Oncologists and Patients Navigate Treatment Decisions Amid COVID-19 Pandemic

Oncologists and patients are looking for guidance regarding cancer treatment during the COVID-19 (coronavirus) pandemic. In their coronavirus FAQs, the American Society of Clinical Oncology (ASCO) has written, “At this time, no specific recommendations can be made … for delay in therapy or choosing alternate therapy in the context of COVID-19 infection.”

According to an early report, patients with cancer who become infected with COVID-19 have a 3.5 times higher likelihood of requiring mechanical ventilation, being admitted to the ICU, or dying, compared with those without cancer.

There are no clear-cut answers and, according to ASCO, treatment decisions should account for stage of the cancer, type of chemotherapy, and risk of recurrence if treatment is delayed. As hospitals cancel elective procedures, postpone routine visits, and request that nonurgent patients switch to telehealth visits, delaying hospital visits for patients with advanced and aggressive cancers may have grave consequences. No one can say how long the pandemic will last, and while many patients could safely skip a dose or two of their chemotherapy, it might not be any safer to resume in the coming weeks or months. Additionally, certain treatments, such as bone marrow transplants, could put patients at greater risk by compromising their immune systems.

If a patient receiving chemotherapy were to test positive for COVID-19, “[we would] follow the guidelines for giving chemotherapy in the context of an infection – any infection, COVID or otherwise – which is to wait until the infection is resolved to resume chemotherapy,” said Siddhartha Mukherjee, MD, a hematologist/oncologist at Columbia University Medical Center. A shortage of COVID-19 test kits to confirm whether the patient has the virus before compromising their immune systems with chemotherapy further complicates treatment decisions.

The American Society of Hematology (ASH) has launched a webpage containing resources for hematologists caring for their patients and continuing important research amid the outbreak of the novel coronavirus (www.hematology.org/covid-19). “As the world grapples with the novel coronavirus, ASH believes that we can help each other be as knowledgeable and prepared as possible. The information and links [on the website] will get us started but please let us know how ASH can help you, your center and your patients. The website will be updated frequently and new features added as needed,” ASH President Stephanie J. Lee, MD, MPH, said.

Sources: Vox, March 20, 2020; ASH COVID-19 resource webpage; ASCO Coronavirus Resources; Ueda M, Martins R, Hendrie P, et al. Managing cancer care during the COVID-19 pandemic: agility and collaboration toward a common goal. J Natl Compr Canc Netw. 2020 March 20. [Epub ahead of print]