Disruptions in Cancer Care in the Era of COVID-19
Even in the midst of the COVID-19 pandemic, cancer care must go on, but changes may need to be made in the way some care is delivered.
"We're headed for a time when there will be significant disruptions in the care of patients with cancer," said Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society (ACS), in a statement. "For some it may be as straightforward as a delay in having elective surgery. For others it may be delaying preventive care or adjuvant chemotherapy that's meant to keep cancer from returning or rescheduling appointments."
Lichtenfeld emphasized that cancer care teams are going to do the best they can to deliver care to those most in need. However, even in those circumstances, it won't be life as usual. "It will require patience on everyone's part as we go through this pandemic," he said.
"The way we treat cancer over the next few months will change enormously," writes a British oncologist in an article published in the Guardian.
"As oncologists, we will have to find a tenuous balance between undertreating people with cancer, resulting in more deaths from the disease in the medium to long term, and increasing deaths from COVID-19 in a vulnerable patient population. Alongside our patients we will have to make difficult decisions regarding treatments, with only low-quality evidence to guide us," writes Lucy Gossage, MD, consultant oncologist at Nottingham University Hospital, UK.
The evidence to date (from reports from China in Lancet Oncology) suggests that people with cancer have a significantly higher risk of severe illness resulting in intensive care admissions or death when infected with COVID-19, particularly if they recently had chemotherapy or surgery.
"Many of the oncology treatments we currently use, especially those given after surgery to reduce risk of cancer recurrence, have relatively small benefits," she writes.
"In the current climate, the balance of offering these treatments may shift; a small reduction in risk of cancer recurrence over the next 5 years may be outweighed by the potential for a short-term increase in risk of death from COVID-19. In the long term, more people's cancer will return if we aren't able to offer these treatments," she adds.
Postpone Routine Screening
One thing that can go on the back burner for now is routine cancer screening, which can be postponed for now in order to conserve health system resources and reduce contact with healthcare facilities, says the ACS.
"Patients seeking routine cancer screenings should delay those until further notice," said Lichtenfeld. "While timely screening is important, the need to prevent the spread of coronavirus and to reduce the strain on the medical system is more important right now."
But as soon as restrictions to slow the spread of COVID-19 are lifted and routine visits to health facilities are safe, regular screening tests should be rescheduled.
The American Society of Clinical Oncology (ASCO) has issued new guidance on caring for patients with cancer during the COVID-19 outbreak.
First and foremost, ASCO encourages providers, facilities, and anyone caring for patients with cancer to follow the existing guidelines from the Center for Disease Control and Prevention (CDC) when possible.
ASCO highlights the CDC's general recommendation for healthcare facilities that suggests "elective surgeries" at inpatient facilities be rescheduled if possible, which has also been recommended by the American College of Surgeons.
However, in many cases, cancer surgery is not elective but essential, it points out. So this is largely an individual determination that clinicians and patients will need to make, taking into account the potential harms of delaying needed cancer-related surgery.
Systemic treatments, including chemotherapy and immunotherapy, leave cancer patients vulnerable to infection, but ASCO says there is no direct evidence to support changes in regimens during the pandemic. Therefore, routinely stopping anticancer or immunosuppressive therapy is not recommended, as the balance of potential harms that may result from delaying or interrupting treatment versus the potential benefits of possibly preventing or delaying COVID-19 infection remains very unclear.
Clinical decisions must be individualized, ASCO emphasized, and suggested the following practice points be considered:
- For patients already in deep remission who are receiving maintenance therapy, stopping treatment may be an option.
- Some patients may be able to switch from IV to oral therapies, which would decrease the frequency of clinic visits.
- Decisions on modifying or withholding chemotherapy need to consider both the indication and goals of care, as well as where the patient is in the treatment regimen and tolerance to the therapy. As an example, the risk–benefit assessment for proceeding with chemotherapy in patients with untreated extensive small-cell lung cancer is quite different than proceeding with maintenance pemetrexed for metastatic nonsmall cell lung cancer.
- If local coronavirus transmission is an issue at a particular cancer center, reasonable options may include taking a 2-week treatment break or arranging treatment at a different facility.
- Evaluate if home infusion is medically and logistically feasible.
- In some settings, delaying or modifying adjuvant treatment presents a higher risk of compromised disease control and long-term survival than in others, but in cases where the absolute benefit of adjuvant chemotherapy may be quite small and other options are available, the risk of COVID-19 may be considered an additional factor when evaluating care.
