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cancer care in the time of COVID 19

the cancer collaborative is dedicated to its commitment to act as a hub for the cancer care community especially during the COVID 19 pandemic. we have been carefully monitoring the evolving situation and continue to maintain up to date information on COVID 19 and cancer throughout this pandemic, as they become available. this post is updated regularly, please check back for more information. last update 02.07.2020

the COVID 19 pandemic has resulted in social and economic disruption throughout the entire world. much of the focus has been on the rapid spread in italy, spain, and the US, the potential impact on the world’s poor, a majority of whom are living in asia, could be devastating. the success of nonpharmaceutical safety measures against coronavirus relies on widespread compliance, which is additionally challenging to achieve in low and middle income countries [LMICs]. many of these challenges are driven by economic insecurity and poverty. and most countries in asia pacific have higher out of pocket health care expenditures. the fragile, overburdened health care systems in most LMICs are particularly prone to severe disruption by natural and manmade disasters. emergency preparedness for cancer care is usually nonexistent in most LMICs. continue reading

patients with plasma cell dycrasias are known to be at high risk of infections. old age, frailty and co morbidities add to the complexity of patient management. COVID 19 poses a significant new threat to their health and well-being. the UK government recommended that myeloma patients shield an initial 12 well period because they fall in the extremely vulnerable group [PHE, 2020]. the thames valley cancer alliance [TVCA] myeloma group examined teh challenges to optimal myeloma outcomes which may be associated with these new COVID 19 related adaptations of care in UK routinee care and how clinical outcomes could be measures in the months to come. continue reading

the current cohort study used data on 928 patients with active or previous malignancy  with laboratory confirmed COVID 19 infection from the US, canada, and spain. a key secondary outcome measure was a composite outcome of severe illness defined as death, severe illness requiring admission to hospital, admission to the intensive care unit [ICU], use of mechanical ventilation, or a combination of these.

  1. risk factors for the severe disease composite endpoint included increased age, higher number of co morbidities, hematologic malignancies vs solid tumours, and progressing cancer.

  2. receipt of cancer treatments within 4 weeks of COVID 19 diagnosis was not associated with increased risk.

this study of patients with cancer and COVID 19 reinforces several important considerations for clinical care, and emphasizes the urgent need for more data. longer term follow up and larger sample sizes are needed to more completely understand the effect of SARS-CoV-2 on outcomes in patients with cancer. continue reading

COVID 19 in children with blood and cancer disorders. what do we know so far? published in the journal of pediatric hematology/oncology june 23. 2020

clinicians know very little about the incidence, treatment and outcome of children with blood and cancer disorders with COVID 19. here, researchers provide an update on the data in children with blood and cancer disorders. in conclusion, very few data are available on the treatment and outcome of COVID 19 in children with disorders of the blood or cancer. most children have a mild course and mostly recover. read the full article

a consortium of over 80 cancer centers and other organizations who have come together to collect data about cancer patients who have been infected with COVID 19. the intent is to rapidly collect and disseminate information about this especially vulnerable population.

ESMO has launched an international collaborative project, the ESMO-CoCARE registry, to quickly gather data and information from healthcare professionals about treatment approaches specifically focusing on the impact of  SARS-CoV-2 on cancer patients  who  are  suspected or confirmed  to have  the novel coronavirus disease [COVID19].

no cancer surgery is purely elective simply because it is scheduled ahead of time. this has placed surgeons caring for cancer patients in a uniquely difficult position regarding the appropriate selection and timing of surgery for patients whose individual interests they must balance with those of the healthcare system. guidelines from surgical societies have been offered with various levels of detail to help address this unprecedented dilemma. however, national society recommendations need to be adjusted to local circumstances. herein we present guidelines for surgical decision making and case prioritization developed among all adult disease specialties in the MD anderson cancer center departments of surgical oncology and breast surgical oncology in houston, texas. continue reading here

the european myeloma network has provided an expert consensus statement in order to guide therapeutic decisions in the era of the COVID 19 pandemic. patient education for personal hygiene and social distancing measures, along with treatment individualization, telemedicine and continuous surveillance for early diagnosis of COVID 19 are essential. treatment initiation should not be postponed for patients with end organ damage, myeloma emergencies and aggressive relapses. autologous [and especially allogeneic] transplantation should be delayed and extended induction should be administered, especially in standard risk patients and those with adequate MM response to induction. watchful waiting should be considered for standard risk relapsed patients with low tumour burden, and slow biochemical relapses. the conduction of clinical trials should continue with appropriate adaptations to the current circumstances. continue reading here

data about COVID 19 infection in cancer patients are scarce, and they point out a higher risk of complications due to the viral infection in this population. moreover, cancer treatments could increase viral complications, specially those treatments based on the use of immunotherapy with checkpoints antibodies. there are no clinical data about the safety of immune check point antibodies in cancer patients when they become infected by SARS-CoV-2. as checkpoint inhibitors, mainly anti PD-1 and anti CTLA-4 antibodies, are an effective treatment for most melanoma patients, avoiding their use during the pandemic could lead to a decrease in the chances of curing melanoma. continue reading here

real life overview of bladder cancer [BC] surgical management in Italy during the first month of COVID 19 pandemic [march 2020] with head to head comparison of the data from march 2019, considered “usual activity” period. the aim is to confront performance of academic centres [AC] vs non academic centres [NAC] as well as non COVID centres [nCC] and COVID centres [CC]. read the full article here

as COVID 19 continues to challenge the practice of head and neck oncology, clinicians are forced to make new decisions in the setting of the pandemic that impact the safety of their patients, their institutions, and themselves. the difficulty inherent in these decisions is compounded by potentially serious ramifications to the welfare of patients and health care staff, amid a scarcity of data on which to base informed choices. this paper explores the risks of COVID 19 incurred while striving to uphold the standard of care in head and neck oncology. the ethical problems are assessed from the perspective of the patient with cancer, health care provider, and other patients within the health care system. read the full article here

the effects of the COVID-19 pandemic on oncological surgery published in the journal of surgical case reports may 19. 2020

the COVID 19 global pandemic is changing the practice of oncologic surgery. accustomed to fighting cancer with all available means, surgeons are now being asked to delay treatment or make use of alternate strategies to conserve resources. telemedicine is being widely employed. we present our thoughts on this topic and where we might be in the next several months. read the full article here

