Lung Cancer and the COVID-19 pandemic: Recommendations from the Brazilian Thoracic Oncology Group

Abstract

New cases of the novel coronavirus disease 2019 , also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated.A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.

Bronchial carcinoid tumor in the era of covid-19 pandemic: A case report

“…Based on histologic differentiation the World Health Organization/The International Association for the Study of Lung Cancer (WHO/IASLC) classifies pulmonary Carcinoid tumors into: Typical carcinoids (76-90%), less than 2 mitosis/2 mm [ 2 ] and no necrosis; Atypical carcinoid, increased mitosis(2-10 mitosis/2 mm 2 ) with confirmed necrosis [ 7 , 8 ]. In the era of covid-19 pandemic, lung cancer patients are at higher risk of being affected by covid-19 and, early identification and differential diagnosis is extremely difficult in the absence of comprehensive evaluation and work up as the clinical and imaging findings of covid-19 may resemble lung cancer [ 9 ]. The most common cause of death in lung cancer patients being infected with Covid-19 is complications associated with the covid-19 not the cancer itself, especially in indolent malignancies like carcinoid tumor [ 9 ].…”

“…In the era of covid-19 pandemic, lung cancer patients are at higher risk of being affected by covid-19 and, early identification and differential diagnosis is extremely difficult in the absence of comprehensive evaluation and work up as the clinical and imaging findings of covid-19 may resemble lung cancer [ 9 ]. The most common cause of death in lung cancer patients being infected with Covid-19 is complications associated with the covid-19 not the cancer itself, especially in indolent malignancies like carcinoid tumor [ 9 ]. With the limited data about lung cancer patients approach and management during covid-19 pandemic, undergoing invasive thoracic procedures like bronchoscopic biopsy and even once diagnosed undergoing open surgical therapy is very challenging as it increases patients and health care workers risk of infection with Covid-19 [ 9 ].Access to mechanical ventilators especially in resource limited areas like ours is also great challenge if the patients require respiratory support post operatively.…”

Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review

“…The majority of the studies were conducted in China Wei et al 2020;Wu et al 2020;Xie et al 2020). Other studies were conducted in Iran (Aghili, Jafari & Vand Rajabpoor 2020;Motlagh et al 2020;Samiee et al 2020), Brazil (Baldotto et al 2020b) and Zambia (Lombe et al 2020). Ten of the included studies employed a qualitative design (Aghili, Jafari & Vand Rajabpoor 2020;Baldotto et al 2020b;Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Samiee et al 2020;Wei et al 2020;Wu et al 2020;Xie et al 2020).…”

“…All studies highlighted the importance of adopting triage systems to sort, assess and prioritise staff, cancer patients and their carers entering the radiotherapy centre (Aghili, Jafari & Vand Rajabpoor 2020;Baldotto et al 2020b;Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Saab et al 2020;Samiee et al 2020;Wei et al 2020;Wu et al 2020;Xie et al 2020). From these studies designing a ow chart helped facilitate the COVID-19 screening and testing process (Samiee et al 2020;Xie et al 2020).…”

Impact of COVID-19 pandemic on a daily-based outpatient treatment routine: experience of a radiotherapy department of a tertiary public/university hospital in Brazil

“…A worldwide series of treatment policies and recommendations regarding radiation treatment were published (4)(5)(6)(7)(8)(9)(10)(11) and summarized in a review by Vordermark (12). Many of these suggestions considered hypofractionated treatment schedules appropriate to reduce hospital visits, i.e., a reduced number of fractions with a higher dose/fraction that produce the same biological effect as conventional fractionation.…”