Advanced cancer and COVID-19 comorbidity: medical oncology-palliative medicine ethics meetings in a comprehensive cancer centre

Abstract

ObjectivesIn managing patients with cancer in the COVID-19 era, clinical oncologists and palliative care practitioners had to face new, disrupting and complex medical situations, challenging the quality of the shared decision-making process. During the first lockdown in France, we developed an onco-palliative ethics meeting to enhance the quality of the decision-making process for patients with advanced cancer treated for COVID-19.MethodsA least one of the institutional ethics committee members was present along with oncologists, palliative care teams, psycho-oncologists, radiologists and intensive care specialists. Specific medical parameters were systematically collected to form a standardised framework for the discussions.ResultsThe main raised issues were the definition of new criteria for the implementation of invasive resuscitation techniques, optimal ways to adapt or delay anticancer treatment and best procedures to address terminal respiratory failure and end-of-life care. The main clinical and ethical guidelines that emerged during these debates are presented. The palliative care team played a major role in assessing and reporting patients’ awareness of cancer-related prognosis and their wishes concerning invasive therapies or transfer to intensive care units, enabling an individualised benefit–risk balance assessment. The ethics committee members ensured continuous monitoring during the discussions. Their function was to recall the main ethical principles including dignity, which is conferred on people when there are treated as having equal status.ConclusionsThe onco-palliative ethics meeting provided a powerful avenue for improvement of collegiality and reinforcement of teamwork, which could be a major protection against burnout for healthcare professionals facing an epidemic onslaught.

Impact of an Interdisciplinary Goals-of-Care Program Among Medical Inpatients at a Comprehensive Cancer Center During the COVID-19 Pandemic: A Propensity Score Analysis

“…The COVID-19 pandemic has catalyzed system-wide implementation in an unprecedented manner to integrate goals-of-care discussions with urgency, attention, and resource. [12][13][14] Our findings might have implications beyond the pandemic given that a majority (95.6%) of our patients did not have COVID-19 disease and sensitivity analysis that excluded the patients with COVID-19 diseases showed similar findings. Longer-term studies are needed to examine the sustainability of this initiative.…”

Bio‐ethical issues in oncology during the first wave of the COVID‐19 epidemic: A qualitative study in a French hospital

“…In France, under the impetus of the CCNE and other ethics committees, similar structures have emerged throughout the country since the start of the first wave of the epidemic. 99,100 A very similar tendency is also emerging in other countries. 16,66,[101][102][103] So, could a principle or general rules for the structuring, organization and functioning of such structures be developed for all hospitals, based on those conceived and implemented at our hospital?…”

“…Emergency MTM could prove useful for oncologists and beneficial for cancer patients beyond the confines of our hospital. In France, under the impetus of the CCNE and other ethics committees, similar structures have emerged throughout the country since the start of the first wave of the epidemic 99,100 . A very similar tendency is also emerging in other countries 16,66,101–103 .…”

Palliative care delivery changes during COVID-19 and enduring implications in oncology nursing: a rapid review

“…Thus, telehealth-facilitated ACP solutions served as a significant policy shift and essential care delivery change in upstreaming ACP before health crises occurred, and electronic systems were leveraged to ensure the documents were available [ 12 ]. As patients’ prognoses worsened, the majority (60%) of specialty palliative care consultations during the pandemic were used to address targeted goals-of-care conversations with surrogates that accounted for individualized risk–benefit assessments to inform decision-making [ 43 ], mainly when patient/caregiver goals appeared misaligned with prognosis [ 10 ▪▪ ].…”