The most important factor in the transmission of the disease is asymptomatic carriers. We’ve tested all oncology patients, that receive anti-cancer therapy, for COVİD-19 to prevent asymptomatic oncology patients from spreading infection and to make the decision to postpone chemotherapy in infected patients. Then, we analyzed the clinical and radiological findings of infected patients. read the full article here

The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert-response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. The best estimate was that 28,404,603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2,367,050 operations per week). Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity. read the full article here

“elective” cancer operations, while not “emergent,” have oncologic windows of opportunity that depend on tumour biology, treatment sequencing, and response to systemic therapy, and do not last indefinitely. there is a societal responsibility to balance the time pressures of individual oncologic surgical care against the societal goal of continued COVID 19 mitigation strategies, especially in the context of varied regional economic re-openings which began april 24. herein, we present the strategic approach for surgical rescheduling during and immediately following the COVID 19 first wave for the 9 departments in the division of surgery at the university of texas MD anderson cancer center, in houston, texas. continue reading the article here

COVID 19 has caused unprecedented societal turmoil, triggering a rapid, still ongoing, transformation of healthcare provision on a global level. in this new landscape, it is highly important to acknowledge the challenges this pandemic poses on the care of the particularly vulnerable cancer patients and the subsequent psychosocial impact on them. we have outlined our clinical experience in managing patients with gastrointestinal, hematological, gynaecological, dermatological, neurological, thyroid, lung and paediatric cancers in the COVID 19 era and have reviewed the emerging literature around barriers to care of oncology patients and how this crisis affects them. moreover, evolving treatment strategies and novel ways of addressing the needs of oncology patients in the new context of the pandemic are discussed. read the full article here

COVID 19 update from the NCI cancer imaging program published online radiology: imaging cancer may 8. 2020

The NCI research facilities are applying their significant expertise in virus biology to investigate potential vaccines, therapies, and research aimed at understanding the pathobiology of coronavirus infection and its heterogeneity in expression in different individuals. The NIH and NCI have issued several guidances on how investigators can cope with research and training pauses, as well as shut down facilities, particularly those activities with timelines. The NCI Cancer Imaging Program is utilizing The Cancer Imaging Archive resource to de-identify and publicly host an initial COVID-19 chest (CT and plain film) reference image dataset for health care providers worldwide and researchers interested in pursuing artificial intelligence (AI) approaches for diagnosis and recovery follow-up. Additionally, the NCI along with many other institutes at the NIH have issued supplemental funding announcements for funded investigators who want to direct a part of their research to COVID-19 biology issues. Interested investigators should view institute websites and contact their grants program officers for information. Altogether, the NCI is significantly involved in support of the NIH mission’s response to the demands on the scientific community for the coronavirus pandemic response. read the full article here

during the epidemic of COVID 19, the management model of colorectal cancer has to be changed at our centre due to relatively limited medical resources. outpatient visits are reduced under well protected after appointment, and rigorous investigation of epidemiological history and clinical symptoms are needed. we prefer a simple and convenient treatment regimen, which may also be postponed appropriately. minimally invasive CRC surgery combined with a perioperative program of enhanced recovery after surgery should be recommended. we also focus on mental health treatments and healthy lifestyle education. in addition, routine follow-up can be moderately delayed. in total, adequate doctor-patient communication is also recommended throughout the treatment. read the full article here

The coronavirus disease 2019 (COVID-19) pandemic is disproportionately affecting patients with cancer and is threatening the health and availability of the oncology workforce. Social distancing is required to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and telehealth is a key strategy to continue delivery of life-saving cancer care while protecting vulnerable oncology patients and providers alike. Significant challenges, including the lack of evidence-based practices, training, and experience, affect the ability of oncology practices to rapidly implement telehealth. read the full article here

lung cancer management challenges amidst COVID 19 pandemic. hope lives here published online lung cancer management may 1. 2020

as lung cancer patients are more vulnerable to unfavorable outcomes, there is an obvious need for immediate treatment and any delay could compromise survival. thus, managing lung cancer during the COVID 19 crisis is a challenging task and all necessary measures should be taken to protect both the patient and the staff, especially from asymptomatic carriers. currently, there are guidelines regarding the continuation of cancer treatment or delaying it, but the onus is on the oncologist after detailed discussion with the patient. continue reading here

researchers report a case of acute lung injury in a lung cancer patient initially treated for ICI-pneumonitis and later found to have concurrent SARS-CoV-2 infection. post mortem analyses revealed diffuse alveolar damage in both the acute and organizing phases, with a predominantly CD68+ inflammatory infiltrate. these date suggest the need for routine SARS-CoV-2 testing in cancer patients, where clinical and radiographic evaluations may be non-specific. read the full article here

when we talk about telemedicine, as with other technologies, the first concern is always its accessibility. a stable connection in remote areas is often problematic. the concern grows bigger for poorer patients with limited access to the internet. another obstacle could be the impossibility of carrying out an appropriate clinical examination from a distance. the biggest problem of all might be the selection of patients who are asked to come to the clinic and those who will be followed at home. patients can be divided into three subgroups with different recommendations: cancer patients in the follow-up phase or on oral therapy; patients with a recently diagnosed cancer under treatment with curative intent; and metastatic cancer patients receiving palliative treatment. finally, we approach the psychological aspect of the fight against cancer, where keeping the patient’s will is of the utmost importance. the lack of direct contact between the patient and the oncologist can adversely affect the patient’s well-being, motivation and sense of security, especially in times of uncertainty such as the current pandemic period. read the full article here

patients with chronic lymphocytic leukemia (CLL) have a median age of about 70 years at diagnosis, andthe majority suffer from additional medical comorbidities and immunosuppressed state. therapeutic agents for CLL have immunomodulatory effects that can potentially alterthe risk of contracting and response to infection. the interface of SARS–CoV-2 infection, severity of COVID–19symptoms, and active treatment of CLL represents a major therapeutic dilemma—should CLL–directed

therapy continue or be held? this is particularly true for patients receiving B-cell receptor kinase inhibitors where abrupt treatment discontinuation can result in rapid decompensation in some patients that could mimic COVID I9 symptoms. these overlapping syndromes bring forthanother layer of complexity to the management of these high risk CLL patients. since the beginning of the COVID 19 pandemic, the CLL community has encountered many questions regardingprimary prevention strategies, application of diagnostic tests for SARS CoV–2, and optimal management of CLL therapy in patients with COVID 19 illness. in the absence of clinical data guidingmanagement of CLL in the setting of COVID 19, expert opinion is critical until ongoing and planned future studies provide high–quality data for evidence–based guidelines. continue reading here

a new analysis estimates that at least 6270 additional deaths could occur in england over the next 12 months in patients with new cancer diagnoses—a 20% increase—as a result of the covid-19 pandemic. this number could rise to an estimated 17 915 additional deaths if all people who currently have cancer are considered, said the research from university college london and data-can, a health data research hub for cancer diagnosis and treatment. some of the excess deaths will be among people with cancer who contract COVID 19, while others will occur because diagnosis was late or treatment such as chemotherapy was delayed, the researchers concluded. read more here

no COVID 19 detour for global hematology therapies published online at onclive april 29. 2020

with travel restrictions and reduced transportation options, the global spread of coronavirus disease 2019 [COVID-19] has disrupted international networks that supply patients with biological materials needed for sophisticated hematologic therapies. for many patients with hematologic malignancies, the pandemic has delayed or limited hematopoietic stem cell transplantations. experts have advised weighing the benefits of transplantation versus the risks, with guidance varying by cancer type, according to COVID 19 resources that the american society of hematology has compiled. continue reading here

the data, was presented april 28 at the american association for cancer research [AACR] virtual annual meeting by dr marina chiara garassino from fondazione IRCCS istituto nazionale tumori in milan, italy, includes the results for the first 200 patients enrolled in the registry up to 12 april 2020, and represents the first large dataset for patients with thoracic cancers infected with COVID 19. this does not appear to be associated with any specific type of treatment or comorbidity. most of these deaths were caused by SARS-CoV2 infection and not cancer, and no risk profile was identified for death in thoracic cancer patients diagnosed with COVID 19 infection. read the full article here

to continue to provide optimal care to patients with cancer through the COVID-19 pandemic, the risks must be weighed with the benefits when determining whether to continue to the next step in the treatment journey for each patient or to alter the course, according to gilberto de lima lopes, MD. read the full article here

despite the presence of 1,518 publications on COVID 19 in a literature search at the time of this writing, no robust data on COVID 19 and the treatment of patients with cancer exist. researchers from china have proposed three major strategies for patients with cancer in the COVID 19 crisis: postponing adjuvant chemotherapy or elective surgery for “stable patients”; providing personal protective equipment [PPE] for patients with cancer or cancer survivors; and more intensive surveillance or treatment for patients with cancer infected with COVID 19. ASCO and the american cancer society [ACS] have suggested preliminary empiric measures to prevent spread in our patient population, protecting health-care workers, and increasing system capacity.1 at the same time, the oncology community is working hard to minimize interruptions in cancer-related care. as we navigate and search for answers to the many new urgent clinical questions posed in the COVID 19 era, it is imperative we make data driven decisions when caring for patients. read the full article here 

the ESMO resilience task force, in collaboration with the ESMO young oncologists committee, the ESMO women for oncology committee, ESMO leaders generation programme alumni members and also the OncoAlert network have planned a series of global surveys to evaluate how oncologists and other oncology professionals are affected by the challenges posed by the COVID 19 pandemic, assessing changes to routine practices, wellbeing and current levels of support available. the survey takes about 10 minutes to complete and the information collected will be instrumental to better understand what can be done to support ESMO members’ through these difficult times. the survey closes may 3.2020  take the survey now

transition to a virtual multidisciplinary tumour board during the COVID 19 pandemic. university of pittsburgh experience published in the journal of the sciences and specialities of the head and neck april 24.2020

considering the complexity of head and neck oncologic care, a multidisciplinary team (MDT) approach in diagnosis, treatment, and survivorship care is essential. there is strong evidence to suggest that MDC implementation may improve pretreatment evaluation (dental, nutrition), proper staging, and appropriate timely treatment. it may also affect disease specific survival, and overall survival, but this is controversial. due to the COVID 19 pandemic, head and neck care coordination has been dramatically altered. In these uncertain times, limitations with clinical resources and health care office availability have made it more difficult for head and neck cancer patients to obtain multidisciplinary care. in the past few weeks, the MDT has adopted hosting a virtual MDC which is accessible to remote UPMC locations away from pittsburgh, PA. the concept is to streamline head and neck oncologic care such that patients in any region of the hospital system would be able to obtain timely diagnosis and treatment plans. continue reading here

cancer patients and research during COVID 19 pandemic. a systematic review of current evidence published in critical reviews in oncology/hematology april 23.2020

according to some chinese studies, cancer patients are more vulnerable to COVID 19 complications. this observation led many oncologists to change their daily practice in cancer care, without solid evidence and recommendations. moreover, the COVID 19 manifestations as well as its diagnosis are particular in this special population. in this review paper we expose the challenges of cancer management in the era of SARS-CoV-2, the epidemiological, clinical, pathological and radiological characteristics of the disease in cancer patients and its outcomes on this population. finally, we focus on strategies that are followed in cancer management with review of national and international guidelines. read the full article here

cancer treatment adaptations in the COVID 19 era published in the JCO oncology practice april 23. 2020

adapt treatment regimens to reduce patient visits– current evidence supports that treatment regimens can be adapted in many cases, favoring oral drugs, shorter administration times, or larger intervals between doses. reduce treatment duration – despite being statistically inferior, the clinical impact of reducing duration of adjuvant trastuzumab was low in some randomized clinical trials. consider not prescribing treatment or delaying treatment initiation – the typical assessment of risk and benefit of prescribing adjuvant therapy has been altered by the pandemic; it is crucial to critically balance decisions before indicating treatment. read the full article here

management of hepatocellular carcinoma in the time of COVID 19 published in the annals of oncology april 21. 2020

during the COVID 19 outbreak, clinical activities are reduced and postponed in order to minimise the risk of infection among patients with cancer. in addition, healthcare staff is prioritised to dealing with clinical emergencies. according to age, comorbidities and underlying cirrhosis, patients with hepatocellular carcinoma are at high risk of poor outcome when infected with SARS-CoV-2. furthermore, interruption and delay in scheduled screenings, treatments, and follow-up contribute to worse outcome. all patients with hepatocellular carcinoma are managed based on discussion at multidisciplinary meetings. they follow the guidelines of the european association for the study of the liver and the barcelona clinic liver cancer staging system. however, they modified the management algorithms during the COVID-19 pandemic according to the following principles- read the full article here

COVID 19. impact on cancer workforce and delivery of care published in the lancet april 20.2020

the pandemic has meant a transformation of every aspect of cancer care, irrespective of treatment, inpatient or outpatient, and radical or palliative intent. oncology teams are adopting new ways of working to minimise risk to patients and staff at the same time as optimising cancer treatment and care. efforts are also underway to relocate cancer teams and services away from general hospitals caring for patients with COVID-19 as much as possible, and switching outpatient consultations and discussions with other health professionals to online or phone rather than face to face is being universally adopted by oncology services. cancer specialists predict that new ways of working in cancer care during the COVID 19 pandemic will permanently change oncology services, after evaluating their impact. this pandemic has led to new ways of working together and we should try to keep the best changes after the pandemic is over. read the full article here

Levine Cancer Institute Approach to Pandemic Care of Patients With Cancerpublished in JCO Oncology Practice april 20. 2020

The recent onset of the coronavirus disease 2019 (COVID-19) pandemic has created an unprecedented set of medical management problems, largely because of the rapid global speed of onset, the severity of management problems for approximately 5%-10% of patients, prevalence of asymptomatic carriers, and general lack of experience internationally in this type of pandemic care. General principles of management were established during the evolution of the severe acute respiratory syndrome and Zika virus epidemics, and many have been applied de facto to the current situation. To ensure the safest care for patients, draconian new approaches have been urgently required for both our health system and our cancer institute to deal with the pandemic. Because LCI involves a major teaching hospital, several rural and smaller urban hospitals, and office-based practices, we have designed an approach that caters to each setting. This article codifies these approaches to guide others in view of the paucity of published information. read the full article here

the global COVID 19 pandemic forced the cancellation of the TROG 2020 face to face annual scientific meeting [ASM]. it was instead delivered as a live virtual meeting with six days of planning. the participants’ experience of this live virtual meeting is reported here. read the full article here

COVID 19. global consequences for oncology published in the lancet april 2020

the effects of COVID-19 are not solely limited to the treatment of patients with cancer, but will also hit the wider oncology community, with inevitable consequences for research, education, and collaboration. with the situation constantly changing, all we can do for now is watch, wait, and adapt as best we can until the immediate and long-term effects of this pandemic fully materialise. ultimately, the situation might lead to substantial changes in how research and medicine are practiced in the future. read the full article here

at some point the acute phase of the pandemic will end, and it will be necessary to understand what the future may look like in health care and in society. there are major concerns and uncertainty not only regarding when a return to some semblance of “normal” activities might occur, but also regarding what that “new normal” will be like, in terms of the implications related to the lingering risk of ongoing COVID 19 disease. these implications may be profound and most likely will have important consequences for daily life and for the health care system. some of the significant and fundamental changes that have occurred in health care and in society will remain in place, and many of these may become permanent. continue reading here

caring for our cancer patients in the wake of COVID 19 published in the british journal of cancer april 17.2020

in response to the current global pandemic, unprecedented healthcare changes may have significant consequences for cancer patients in the united kingdom. this article explores why cancer patients may be more susceptible to severe infection and complications, highlighting various interventions that may help to ensure continuity of care in this unique cohort. the potential to cause harm by COVID-19 is at least three-fold in oncology patients. although data on COVID 19 and malignancy remain limited at present, liang et al. recently reported 18 cases of coronavirus infection in oncology patients, noting that these patients were more likely to experience severe sequelae of COVID-19 infection.some chemotherapy agents and immune checkpoint inhibitors [ICI] can themselves contribute to or cause pneumonitis. managing COVID 19 in these patients could be challenging and requires a multidisciplinary approach due to the difficulties in distinguishing the contributions of SACT versus COVID 19.  in addition, the effect that novel anticancer treatments [such as ICI and targeted therapies] will have on the virulence and/or severity of COVID 19 has yet to be established. continue reading here

managing COVID 19 in patients with cancer. a double blow for oncologists published in JCO oncology practice april 17. 2020

many other practical challenges exist while managing cancer in patients with COVID 19. a multidisciplinary team approach with a panel discussion that includes oncologists, pathologists, and radiologists might be helpful in such scenarios to come to a conclusion. usually, patients with cancer are already on multiple medications, including antiemetics, opioid analgesics, and proton pump inhibitors, in addition to anticancer drugs. In that scenario, it becomes essential for the treating oncologist to be aware of the potential drug interactions between the chemotherapeutic drugs and COVID 19 antiviral agents. read the full article here

caring for patients with cancer in the COVID 19 era published in nature april 16. 2020

the current COVID 19 pandemic challenges oncologists to profoundly re-organize oncological care in order to dramatically reduce hospital visits and admissions and therapy induced immune related complications without compromising cancer outcomes. the authors report how the seven comprehensive cancer centres of cancer core europe have organized their healthcare systems at an unprecedented scale and pace to make their operations ‘pandemic proof’. they identify and discuss commonalities, and important local differences, pinpoint critical research priorities to enable evidence-based remodelling of cancer care during the COVID 19 pandemic. and discuss how the current situation offers a unique window of opportunity for assessing the effects of de-escalating anticancer regimens, which may fast-forward the development of more refined and less toxic treatments. by sharing their joint experiences, they offer a roadmap for proceeding and aim to mobilize the global research community to generate the data that are critically needed to offer the best possible care to patients. read the full article here

the impact of the COVID 19 pandemic on cancer patients published in the american journal of clinical oncology april 16. 2020

the immunosuppressed status of some cancer patients [whether caused by the disease itself or the treatment] increases their risk of infection compared with the general population. this short review aims to focus on the impact of COVID 19 on a cancer patient and discuss management options and recommendation in addition to highlighting the currently available clinical guidelines and resources. read the full article here

many disease groups, including those representing breast cancer and melanoma, have published treatment guidelines attempting to standardize treatment modifications for the months ahead. individual cancer centres have developed internal guidelines for colon cancer management, but no major national group has published any recommendations to date. in partnership with the colorectal cancer alliance [DC, USA] and the otto j. ruesch centre for the cure of gastrointestinal cancers at the georgetown university lombardi comprehensive cancer centre [DC, USA], a practical set of guidelines and recommendations for the management of colorectal cancer during the COVID-19 pandemic has been presented. read more here

the UK coronavirus cancer monitoring project [UKCCMP] aims to collect, analyse, and disseminate in real time data from the UK cancer centres about severe acute respiratory syndrome coronavirus 2 [SARSCoV2] infection rates in patients with cancer, and their outcomes in terms of coronavirus disease 2019 [COVID 19]. this approach will enable oncologists to gain crucial insights to inform decision making. substantial reallocation of resources away from cancer care services could potentially have unintended cancer-related implications, including increased morbidity and mortality, therefore, real time collection, analysis, and dissemination of data from our cancer centres about SARSCoV2 infection rates in patients with cancer, and their disease outcomes, is needed. UKCCMP delivers meaningful real time data to all UK cancer centres and clinicians to allow more personalised approaches to individual patient care and inform clinical decision making. this initiative will improve cancer care in the UK and beyond at this time of unprecedented global turmoil and reliance on health-care resources. to continue reading

cancer patients represent a vulnerable population due to the acquired immunodeficiency associated with anti cancer therapy. immune checkpoint inhibitors [ICI] have largely impacted the prognosis of a multitude of malignancies with significant improvement in survival outcomes and a different, tolerable toxicity profile. in this paper,  the safety of ICI administration in cancer patients during the coronavirus pandemic in order to guide the usage of these highly efficacious agents is assessed. continue reading here

for the well being of all. cancer care during the COVID 19 public health crisis guest commentary on ASCO connection published online april 14.2020

the past few weeks have brought many challenges to our country, with our normal lives being upended by the SARS-CoV-2 virus. with many “non essential” activities postponed or canceled, we have been tasked with defining what “essential” means to provide cancer care. recognizing that our population of patients is particularly vulnerable, we are approaching cancer care from a new paradigm. generally, we are accustomed to making treatment decisions based on the best available evidence, carefully balancing clinical trial data for a specific disease in the context of an individual’s overall circumstance to come up with a treatment plan that is best for the patient. now, for the first time, we must consider the implications of our treatment that lie beyond an individual patient and consider the health of the population as a whole.  read the full article here

a registry launched by the american society of clinical oncology [ASCO] is seeking to learn more about the pattern of symptoms and severity of the disease among patients with cancer, as well as how its infections affect the delivery of cancer care and patient outcomes. the ASCO survey on the coronavirus disease 2019 [COVID-19] in oncology registry will collect both baseline and follow up data throughout the COVID 19 pandemic and into 2021. as sufficient data comes in, ASCO anticipates delivering periodic reports to the cancer community on key learnings. additionally, ASCO indicated that they plan to develop peer reviewed manuscripts based on the data provided. learn more about the registry or read the full press release here

there is an urgent need to share expertise and offer emergency guidance for breast radiation therapy [RT]  during the COVID 19 [coronavirus] pandemic. by adopting these recommendations where RT is minimised and targeted to those with the highest risk of relevant breast recurrence, we aim to protect our patients and health care professionals from potential exposure to COVID 19 as well as reducing the workload for health care providers and/or infrastructure at the moments that resources face strain due to the pandemic. a general guiding principle in this unusual setting is that: (i) where clinical equipoise has been sufficient to support the conduct of randomised trials testing a less resource-intensive approach, and (ii) results available to date have not provided evidence that such a test arm is clearly inferior, then (iii) the approach involving fewest patient visits and duration should be encouraged in the context of a pandemic like COVID 19 even when level 1–2 evidence has not formally been delivered. continue reading here

practicing oncology in the era of COVID 19 published in the ASCO post april 10. 2020

in italy, the number of people dying from COVID 19 has dropped to about 500 per day—a decrease from the 900 to 1,000 patients who had been dying daily when the disease spread was at its peak. how to be sure that patients who survived COVID are really negative for the COVID infection, the european institute of oncology, italy will be launching a program to perform a serological test. this testing will be done on a population of cancer patients, including five big hospitals in regione lombardia. the idea is also to study the immunization of cancer patients. read more here

this story is part of the cancer letter’s ongoing coverage of COVID 19’s impact on oncology. a full directory of their coverage is available here.

