Older Cancer Patients during the COVID-19 Epidemic: Practice Proposal of the International Geriatric Radiotherapy Group

Abstract

The coronavirus disease 19 (COVID-19) pandemic is unprecedented as it reached all countries in the world within a record short period of time. Even though COVID-19 infection may be just severe in any adults, older adults (65-year-old or older) may experience a higher mortality rate. Among those affected, cancer patients may have a worse outcome compared to the general population because of their depressed immune status. As the health resources of most countries are limited, clinicians may face painful decisions about which patients to save if they require artificial ventilation. Cancer patients, especially the older ones, may be denied supportive care because of their shorter life expectancy. Thus, special considerations should be taken to prevent infection of older cancer patients and to provide them with adequate social support during their cancer treatment. The following proposal was reached: (1) Education of health care providers about the special needs of older cancer patients and their risks of infection. (2) Special consideration such as surgical masks and separate scheduling should be made to protect them from being infected. (3) Social services such as patient navigators should be provided to ensure adequate medical supply, food, and daily transportation to cancer centers. (4) Close monitoring through phone calls, telecommunication to ensure social distancing and psychological support from patient family to prevent anxiety and depression. (5) Shorter course of radiotherapy by use of hypofractionation where possible to decrease the needs for daily transportation and exposure to infection. (6) Enrollment of older cancer patients in clinical trials for potential antiviral medications if infection does occur. (7) Home health care telemedicine may be an effective strategy for older cancer patients with COVID-19 infection to avoid hospital admission when health care resources become restricted. (8) For selected patients, immunotherapy and targeted therapy may become the systemic therapy of choice for older cancer patients and need to be tested in clinical trials.

Impact of COVID-19 Outbreak on Cancer Patient Care and Treatment: Data from an Outpatient Oncology Clinic in Lombardy (Italy)

“…However, some potentially alarming signals of under-treatment were observed and clinical research and scientific activities resulted in being reduced by 80.3% and 80.1%, respectively. Specific guidelines for the treatment of patients with gastrointestinal cancers [ 22 ] and older patients with cancer [ 23 ] were also published. In fact, older cancer patients may be denied supportive care because of their shorter life expectancy.…”

Technology-based Health Solutions for Cancer Caregivers to Better Shoulder the Impact of COVID-19: A Systematic Review Protocol

“…As a result, cancer caregivers often have to step up to address patients' healthcare needs and wants [37,[46][47][48][49], which, in turn, could exert substantial mental and physical stress on informal caregivers, above and beyond COVID-19-related burdens the general public shoulders on a daily basis [17][18][19]. Technology-based health solutions can bypass spatial distancing constraints caused by COVID-19 and have the abilities to address unique challenges cancer patients and their caregivers face amid COVID-19 [50][51][52][53].…”

Radiation Therapy Delivery Challenges in Older Patients During Coronavirus Disease 2019 Pandemic

“…Preliminary data showed that patients treated with radiation were at high risk of contracting the virus and were more likely to develop a severe form of the illness because of their underlying immunosuppression related to the cancer and various anticancer drugs ( 3 ). According to general radiation guidelines for elderly patients ( 6 , 7 , 8 ), physicians had to take pragmatic actions in order to mitigate the negative effects of the Covid-19 pandemic in a vulnerable population while ensuring tumor control ( 8 ). Most focused on systemic therapies and selected oncology guidelines, especially from the international early recommendations for departments organization and cancer management during COVID-19 pandemic ( 10 ), that served as a framework for the drafting of a protocol for each tumor location in our department.…”

“…There is a necessity to allocate specific slots for consultation, simulation CT, and radiation courses for vulnerable patients which requires additional human and material resources. Implementation of protective measures from caretakers and telemedicine practice and other social distancing measures may increase the feeling of abandonment, isolation and incurability ( 6 , 7 ). In addition, in our department a specific workflow dedicated to elderly oncologic patients involving a radiation oncologist with oncogeriatric expertise has been implemented prior the pandemic with time slots and a dedicated visits area.…”