Delay Stem Cell Transplants
For patients who are candidates for allogeneic stem cell transplantation, a delay may be reasonable if the patient is currently well controlled with conventional treatment, ASCO comments. It also directs clinicians to follow the recommendations provided by the American Society of Transplantation and Cellular Therapy and from the European Society for Blood and Marrow Transplantation regarding this issue.
Finally, there is also the question of prophylactic antiviral therapy: Should it be considered for cancer patients undergoing active therapy?
The answer to that question is currently unknown, says ASCO, but "this is an active area of research and evidence may be available at any time."
As the coronavirus pandemic escalates in the United States, Medscape Oncology reached out to a group of our contributors and asked them to provide their perspective on how their oncology departments and centers are preparing. Here are their responses to a number of issues facing oncologists in the US and around the world.
Please share your own approaches and experiences in the comments.
Have you shifted nonurgent follow-up visits to telemedicine, either via video or phone?
Kathy Miller, MD, Associate Director of Indiana University Simon Cancer Center: We are reviewing our clinic schedules and identifying "routine" follow-up patients who can be rescheduled. When patients are contacted to reschedule, they are asked if they have any urgent, immediate concerns that need to be addressed before the new appointment. If yes, they are offered a virtual visit.
Don Dizon, MD, Director of Women's Cancers, Lifespan Cancer Institute; Director of Medical Oncology, Rhode Island Hospital: We have started to do this in preparation for a surge of people with COVID-19. Patients who are in long-term follow-up (no evidence of disease at 3 years or longer, being seen annually) or those in routine surveillance after curative treatment (that is, seen every 3 months) as well as those being seen for supportive care–type visits, like sexual health or survivorship, are all being contacted and visits are being moved to telehealth.
Jeffrey S. Weber, MD, PhD, Deputy Director of the Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center: Yes. Any follow-up, nontreatment visits are done by phone or video if the patient agrees. (They all have).
Have you delayed or canceled cancer surgeries?
Ravi B. Parikh, MD, MPP, Medical oncologist at the University of Pennsylvania and the Philadelphia VA Medical Center: The University of Pennsylvania has taken this seriously. We've canceled all elective surgeries, have ramped up our telemedicine (video and phone) capabilities significantly, are limiting our appointments mostly to on-treatment visits, and have been asked to reconsider regular scans and reviews.
Dizon: We have not done this. There are apparently differences in interpretation in what institutions might mean as "elective surgeries." At our institution, surgery for invasive malignancies is not elective. However, this may (or will) change if resources become an issue.
Lidia Schapira, MD, Associate Professor of Medicine and Director of Cancer Survivorship at the Stanford Comprehensive Cancer Institute: Delaying elective surgery is something that hospitals here have already implemented, and I imagine that this trend will spread. But it may be difficult to decide in situations that are not exactly "life-saving" but where an earlier intervention could preserve function or improve quality of life.
Mark A. Lewis, MD, Director of Gastrointestinal Oncology at Intermountain Healthcare in Utah: Cancer surgeries have not been deemed elective or delayed.
Have you delayed or altered the delivery of potentially immune-comprising treatments?
David Kerr, MD, Professor of Cancer Medicine at the University of Oxford in England: We are considering delaying initiation of our adjuvant colorectal cancer treatments, as we have data from our own QUASAR trials suggesting that patients who commence chemotherapy between 2 and 6 weeks do equally as well as those who begin 6-12 weeks after surgery.
Parikh: I personally haven't delayed giving chemotherapy to avoid immune compromise, but I believe some others may have. It's a delicate balance between wanting to ensure cancer control and making sure we are flattening the curve. As an example, though, I delayed three on-treatment visits for my clinic last Monday, and I converted 70% of my visits to telemedicine. However, I'm a genitourinary cancer specialist and the treatments I give are very different from others.
Lewis: The most difficult calculus is around adjuvant therapy. For metastatic patients, I am trying to use the least immunosuppressive regimen possible that will still control their disease. As you can imagine, it's an assessment of competing risks.
Schapira: Patients who need essential anticancer therapy should still get it, but attempts to deintensify therapy should continue—for example, holding or postponing treatment without harm (based on evidence, not opinion). This may be possible for patients considering hormonal therapies for breast or prostate cancer.
Patients who need radiation should discuss the timing with their radiation oncologist. In some cases, it may be possible to delay treatment without affecting outcomes, but these decisions should be made carefully. Alternatively, shorter courses of radiation may be appropriate.
Have you advised your own patients differently given the high risk to cancer patients?