the authors emphasise in their article that lung cancer patients represent a specific population for COVID 19 testing prioritisation. while all types of cancers seem to be associated with high COVID 19 prevalence, morbidity and mortality, lung cancer represents a specific scenario of cumulative risk factors for COVID 19 complications, including older age, significant cardiovascular and respiratory co-morbidities, smoking related lung damage, as well as treatment-related immune impairment or suppression. despite the current lack of robust data, it is of paramount importance to come-up with an international consensus on SARS-CoV-2 testing among patients with lung cancer, as early identification of infection with this novel virus may result in tailored management. read the full article here

testing for COVID 19 in lung cancer patients published in annals of oncology april 9. 2020

italy adopted a non-discriminative testing strategy that included both symptomatic and asymptomatic patients. but after 6 days, when large numbers of patients suffered from severe SARS-CoV-2-related ARDS, the italian ministry of health decided to allow testing only in symptomatic patients who were potential candidates for hospitalization, and this decision may have resulted in a biased selection and delayed treatment of these patients. in this editorial, we would like stress the identification of lung cancer patients as a specific population for testing prioritization for COVID 19. read the full article here

the prioritisation of health support towards patients with COVID-19 is raising apprehension within the medical oncology community, in which physicians are increasingly being forced to select which patients should receive anticancer therapy on the basis of who is most likely to have a positive outcome. in this context, the threat of COVID 19 infection might also factor into decision making—a role which could possibly be lessened by knowledge of the COVID 19 status of patients suitable for anticancer therapy. this already dismal scenario seems to be even more severe for patients with lung cancer because of the high risk of interference of COVID-19 with their effective diagnostic and therapeutic management by treating physicians. read more here

management of cancer surgery cases during the COVID 19 pandemic. considerationspublished in annals of surgical oncology april 8. 2020

in these unprecedented times of COVID 19, surgical oncologists are being forced to consider triage and rationing of cancer surgery cases, for a number of reasons:

  1. the potential shortage of personal protective equipment, such as masks, gowns, gloves;

  2. the potential shortage of hospital personnel due to sickness, quarantine, and duties at home;

  3. the potential shortage of hospital beds, intensive care unit (ICU) beds, and ventilators;

  4. the desire to maximize social distancing among our patients, colleagues, and staff.

the society of surgical oncology [SSO] asked each of the SSO disease site work group chairs and vice chairs to provide their recommendations for managing care in their specialties, assuming a 3 to 6 month delay in care. these recommendations are summarized in the article. read more

canada’s public health leaders and politicians, some of whom have been fierce adversaries, appear to be working well together to deliver consistent messaging. given this new evidence, however, our leaders now need to communicate clearly that canadians will likely need to embrace social distancing for much longer than previously indicated. If people in the community are the front line, then presenting evidence transparently and acknowledging uncertainties will be essential to maintain their trust.

with a preventive vaccine unlikely to be widely available in the next couple of years and no antiviral treatment of certain effect currently available, COVID 19 is going to threaten canada’s health systems for a long time. short term public health measures, incompletely observed, will do nothing but delay the time until our critical care capacity is overwhelmed. that means it’s time for our leaders to trust the public with the truth about long term measures and be explicit about what people need to anticipate. read the full article here

COVID 19 and cancer. lessons from a pooled meta analysispublished in the JCO global oncology april 6. 2020

the objective of the study was to obtain a pooled prevalence analysis of cancer among patients with COVID 19.  a meta analysis was performed using random effects models to analyze the pooled prevalence of cancer among patients with COVID 19. authors found that the overall pooled prevalence of cancer in patients with COVID 19 in these studies was 2.0% [95% CI, 2.0% to 3.0%; I2 = 83.2%]. on further subgroup analysis based on sample size, we found that in studies with a sample size < 100, prevalence was slightly higher, at 3.0% [95% CI, 1.0% to 6.0%], but in larger studies, with a sample size > 100, they found a lower overall prevalence of 2.0% [95% CI, 1.0% to 3.0%;]. read the full article here read the guidelines in english or in french

the report, recently published in blood advances, demonstrates that the immunosuppressant, tocilizumab, could be an effective therapy against COVID 19 symptoms for patients with multiple myeloma and other blood cancers. additional findings from the report suggest that blood cancer patients may have atypical COVID 19 symptoms. read the full article here or the oncology central report here

there is an urgent need to address the impact of such a pandemic on cancer patients. this include changes to resource allocation, clinical care, and the consent process during a pandemic. currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID‐19 infection pandemic will be addressed, with suggestions of some practical approaches. full article available here

safety at the time of the COVID 19 pandemic. how to keep our oncology patients and healthcare workers safe published in the journal of the national comprehensive cancer network [JNCCN] april 3. 2020

healthcare providers have had to rapidly alter care delivery models while simultaneously acknowledging the crucial unknowns of how these changes may affect clinical outcomes. this special feature reviews strategies on how to mitigate transmission of COVID-19 in an effort to reduce morbidity and mortality associated with the disease for patients with cancer without infection, for patients with cancer with COVID-19 infection, and for the healthcare workers caring for them, while continuing to provide the best possible cancer care. read the article here

cancer guidelines during the COVID 19 pandemic published in the lancet april 2.2020

the pandemic poses several challenges for oncology services. caregivers have to think about how to minimise their patients’ exposure to health-care facilities. systems are adapting with telephone and telehealth consultations, people receiving laboratory testing at facilities closer to their homes, and some evaluations being delayed. a patient might be at high risk of contracting the infection and dying from it; on the other hand, the patient might be at high risk of the cancer progressing or causing death if it is not treated appropriately. physicians have to assess whether treatment plans should be initiated on schedule or delayed, and if so, for how long? continue reading

experiences with cancer care and COVID 19 from colleagues around the world published in ASCO connection and ASCO daily news april 2. 2020

ASCO has published stories from colleagues around the globe and the changes they are facing in their practices and the issues and challenges they’re facing and thinking about.

