As doctors, we all have general responsibilities in relation to coronavirus and for these we should act on national and local guidelines. We also have a specific responsibility to ensure that essential cancer service care continues with the minimum burden on the hospital.
Who is at specific risk?
So far, no systematic reports are available regarding a higher incidence of COVID-19 infections in cancer patients.
Available data indicates that older people are more vulnerable, with underlying health conditions such as chronic respiratory, cardio-vascular or chronic kidney disease, diabetes, active cancer and more generally severe chronic diseases. Therefore, during the COVID-19 pandemic, the Benefit: Risk ratio of cancer treatment may need to be reconsidered in various patients.
Two groups of patients have been identified:
For all patients (A and B) it is mandatory to provide health education:
Group-(B) Patients receiving active treatment:
Whether patient living in epidemic zones or not, there should be specific pathways in order to guarantee timing of treatment with curative intent and also for patients with metastatic disease. Outpatient visits for cancer patients should be reduced to the safest and most feasible level without jeopardizing patient care.
For patients receiving oral treatment for which monitoring can be done remotely, drug supply should be provided for at least 3 courses to reduce their visits to the hospital. Blood monitoring for those patients can be done in local labs also or by home sample collections. We suggest implementation of telemedicine services. We advise to delay all follow-up visits. Intensive measures should be under taken to avoid nosocomial spread. Strict and safe triaging procedures should be followed
Special attention should be considered in case of recent new symptoms such as:
In such situations, recommendations include: