COVID-19 and the multidisciplinary care of patients with lung cancer: an evidence-based review and commentary

Abstract

Delivering lung cancer care during the COVID-19 pandemic has posed significant and ongoing challenges. There is a lack of published COVID-19 and lung cancer evidence-based reviews, including for the whole patient pathway. We searched for COVID-19 and lung cancer publications and brought together a multidisciplinary group of stakeholders to review and comment on the evidence and challenges. A rapid review of the literature was undertaken up to 28 October 2020, producing 144 papers, with 113 full texts screened. We focused on new primary data collection (qualitative or quantitative evidence) and excluded case reports, editorials and commentaries. Following exclusions, 15 published papers were included in the review and are summarised. They included one qualitative paper and 14 quantitative studies (surveys or cohort studies), with a total of 2295 lung cancer patients data included (mean study size 153 patients; range 7–803). Review of current evidence and commentary included awareness and help-seeking; lung cancer screening; primary care assessment and referral; diagnosis and treatment in secondary care, including oncology and surgery; patient experience and palliative care. Cross-cutting themes and challenges were identified using qualitative methods for patients, healthcare professionals and service delivery, with a clear need for continued studies to guide evidence-based decision-making.

Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases

“…This is due to several reasons; firstly, because LC screening programs (which have demonstrated several beneficials in the context of the high prevalence of LC) 50 , 51 , 52 , 53 are interrupted due to the existing health care bottleneck and to avoid transmission of infection to both patients and health care workers. 54 , 55 This delay in screening may not have an impact on survival as long as it does not extend beyond 18 months. 56 , 57 On the other hand, the number of consultations decreases either because users do not come to the hospital because of fear of contracting the disease, or because they are not referred to the hospital due to both the health care overlap and the overlap of symptoms between COVID-19 and LC.…”

“…Not only the delay in treatment but also the suspension of consultations, surgery and treatments such as chemotherapy or immunotherapy 79 have had an impact on patients with LC, as they have led to disease progression and increased mortality from LC. 54 In a study of 288 hospitalised patients with COVID-19 and LC, disease progression was estimated in 10.7% of cases due to discontinuation of radiotherapy and 26% due to discontinuation of chemotherapy and/or immunotherapy. 80 Regarding surgery, in the first publication of the CovidSurg Cohort Study, a mortality of 42.9% was observed in resection surgery.…”

The Impact of the COVID-19 Pandemic on Oncology Care and Clinical Trials

“…The reduced functioning capacity introduced a greater dependence on triaging patients in order of urgency, with resources being prioritized to cases with a high index of suspicion of cancer [ 20 ]. Subsequently, patients displaying experiencing milder symptoms who did not meet the criteria for urgent referral experienced the most significant delay in referral to secondary care [ 21 ]. The delays were not just confined to the initial assessment in secondary care, but were found throughout the pathway.…”

Multidisciplinary Effort and Integrative Preparedness: A Lesson for the Foreseen Multivariate COVID-19 Pandemic Flare-Up

“…As with many aspects of the pandemic, lung cancer multidisciplinary teams should pull together to optimize patient outcomes. 77 A multidisciplinary team from pulmonologists, internists, and all sub-specialties must work on identification of deteriorations; testing co-infections; promoting evidence-based prescribing; encouraging early mobilization and rehabilitation, and providing psychological support. 60 Various functional foods, phytochemicals, herbal products, and vitamins showed beneficial effects in strengthening the immune system.…”