during the COVID 19 global pandemic, the cancer community faces many difficult questions. the article first discuss’ safety considerations for patients with cancer requiring treatment in SARS-CoV-2 endemic areas and then discuss a general framework for prioritizing cancer care, emphasizing the precautionary principle in decision making. read the full article here

patients with cancer are usually characterized by older ages, multiple complicated diseases, and lower immunity, meaning a higher probability of severe illness and increased mortality compared with the healthy population once infected with COVID 19. to alleviate the difficulties of patients with cancer in seeking medical aid and simultaneously avoid COVID 19 related nosocomial cross infection between patients and medical staff, several mandatory measures are being carried out in the national cancer centre/cancer hospital, chinese academy of sciences during this period. first, multiple on site temperature tests are performed at the entrances of the hospital, the outpatient clinic, and the wards. contact and travel histories regarding the epidemic area of all individuals are recorded. second, an appointment scheduling system is available for outpatients, which allows both online appointment scheduling and on-site registration. third, for patients preparing to be admitted, symptoms that are potentially associated with COVID 19, such as fever and cough, are required to be routinely recorded. mandatory routine blood tests and high-resolution computed tomography scans of the lungs are performed.  read the full article here

choosing wisely COVID 19 recommendations last updated april 1.2020

the COVID 19 pandemic presents an unprecedented challenge to the capacity of health care systems and providers around the world. now, more than ever, stewardship of limited resources is critical. in response, this list was developed to raise awareness about the need to use limited health care resources wisely.

a recent study, discussed by authors in JAMA Oncology, has suggested that several measures being implemented at the National Cancer Center/Cancer Hospital [chinese academy of sciences, beijing, china] could help to reduce the risk of COVID 19 for patients with cancer who are seeking treatment.

maintaining cancer care in the face of COVID 19 published in medscape march 31.2020

to protect patients with cancer, who are among the most vulnerable to the virus, oncologists are embracing telemedicine to allow most patients to stay home. “we’re really concentrating on decreasing the risk to these patients, with a widespread massive scale conversion to telehealth,” said anne chiang, medical oncologist at smilow cancer network. “this is something that, in the space of about a week, has transformed the care of our patients — it’s a really amazing transformation.”

across the US border in canada, the medical director of toronto’s princess margaret cancer centre is directing a similar transformation. “We have converted probably about 70% to 80% of our clinic visits to virtual visits,” says radiation oncologist mary gospodarowicz, MD. “we have three priorities: number one, to keep our patients safe; number two, to keep our staff safe, because if staff are sick we won’t be treating anybody; and number three, to treat as many patients with cancer as possible.” read the full article here.

a panel made up of 15 experts has recently published updated recommendations for radiotherapy treatment for bowel cancer during the ongoing COVID 19 pandemic. their guidance suggests higher doses for shorter periods to maximize social distancing whilst maintaining efficacy of treatment.

a war on two fronts. cancer care in the time of COVID 19 published in annals of internal medicine march 27.2020

the rapidly expanding coronavirus disease 2019 (COVID-19) (SARS–CoV-2) acute respiratory pandemic has assaulted all aspects of daily life [1, 2]. as of 25 March 2020, there were more than 450 000 cases worldwide. in the absence of a vaccine or a therapeutic agent, a “social distancing” strategy is the primary intervention to hamper the spread of infection [1]. a major fear of most governments and individuals is the heavy impact on the health care delivery system.  during this extraordinary time, the oncology community faces unprecedented challenges. initial reports suggest that COVID 19 can be particularly lethal in patients with cancer [2]. as such, oncology specialists as well as other providers regularly involved in the diagnosis, active treatment, and longitudinal follow up of patients with cancer must consider how to 1. balance a delay in cancer diagnosis or treatment against the risk for a potential COVID 19 exposure, 2. mitigate the risks for significant care disruptions associated with social distancing behaviours, and 3. manage the appropriate allocation of limited health care resources in this unprecedented time of health care crisis. read the full article here

are patients with cancer at higher risk of COVID 19? published in oncology nursing news march 27.2020

cancer patients show deteriorating conditions and poor outcomes from the COVID 19 infection,” the study, which was recently published in the annals of oncology, states. “it is recommended that cancer patients receiving anti-tumour treatments should have vigorous screening for COVID 19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID 19 co-infection. read the full article here

controversies about COVID 19 and anticancer treatment with immune checkpoint inhibitors published as commentary in the journal of immunotherapy march 26. 2020

cancer patients represent a large subgroup at high risk of developing coronavirus infection and its severe complications. a recent nationwide analysis in china demonstrated that, of 1590 COVID 19 cases from 575 hospitals, 18 had a history of cancer, with lung cancer as the most frequent diagnosis. the limited cancer patient population described in this first report from the literature, was curiously characterized by the lack of individuals receiving anticancer immunotherapy [immune checkpoint inhibitors ICI]. specific susceptibility to bacterial or viral infections has not been investigated in patients undergoing ICI therapy. considering that immunotherapy with ICI is able to restore the cellular immunocompetence, as we previously suggested in the context of influenza infection, the patient undergoing immune checkpoint blockade could be more immunocompetent than cancer patients undergoing chemotherapy. read more here

early reports on the prognosis for cancer patients are conflicting and, for the most part, non-peer-reviewed. to our knowledge, the largest study published to date includes 18 patients with cancer, who were shown to have increased risk for severe events in multivariate analysis. given this acute lack of knowledge and concern for extreme vulnerability, the COVID-19 and Cancer Consortium (CCC19) was formed. this national collaborative effort began organically and has quickly grown. the driving goal of the consortium is to collect prospective, granular, uniformly organized information on cancer patients infected with COVID-19 as rapidly as possible. read the full article here visit the consortium page here

prise en charge chirurgicale des cancers gynécologiques en période de pandémie COVID 19 – recommandations du groupe FRANCOGYN pour le CNGOF publié dans gynécologie obstétrique fertilité & sénologie le 25 mars. 2020 guidelines for surgical management of gynaecological cancer during pandemic COVID 19 period – FRANCOGYN group for the CNGOF published in gynécologie obstétrique fertilité & sénologie march 25.2020

