A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group

Abstract

The outbreak of coronavirus disease 2019 (COVID‐19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID‐19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), is characterized by rapid human‐to‐human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS‐CoV‐2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, 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. Implications for Practice The main management strategies for treating cancer patients during the COVID‐19 epidemic include clear communication and education about hand hygiene, infection control measures, high‐risk exposure, and the signs and symptoms of COVID‐19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case‐by‐case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS‐CoV‐2 virology and epidemiology.

SARS-CoV-2 (COVID-19) and Chronic Myeloid Leukemia (CML): a case report and review of ABL kinase involvement in viral infection

“…9 Immunocompromised patients are considered to be at risk of developing severe SARS-CoV-2 symptoms, and international consensus recommendations regarding this population have been issued. 10 The impact of SARS-CoV-2 on the hematologic patient population is, however, not yet known.…”

Neurosurgical management of brain and spine tumors in the COVID-19 era: an institutional experience from the epicenter of the pandemic

“…Patients with diabetes mellitus are also at much higher risk for severe complications [6,7]. Second, patients with malignant brain or spine tumors may have undergone chemotherapy prior to surgical resection or in between subsequent resections, thus placing them in an immunocompromised state and further increasing their risk of acquiring COVID-19 [8]. Patients who have metastatic disease are also often immunosuppressed on systemic chemotherapeutic agents.…”

Surgical Strategy During the COVID‐19 Pandemic in a University Metropolitan Hospital in Milan, Italy

“…The most significant changes have been the curtailment of elective surgical procedures and the prioritization of non-delayed oncologic or emergency surgery [3]. While some cases can be postponed for some weeks without a relevant impact on patient's general conditions and outcomes, such as small surgery, abdominal wall surgery, bariatric and functional surgery, the same standards cannot be applied to other types of surgery [4].…”