologic therapy, immunotherapy, high-dose corticosteroids, extensive radiotherapy or stem cell transplantation. Ideally, the test should be conducted 48-72 hours prior to the start of the immunosuppressive treatment if patient resources or institutional logistics allow[21,22]. If the test is found impractical to do by the attending oncologist because of logistical/financial concerns or the patients' clinical sce-A systematic review showed that among asymptomatic individuals with possible exposure to COVID-19, the sensitivity of detecting active COVID19 infection with a 14-day symptom-based test is 92.8% and specificity is 98.3%[32].…”