To Treat or Not to Treat? Cancer During the COVID-19 Pandemic

Clinicians must weigh out the pros and cons when treating patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic, according to an article by Fox Chase Cancer Center researchers that was recently published in the Annals of Internal Medicine.

“Oncology specialists as well as other providers regularly involved in the diagnosis, active treatment, and longitudinal follow-up of cancer patients must consider how to 1) balance a delay in cancer diagnosis or treatment against the risk for a potential COVID-19 exposure, 2) mitigate the risks for significant care disruptions associated with social distancing behaviors, and 3) manage the appropriate allocation of limited health care resources in this unprecedented time of health care crisis,” the authors wrote.

Statistics have shown that people who are elderly or who have other health conditions are most negatively impacted by COVID-19, which could put patients with cancer at an increased risk.

Treatment Decisions

Not only can it be risky to potentially expose a patient to the virus during cancer treatment, but such exposure can cause major issues after treatment as well. The researchers encourage clinicians to make decisions on a case-by-case basis, taking into consideration the type of cancer a patient has.

“Many solid tumors (such as lung or pancreatic cancer) and some hematologic cancers (such as acute leukemia) require immediate diagnosis and treatment. However, other common early-stage cancers (breast, prostate, cervical, nonmelanoma skin) may not,” they wrote.

While there shouldn’t be a “one-size-fits-all” approach, the authors said that experienced oncology providers should exercise their best judgement, and those decisions could change, “as efforts by the healthcare system to mitigate risks for exposure to COVID-19 improve.”

Social Distancing

The researchers also outlined that patients undergoing cancer treatment disrupt social distancing protocols that were put in place to mitigate the spread of COVID-19.

“Every patient who engages with the traditional oncology care delivery system significantly disrupts this social distancing tactic, resulting in innumerable ripple effects,” the researchers wrote. “Clinic visits, surgical stays, infusion sessions, radiation planning and treatment appointments, hospital admissions, phlebotomy visits for laboratory tests, and radiographic imaging studies—all often attended with family members in tow—result in a massive number of personal contact points and many potential opportunities for viral transmission.”

Some patients, especially those receiving survivorship care, may be better off with “nontraditional care delivery strategies” and the use of modern technology, such as telehealth. The Centers for Medicare & Medicaid Services, along with other private insurers, have expanded telehealth benefits during the outbreak. The US Department of Health and Human Services will not impose penalties on providers who use telehealth in the event of nonadherence to Health Insurance Probability and Accountability Act (HIPAA).

Limited Healthcare Resources

Another major concern born out of the pandemic is the saturation of the healthcare system, especially when it comes to intensive care unit (ICU) beds, ventilators, pharmaceuticals, blood products, staff (and protective equipment for them), and basic medical supplies.

“Although most cancer care is not typically considered ‘elective,’ as resource constraints grow owing to supply chain issues, variations in geographic needs, and reallocation of medical infrastructure to care for infected patients, difficult tradeoffs will need to be made,” the authors wrote.

Patient education is key here. Additionally, standard post-acute treatment strategies including lab testing, imaging, and office visits may be postponed as well.

“In summary, as cancer care and COVID-19 collide, patients and providers will face extremely difficult choices. The combat plan during this battle must involve patience, communication, diligence, and resolve. Risks must be balanced carefully, public health strategies implemented thoroughly, and resources utilized wisely. Furthermore, the policies and procedures developed today will serve as the basis for addressing the next outbreak or similar crisis,” the authors wrote.

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