Kerr: We have factored potential infection with the virus into discussions where the benefits of chemotherapy are very marginal. This could tip the balance toward the patient deciding not to pursue chemotherapy.
Dizon: The data from China are not entirely crystal-clear. While they noted that people with active cancer and those who had a history of cancer are at increased risk for more severe infections and worse outcomes, the Chinese cohort was small, and compared with people without cancer, it tended to be much older and to be smokers (former or current). Having said this, we are counseling everyone about the importance of social distancing, washing hands, and not touching your face.
Lewis: If I have a complete blood count with a differential that includes lymphocytes, I can advise my lymphopenic patients (who are particularly vulnerable to viral infection) to take special precautions regarding social distancing in their own families.
Have any of your hospitalized patients been affected by policy changes to prepare beds/departments for the expected increase in COVID-19–positive patients?
Weber: Not yet.
Dizon: No, not at the moment.
Have you been asked to assist with other services or COVID-19 task forces?
Dizon: I am keenly involved in the preparations and modifications to procedures, including staffing decisions in outpatient, movement to telehealth, and work-from-home policies.
Lewis: I am engaged in system-wide COVID-19 efforts around oncology.
Kerr: Perhaps oddest of all, I am learning with some of our junior doctors to care for ventilated patients. I still consider myself enough of a general physician that I would hope to be able to contribute to the truly sick, but I accept that I do need an appropriate refresher course.
Bishal Gyawali, MD, PhD, medical oncologist at Queen's University Cancer Research Institute: Queen's Hospital medical students are now volunteering to help with daycare, groceries, and other tasks for staff who are working in the hospital.
Are you experiencing any shortages in personal protective equipment (PPE) at your center?
Miller: Some supplies are running short, though none are frankly out at this point. However, rationing and controls are in place to stretch the supplies as far as possible, including reusing some PPE.
Dizon: We are rationing face masks and N95 respirators, eye shields, and even surgical scrubs. We are talking about postponing elective surgery to save PPE but are not yet to that point. We're asking that face masks be reused for at least 2 days, maybe longer. PPEs are one per day. Scrubs are kept secure.
Lewis: We are being very careful not to overuse PPE but currently have an adequate inventory. We have had to move gloves and masks to areas where they are not accessible to the general public, as otherwise they were being stolen (this started weeks ago).
Kerr: Our National Health System has an adequate supply of PPE equipment centrally, but there seems to be a problem with distribution, as some hospitals are reporting shortages.
Weber: Masks are in short supply, so they are being used for several days if not wet. We are short of plastic gowns and are using paper chemo gowns. Similar story at many places.
Should Docs Stop Providing Routine Care in the Era of COVID-19?
Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
As the COVID-19 crisis deepens and pressure on the medical system increases, clinicians and facilities are having to prioritize care.
To help, medical societies and hospitals are working with providers to determine what care must go on and what can be delayed, rescheduled, canceled, or performed remotely to protect providers and patients and to make way for a predicted surge of COVID-19 patients.
Some decisions are easier to make than others, experts from a variety of specialties and settings told Medscape Medical News.
Leonard Feldman, MD, a hospitalist and associate professor of medicine at Johns Hopkins Medicine in Baltimore, Maryland, told Medscape Medical News that adult wellness visits should be canceled for the time being.
Likewise, if there's no pressing reason to order lab tests, this is the time to put those off, he said.
"If you have a brittle diabetic, maybe we're going to have them come in to get their hemoglobin A1, but the HbA1c is a reflection of 3 months, and you don't want to get it any earlier than you absolutely need to," he said. "It will be a very small subset of diabetic patients we will be encouraging to get lab testing."
He adds that this is not the time to bring in relatively healthy patients for a routine blood pressure check. A much better solution is to urge patients to get a home monitor and transmit readings, he explained.
Don't Delay Child Vaccines
Vaccines for children should be given on schedule, he said, especially for those younger than 2 years and for 4-year-olds (who will be due for their second measles-mumps-rubella shot).
But vaccines for adults, such as shingles and pneumococcal vaccines, can wait, he said. "We don't need to be prioritizing them in the middle of a pandemic."
A routine pulmonary function test for chronic obstructive pulmonary disease(COPD) or any routine test that puts droplets into the air should not be conducted at this time, he said. Likewise, manometry to check esophageal function should wait, he said, if a patient won't develop significant morbidity if the test is not performed.
"The big take-away from all of this is how quickly can you ramp up telemedicine," he said. That would enable more routine care.
