To Do or Not to Do?—A Review of Cancer Surgery Triage Guidelines in COVID-19 Pandemic

Abstract

COVID-19 pandemic has emerged as a global health emergency involving more than 200 countries so far. The number of affected population is on rising, so is the mortality. This crisis has overwhelmed the healthcare infrastructures in many affected countries. Due to overall rising cancer incidence and specific concerns, a cohort of cancer patients forms a distinct subset of the population in whom a correct and timely treatment has a huge impact on the outcome. During this period, oncology care is definitely affected owing to many factors like lockdowns, reduced beds and deferral of elective cases to halt the spread of the pandemic. Surgery remains the best line of defence in many solid organ tumours especially in early stage and is potentially curative. China, the source of this pandemic, has taken more than 3 months to enter the post transitional phase of this pandemic. Deferring cancer surgeries for this long period may have a direct impact on the long-term outcomes of cancer patients. Many surgical oncology associations across the globe have come up with triage guidelines for surgical care of cancer patients; however, these are based on expert opinion rather than actual data. Herein, we intend to review these guidelines with respect to the risk of disease progression in cancer patients. In the absence of actual data on cancer surgery care during this pandemic, clinical decisions should be based on careful consideration of disease-related and patient-related factors. While some of the cancer surgeries can be safely delayed for some time, how long we can delay surgeries safely cannot be answered/ explained by any means. Thorough evaluation and discussion by an expert and experienced multidisciplinary team appears to be the most effective way forward.

Cancer management during the COVID-19 pandemic: Choosing between the devil and the deep blue sea

“…This is especially true in hospitals serving populations with a high caseload of COVID-19 such as in New Delhi, Mumbai, Milan, Madrid, and New York, where routine activities such as cancer screening and therapy where held up ( de Las Heras et al, 2020 ). In point of fact, surgical treatment of cancer patients utilizes substantial resources including diagnostic modalities, blood products, ICU beds and even ventilators and personal protective equipment (PPE) ( Shinde et al, 2020 ). Consequently, 70% of centers experienced a shortage in blood products and 47% to 62% of medication shortage was reported in 34 centers from 19 countries in the Middle East, North Africa, and West Asia Region ( Saab et al, 2020 ).…”

Continuing surgical care in cancer patients during the nationwide lockdown in the COVID‐19 pandemic—Perioperative outcomes from a tertiary care cancer center in India

“…The majority of associations and guidelines recommend clinical triage of patients based on various disease subsites or biology 1 . However, as these guidelines are based on expert opinion rather than solid evidence, emphasis was placed on individualization of treatment planning taking into account patient factors, available health care resources and local epidemiological conditions 2 . For many solid organ cancers, surgery remains the mainstay of treatment, and cannot be postponed indefinitely, given the uncertainty of the timeline for cessation of propagation of the epidemic.…”

Ocular oncology practice guidelines during COVID-19 pandemic-An expert consensus

“…The impact on the outcome can be adverse if the management is neglected or delayed in cancer patients. [ 1 2 ] There is a growing concern that coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can impact the management of cancer patients by overwhelming the medical care systems and overshadowing the rest of the clinical care. There is an international consensus that any patient with a potentially malignant tumor diagnosed during the COVID-19 pandemic should undergo a thorough clinical assessment, appropriate investigations, and possibly a biopsy to confirm the diagnosis and protocol-based management as appropriate.…”