Conceptual Framework for Cancer Care During a Pandemic Incorporating Evidence From the COVID-19 Pandemic

Abstract

PURPOSE With successive infection waves and the spread of more infectious variants, the COVID-19 pandemic continues to have major impacts on health care. To achieve best outcomes for patients with cancer during a pandemic, efforts to minimize the increased risk of severe pandemic infection must be carefully balanced against unintended adverse impacts of the pandemic on cancer care, with consideration to available health system capacity. Cancer Australia's conceptual framework for cancer care during a pandemic provides a planning resource for health services and policy-makers that can be broadly applied globally and to similar pandemics. METHODS Evidence on the impact of the COVID-19 pandemic on cancer care and health system capacity to June 2021 was reviewed, and the conceptual framework was developed and updated. RESULTS Components of health system capacity vary during a pandemic, and capacity relative to pandemic numbers and severity affects resources available for cancer care delivery. The challenges of successive pandemic waves and high numbers of pandemic cases necessitate consideration of changing health system capacity in decision making about cancer care. Cancer Australia’s conceptual framework provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimizing infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption. CONCLUSION Evidence from the COVID-19 pandemic supports continuation of cancer care wherever possible during similar pandemics. Cancer Australia's conceptual framework, underpinned by principles for optimal cancer care, informs decision making across the cancer care continuum. It incorporates consideration of changes in health system capacity and capacity for cancer care, in relation to pandemic progression, enabling broad applicability to different global settings.

Setting the policy agenda for cancer control reform: Australia's first national cancer control plan

“…Through identified activities, the Plan addresses contemporary, critical issues relevant to national level cancer control initiatives. These include health literacy, 8 particularly for Aboriginal and Torres Strait Islander people and other priority population groups, and health emergency preparedness arrangements, 4,9 to mitigate and manage the impacts of public health emergencies including pandemics, extreme weather events, and other consequences of climate change on cancer control, care and service delivery 10‐13 …”

“…to mitigate and manage the impacts of public health emergencies including pandemics, extreme weather events, and other consequences of climate change on cancer control, care and service delivery. [10][11][12][13] The Plan both leverages and supports existing national health strategies, together with other national, state and territory strategies supporting priority populations. Ensuring equity and access for all and Perspectives aligning with existing plans to achieve national health goals is in line with calls from international cancer control peak bodies, 3,14 including the World Health Organization's 2017 resolution on cancer prevention and control.…”