In the current situation, clinicians at Hopkins are treating more patients over the phone. "[W]e are treating strep throat over the phone," Feldman said. "We may not be able to feel their lymph nodes and look into their throat, and we'll have to be more liberal about things."
But not everyone fits a telemedicine model. "The hard stuff is a patient you've never seen before transferring to the clinic who wants to have their medicines refilled and we don't know them at all," he said.
Changing prescription strategies can help minimize clinic visits. Clinicians are beginning to prescribe buprenorphine for opioid use disorder for longer periods than they ideally would, Feldman said.
"We'd like to see [these patients] every week, but we also don't want them to have to come into a clinic," he continued.
Decisions on Endoscopies, Surgeries
Gastrointestinal societies issued a joint statement this week in which they urged physicians to "[s]trongly consider rescheduling elective non-urgent endoscopic procedures." They note that some nonurgent procedures may still need to be performed, such as removals of prostheses and evaluations for patients with cancer or with significant symptoms.
However, Mark Pochapin, MD, president of the American College of Gastroenterology, told Medscape Medical News that for gastroenterologists, priorities are, "Cancel all colon cancer screening and surveillance and Barrett's esophagus surveillance."
US Surgeon General Jerome Adams, MD, MPH, tweeted on March 14: "Hospital & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve!"
Each elective surgery, he notes, brings possible COVID-19 cases in, reduces personal protective equipment supplies, and pulls away providers who may be needed to respond to exisiting COVID-19 cases.
The American College of Surgeons (ACS) last week directed members to cancel elective surgeries and endoscopies. But the college noted in guidance this week that those decisions come with risk as well.
"[G]iven the uncertainty regarding the impact of COVID-19 over the next many months, delaying some cases risks having them reappear as more severe emergencies at a time when they will be less easily handled," the ACS explained.
The association has provided recommendations on how decisions should be made about surgeries.
"[I]n general, a day-by-day, data-driven assessment of the changing risk-benefit analysis will need to influence clinical care delivery for the foreseeable future," the authors write.
The advice is not just for those in COVID-19 hot zones, they write.
"If you practice in an area that's not a hot zone," the ACS says, "we still recommend that you refer to the Centers for Disease Control and Prevention (CDC) website for guidance." Recommendations are available in the section, Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States.
Mayo Shuts Down Most Elective Care for 8 Weeks
The Mayo Clinic announced Tuesday that starting March 23, all Mayo locations nationwide "will defer all elective care that can be deferred for eight or more weeks. This will include both elective surgeries, procedures and office visits. Semi-urgent, urgent and emergency care will continue in clinic and hospital settings."
Similarly, the American Dental Association recommended on March 16 that dentists postpone all elective procedures for the next 3 weeks.
Making way only for dental emergencies will "alleviate the burden that dental emergencies would place on hospital emergency departments," the ADA writes.
At Confluence Health in Washington state, urgent and emergent surgeries, such as appendectomies and broken bones, will be performed as usual, according to a recent statement.
However, since March 17, in-person routine care visits have been "curtailed" for 6 weeks. Patients who have already scheduled nonurgent appointments and elective procedures are being asked to call ahead and cancel.
The health system says that if patients and providers agree that an appointment or treatment needs to be conducted in person, "we will make sure you are seen.
"We are working to offer telephone-based visits and are working as hard as we can to offer video conferencing options shortly," Confluence Health writes.
Robert McLean, MD, president of the American College of Physicians (ACP), said that the primary overall change for physicians should be in reducing the numbers of patients coming to medical facilities for care.
The ACP on Wednesday issued a statement saying it supports suspending elective medical procedures and is also calling for the Centers for Medicare & Medicaid Services (CMS) to do even more to help enable telehealth.
As Medscape Medical News previously reported, the CMS is expanding telehealth coverage for beneficiaries and is easing restrictions during the COVID-19 crisis.
Easing telehealth restrictions will help, McLean said, but not everyone will be able to use the services. Seniors, for instance, may be less likely to have smartphones and less likely to move quickly to telehealth options during a pandemic.
As medical director of Northeast Medical Group of Yale–New Haven Health System in Connecticut, he has asked his group in the past 2 days to determine which patients can be treated via phone or video.
Amy Mullins, MD, medical director of quality and science at the American Academy of Family Physicians (AAFP), told Medscape Medical News, "We recommend that physicians consider postponing wellness exams and nonurgent care until a later date."
