By Tânia Madureira, MD, Medical Oncology Department, University Hospital Center of Algarve, Medical Oncology Department, Faro, Portugal.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that the world is facing is truly challenging for both patients and medical doctors. While learning how to treat patients with COVID-19 (the disease caused by SARS-CoV-2) there is also an important focus on preventing the spread of this viral infection. This is particularly important in some groups of patients that we define as risk groups, such as older adults and people of any age that have serious medical conditions (chronic lung disease, serious heart conditions, people who are immunocompromised, etc.).

These risk groups have higher risk of severe illness from COVID-19, and for this reason they deserve special attention and protection during this pandemic. COVID-19, as a new disease, is still very undefined in the general population as well as subgroups such as cancer patients.

Oncologic patients are a group of great concern.¹ Their condition and the antineoplastic treatments they are taking lead to an immunosuppression state with a higher risk of infections. These patients are usually frail, going through physically and psychologically hard times that make them even more vulnerable. Despite limited data, it is considered that cancer patients are particularly at risk for severe events related with COVID-19, with need for intensive care and higher risk of death.^2,3

Medical oncologists are always seeking early diagnosis and treatment at the right time with the best protocol in order to improve prognosis and quality of life. It’s challenging to keep going in this direction during the pandemic without increasing the risk of coronavirus exposure. In cancer, there are many situations where delayed treatment is correlated with death. So, oncologists are trying hard to select patients who undoubtedly require immediate treatment and who really need to visit an oncology department.

Various strategies to avoid unnecessary hospital visits are always under discussion and being developed by medical societies, oncology departments and professionals. Some of the already implemented measures include: to provide patients on oral treatment with drugs for a longer time; to create a phone line available for patients to ask questions and to report new symptoms - trying, when possible, to manage them at home instead of going immediately to hospital; to delay exams that are not urgent; to opt for oral treatments or the ones with less administrations but similar efficacy; and to make the follow-up appointments by telephone as much as possible.

Every decision concerning anticancer treatment is made case by case. Efforts are being made to minimise the exposure to coronavirus. A special circuit for cancer patients should be created in every hospital. Patients should be aware of the risks and of the precautions they should take. The established interventions to prevent the spread of the coronavirus infection in the general population are transferrable to cancer patients.³ They need to respect social distancing, adopt measures of respiratory hygiene and to stay at home as much as possible, as recommended. Oncology inpatients should be separated from other patients at the hospital, should have a specific team for their care and shouldn’t have visits.³ Despite the emotional challenge present every day for these patients due to their disease, social distancing must be implemented, which is likely to cause more psychological difficulties.⁴ Psychological support becomes even more important during the pandemic.⁴ As with all other health care professionals, doctors and nurses caring for cancer patients should use personal protection equipment as recommended.

Oncologists will have extremely difficult decisions to make during the co-existing of cancer and COVID-19. More than ever it’s important to work as a multidisciplinary team, including managers and administrators, to offer the best possible care to our patients despite the challenging circumstances, and never forgetting the protection of professionals.

References

• 1. COVID-19 Patient Care Information, American Society of Clinical Oncology (ASCO). (Accessed on April 14, 2020).
• 2. Xia Y, Jin R, Zhao J, et al. Risk of COVID-19 for patients with cancer. Lancet Oncology 2020; 21:e180.
• 3. Kutikov A, Weinberg DS, Edelman MJ, et al. A War on Two Fronts: Cancer Care in the Time of COVID-19. Ann Intern Med 2020.
• 4. Torales J, O'Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry 2020; :20764020915212.