Clinical Guidance for the Management of Patients with Urothelial Cancers During the COVID-19 Pandemic – Rapid Review

Abstract

The current COVID-19 pandemic presents a substantial obstacle to cancer patient care. Data from China as well as risk models suppose that cancer patients, particularly those on active, immunosuppressive therapies are at higher risks of severe infection from the illness. In addition, staff illness and restructuring of services to deal with the crisis will inevitably place treatment capacities under significant strain. These guidelines aim to expand on those provided by NHS England regarding cancer care during the coronavirus pandemic by examining the known literature and provide guidance in managing patients with urothelial and rarer urinary tract cancers. In particular, they address the estimated risk and benefits of standard treatments and consider the alternatives in the current situation. As a result, it is recommended that this guidance will help form a framework for shared decision making with patients. Moreover, they do not advise a one-size-fits-all approach but recommend continual assessment of the situation with discussion within and between centres.

SARS-CoV-2 Infection in Cancer Patients: Effects on Disease Outcomes and Patient Prognosis

“…The National Institute for Health and Care Excellence (NICE) guidelines recommend cisplatin-based chemotherapy after surgery to increase the survival rate. Neoadjuvant chemotherapy should be discouraged as it causes prolonged immunosuppression [90].…”

Combination treatmnet of breast cancer patients during the COVID-19 pandemic

“…Диагностические процедуры необходимо планировать с учетом доступности и ресурсов в каждом регионе. Следует предпринять усилия, направленные на избежание задержек верификации диагноза при наличии симптомов, подозрительных на рак [BIRADS 5 (высокий приоритет) или BIRADS 4 (средний приоритет)] [13,14,18,[20][21][22][23]. Важен баланс между поддержанием высокого качества лечения РМЖ, не ставящего под угрозу исходы лечения, и минимизацией риска как заражения SARS-CoV-2, так и осложнений противоопухолевого лечения.…”

Recomendaciones sobre el tratamiento y monitoreo de personas con cáncer durante la pandemia de COVID-19

“…También se proponen opciones para la adaptación de los esquemas de tratamiento bajo las directrices de aislamiento. Para esto, diferentes grupos de trabajo han desarrollado guías basadas en su experiencia (38,40,(45)(46)(47)(48)(49). Además, se hace hincapié en el uso de recursos digitales para mantener el contacto con el paciente y realizar un adecuado seguimiento (50, 51) (Cuadro 1).…”

“…El equipo tratante debe determinar la continuidad del tratamiento (radio y quimioterapia), considerando las características de cada paciente, el estadio de la enfermedad, el tipo de patología, la intención del tratamiento, entre otras (40,(53)(54)(55)(56). Dicha decisión puede basarse en guías existentes (38,40,(45)(46)(47)(48)(49)57).…”

“…Se deben modificar los planes de tratamiento cuando sea posible controlar la enfermedad mediante alternativas como quimioterapia, radioterapia o terapia hormonal (32,36,48,49,65).…”