The AAFP also recommends designating an area of practice (a connected building or temporary structure) as a "respiratory virus evaluation center," Mullins said.
Don't Travel, Move Research Masks to the Clinical Side
Eric E. Howell, MD, chief operating officer of the Society of Hospital Medicine (SHM), told Medscape Medical News that the SHM is advising hospitalists not to travel professionally or personally.
"We can't forbid it, but we ask. When we lose a provider, it is a massive hit to the rest of us," he said.
Howell said they are also imploring physicians to reuse face masks, not to hoard them, and to divert to clinical use masks and supplies that had been meant for research.
"I have my own single N95 mask that I carry in a baggie in my lab coat," he said.
Howell says providers can use a mask for patients under investigation or for a COVID-19 patient and then, instead of throwing it away, put it in a paper bag so that it dries and can be reused.
Italian Oncologist Offers Cautionary Advice on COVID-19 for US Centers
Marina Garassino, MD, is chief of the Medical Thoracic Oncology Unit at the Istituto Nazionale dei Tumori in Milan, Italy. The day after this interview was recorded, Italy announced that deaths from the COVID-19 virus had reached 3405, outstripping the toll in China, where the virus first hit.
In this discussion with Jack West, MD, she talks about how her team of oncologists has responded to the COVID-19 pandemic and what lessons she can pass on to US and global oncologists for the care of their cancer patients during the outbreak.
This interview has been edited for length and clarity. Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
You are in the epicenter of the COVID-19 pandemic right now. Can you give us a sense of what it is like currently and what it has been like over the past couple of weeks, from the inside?
We are surviving, but it's very hard. As an oncologist, I can only speak generally about COVID-19 treatments because it's not my field. We send people who are COVID-19–positive to be treated in specific centers; the intensive care is in another hospital.
How has it been working in a system as taxed as the medical system has been in Italy, in terms of how you and your cancer patients are coping?
We were not prepared because we thought that China was very far away, and Italy was a small country in a different environment and therefore it wasn't possible that we would be attacked by the virus.
The start was very simple: There was a case of a very young man in a small hospital in Emilia-Romagna, which is a small region in Italy. After watching a difficult resolution in this man, the anesthesiologist decided to do a COVID-19 test. When the test came back positive, it started the story in Italy. But we think that it was just by chance that Italy was first, and not another country, because we started to test earlier.
If you are not prepared to have 15% of cases in intensive care, you have big problems.
What we see is that you can have multiple different types of COVID-19. The majority of cases are asymptomatic. This is very important because you can't recognize them, but they are there and they can spread the virus everywhere—this is the most relevant point of the story.
Then there are patients with mild flu-like symptoms—a small fever, cough, maybe rhinorrhea, conjunctivitis.
And then you have another category of about 15% of the cases that need intensive care. If you are not prepared to have 15% of cases in intensive care, you have big problems. Sometimes you have to face decisions about which patients must go to intensive care and which will not. The problem here is not the deaths that occur mostly in the elderly; the problem is that 15% of patients need intensive careMost often, intensive care is for patients who present with terrible pneumonitis. Other types of presentations include diarrhea, high fevers, conjunctivitis; some cases present with ageusia, dysgeusia, or anosmia as well. Otitis can be present. So you can have multiple symptoms.
These patients can start with mild symptoms and in a short time they need intensive care. So my first suggestion is to be prepared to have enough beds for intensive care. In Italy, we have intensive care everywhere but we need more beds because there are not enough.
With so many ICU beds and ventilators occupied by patients with COVID-19, that must mean that even people with other medical problems that are potentially treatable and reversible suddenly can't get their necessary treatments.
Yes, and this is the most relevant point for oncology. We tried to avoid all follow-ups. We created a team for follow-ups to stay in touch with people by phone and to reassure them that every treatment will be finished—we will take care of them. We are also trying to take care of them through Web-based medicine. It is important that they don't feel like they are being abandoned.
But, for example, all CT scans of patients after surgery are delayed. Everything that we feel is unnecessary is delayed.
It is difficult to define what is unnecessary and what is not. We are delaying the second- and third-line treatments. We are trying to delay chemotherapy and immunotherapy treatments for 1 week. We don't know if we are right or wrong, but we are trying to make decisions based on every patient's situation and knowing that they do not have beds in the ICUs.
At the very least, the risk of COVID-19 infection needs to be factored into the balance of anticipated benefits and risks of treatments that may have a debatable, or only marginal, benefit, yet we still routinely provide.