proposer des recommandations de prise en charge des patientes atteintes de cancer gynécologique dans la période de pandémie du COVID 19. en période de pandémie COVID 19, il convient de ne pas faire perdre de chance aux patientes atteintes de cancer, tout en limitant les risques liés au virus. lire la suite ici

recommendations for the management of patients with gynecological cancer during the COVID 19 pandemic period. during COVID 19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus. read the full article here

on request of the french health ministry, the french high council for public health (haut conseil de santé publique [HCSP]) entrusted a representative group of french medical oncologists and radiation oncologists, working across academic and private practice, with the task of preparing guidelines to protect patients with cancer against severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection, while maintaining the possibility of cancer treatment. the following guidelines apply to adult patients with solid tumours only, and should be considered complementary to the standard rules adopted by the french health authorities for the general population. read the full article here

the following short term guidance may depend on prevalence of COVID 19 in the practitioner’s region. however, an abundance of caution should be exercised to reduce the transmission and impact of SARS-CoV-2. read the recommendations here

the COVID 19 pandemic poses unprecedented challenges for patients, clinicians and health care systems. representatives from multiple cancer care organizations with expertise in the multidisciplinary management of breast disease to provide preliminary recommendations for the triage and treatment of patients with breast disease amidst the COVID 19 pandemic were assembled. these are recommendations, and are not intended to supersede individual physician judgement, nor institutional policy or guidelines. the consortium highly recommends multidisciplinary discussion regarding priority for elective surgery and adjuvant treatments for your breast cancer patients.

recommendations are broken down into the following priority categories based on patient condition1: a) priority A: patient condition is immediately life threatening, clinically unstable, b) priority B: patient situation is noncritical but delay beyond 6-8 weeks could potentially impact overall outcome, c) priority C: patient’s condition is stable enough that services can be delayed for the duration of the COVID-19 pandemic. continue reading here

COVID 19. the changing landscape in oncology published on touch oncology march 24.2020

with the rapid progression and global impact of COVID 19, the latest information and research on the current situation is constantly being updated, focusing on how this is affecting the fields of oncology and haematology. with patients undergoing chemotherapy and radiotherapy on the list of those most at risk, it is important that caregivers are kept informed on how to manage cancer care during the COVID-19 pandemic. read more here

The predominant goal should be to keep our cancer patients and staff safe while continuing to provide empathetic, high-quality care under circumstances we have never had to face before.

cancer care in the time of COVID 19 published in ASCO connection march 23. 2020

an early report from China suggests that patients with cancer have a markedly elevated risk of intubation, ICU admission, or death, both for people actively receiving treatment and for cancer survivors.1 oncologists have an ethical obligation to help their patients by both remaining involved in their cancer management and protecting them from unnecessary exposure. decreasing infection rates will help lessen the burden on critical care and emergency medicine staff.  but how can they do both? read the full article here

a specialty guide for patient management during the coronavirus pandemic was published by the NHS. the NHS action plan, makes clear that ‘at all phases of a future pandemic, the NHS/HSCNI and local authorities have plans in place to ensure people receive the essential care and support services they need – and sometimes this might mean that other services are reduced temporarily’. It also states that as the disease moves into different phases ‘the chief focus will be to provide essential services, helping those most at risk access the right treatment’.

experts share recommendations on managing cancer during COVID 19 pandemic published in cure march 23.2020

“the COVID 19 pandemic is impacting every facet of our global and domestic societies and health care systems in unprecedented fashion,” dr. robert w. carlson, chief executive officer of the national cancer comprehensive network, said in a press release. “people with cancer appear to be at increased risk of COVID 19, and their outcomes are worse than individuals without cancer. as is the nature of the NCCN member institutions, they are sharing their experience in organizing and managing institutional and care systems responses and best practices in this rapidly evolving global effort.”

one of the key recommendations from the article is the establishment of an incident command structure to ensure all channels of communication between staff and patients alike remain open through the pandemic. they also believe this will provide a benefit to coordinating within the institution to respond to the information that is rapidly changing.

clinicians are also recommended to have proactive and open talks with their patients about palliative concerns for patients with cancer who may have been exposed to COVID 19 and could become infected. the disease can be more severe in those who are immunocompromised, like patients with cancer. read the full article here

managing cancer care during the COVID 19 pandemic. agility and collaboration toward a common goal published in the journal of the national comprehensive cancer network [JCCN] march 16.2020

the COVID 19 pandemic has presented unique challenges and learning opportunities for cancer centres. the future trajectory of this pandemic is uncertain, and we must continue to prepare for its widespread impact. the situation is dynamic, and policies and recommendations may change at any time. the healthcare crisis surrounding COVID 19 continues to evolve, and new conditions could change some of our existing the full article here

managing COVID 19 in the oncology clinic and avoiding the distraction effect pre published in annals of oncology march 13.2020

the safety and management of cancer patients in the current SARS-CoV-2 outbreak is urgent and most cancer clinics need to establish a contingency plan. it is well established that cancer patients are more susceptible to infections because of the immunosuppressive state caused by both anticancer treatments and surgery [1-3]. a recent study from prof he and colleagues shows that the risk of developing severe events in COVID 19 disease is statistically significant higher in patients with cancer. the authors suggest that postponing adjuvant chemotherapy or elective surgery for less aggressive cancers should be considered and that the increased risk for personal protection provisions should be emphasized for patients with cancer or cancer survivors. furthermore, more intensive surveillance or treatment should be considered for those patients with cancer who are infected with SARS-CoV-2 virus. read the full article here

risk of COVID 19 for patients with cancer published in the lancet march 3. 2020

in this COVID 19 outbreak, the major risk for patients with cancer is the inability to receive necessary medical services (both in terms of getting to hospital and provision of normal medical care once there) because of the outbreak. during this epidemic, in addition to better protection, patients with cancer need online medical counselling and appropriate identification and treatment of critical cases. decisions on whether or not to postpone cancer treatment need to made on a patient- by-patient basis and according to the risk to the patient and the prevailing situation because delays could lead to tumour progression and ultimately poorer outcomes. read the full article here


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