Especially in older patients, the potential harm of causing immunosuppression may be greater than the anticipated benefit. It forces us to recalculate whether our treatments are definitely more likely to help than to harm patients now.
Yes. When we spoke with all the patients, I can say that they understood very well. They understand that they are more frail and that there is greater danger if they come to the hospital. They agreed to postpone everything as much as possible.
At the same time, we are treating in the neoadjuvant setting and first-line metastatic non–small cell lung cancer patients. But we are delaying everything that is less important. It really is not less important, but we are trying to prioritize what is life-threatening.
Do you feel that your colleagues who are on the frontlines managing patients at COVID-19 treatment facilities and in the ICUs are overwhelmed, or is the feeling at this point that they have maybe been through the worst and are better equipped to manage in the coming weeks?
In Italy, we have a public health system, so everything is paid for every citizen. There are a lot of philanthropic institutions that are donating money to get more ICU beds, so the situation now is not at the point of collapse. But we—the physicians—are not something that you can buy.
Sometimes you do have to make hard decisions. For example, a woman being treated by my group was in her last line of treatment and we decided to have her stay at home because she was positive. It's very sad because you may have helped a patient for years, and as they are dying it may be difficult to find a place for them. I think that it's important to be prepared for this part as well—to create a COVID-19–positive hospice and be prepared for every phase of the disease.
Is the general public in Italy now entirely onboard with social isolation, or are there still people who may not be responding as aggressively as the medical community would like?
The Italian people love hospitality so it's difficult for them to stay at home. I can tell you that my city [Milan] has been totally empty for 10 days, so I think that people are now starting to understand that this is a real danger and they are staying at home. You may see some people jogging or out with their dogs; there are a lot of messages saying that's okay, but there are also some suggestions that people should not go out at all.
What we learned from China is that the only way to contain the situation is isolation and segregation. We must also be aware that hygiene is very important. We have to stay at home as much as possible and convince the community to stay at home, because I can tell you that it's really frighteningCancer patients are very resilient.
Is it fair to say that one of your key recommendations for other parts of the world, like the United States, that have yet to see the brunt of this and may be 1 or 2 weeks behind Italy, is to take it as seriously as possible and pursue social distancing and promote broad testing?
In Italy, there have been two suggestions for testing. We started by testing only symptomatic people because we had to take care of them; but now we are feeling that we also have to test those who are asymptomatic because they can potentially infect others. I can't tell you the final decision on that.
For your hospitals, what I can say is to try to track the people who are infected. Technology can help. There are apps that track where people go, where they stay, and who they visit.
I think South Korea is doing a very good job in terms of isolation, segregation, and testing.
Has this forced you as a subspecialist in oncology to work outside of your usual field and basically become a generalist, or to be a part-time emergency room physician or pulmonologist? Or are you still exclusively focusing on managing cancer patients?
I work in a comprehensive cancer center, so we are trying to continue to take care of cancer patients. As I mentioned, we are designating COVID-19–positive centers and COVID-19–negative centers. In the negative centers, we then have to divide patients into two different pathways—positive and negative—because this is the only way to continue to take care of the oncology patients.
But I can tell you that in general hospitals, people are being converted to different activities to take care of these patients.
How are patients with cancer accepting these new challenges? Are they seeing this as being part of a larger community and accepting that there are potentially other patients with higher acuity? Or is there a lot of frustration that their cancer issues are now secondary and they may not get access to care?
What we see is that cancer patients are very resilient. They understand better than the citizens without cancer. So they are more with us than other people. But again, I think the most relevant point is to stay in touch with them as much as you can.
What are the key lessons for oncologists in terms of recommending or avoiding treatments for their patients in regard to risk for COVID-19 infection?
Right now we have very little information available. We know from the first data in Italy that 20% of patients who have died are cancer patients.
What we don't know is whether there is a treatment that can potentially cause harm—for example, the ibuprofen story. We need to understand which patients are most likely to have pneumonitis and which patients may be potentially harmed by the treatments.
We have to join forces. Hopefully each one of us has only a few COVID-19–positive patients, but if we all join together and share cases, maybe we can get some answers very soon.
Yes. I want to credit you. You've been one of the earliest and strongest proponents of bringing together an international community of lung cancer specialists and other physicians to share as much information as possible and create databases that we can learn from. Thank you for all you've been doing. I wish you and your patients all the best.
H. Jack West, MD, associate clinical professor and executive director of employer services at City of Hope Comprehensive Cancer Center in Duarte, California, regularly comments on lung cancer for Medscape.
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