The National Comprehensive Cancer Network (NCCN), an alliance of leading cancer centers, released an evidence-based consensus from leading medical experts on how best to provide optimal cancer management during the COVID-19 pandemic. The nonprofit organization’s Best Practices Committee detailed specific recommendations for keeping cancer patients, caregivers, and staff as safe as possible in a special feature published in the Journal of the National Comprehensive Cancer Network.
Adjusting Care Delivery
Lead author Pelin Cinar, MD, clinical assistant professor of gastrointestinal oncology, University of California San Francisco (UCSF), and medical director of Quality & Safety, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, said providing patients with effective and compassionate care without sacrificing the health and safety of oncology teams, colleagues, and families is possible. However, it is only possible by carefully evaluating all emerging research and modifying treatment approaches accordingly.
“The biggest change has been in how we are delivering care. With continued focus on our patient’s well-being, visits have in general moved to telemedicine (video or telephone visits), except for cases in which patients need to present to the cancer center for infusional anticancer therapy, radiation therapy, procedures, or tests,” Dr Cinar explained (personal communication, April 2020).
Cancer cases are evaluated very carefully and surgeries are still being offered to patients whose outcomes would be affected by a treatment delay. “There are often multidisciplinary conversations on how we can continue to provide the best possible care in a safe manner and without jeopardizing patient outcomes,” explained Dr Cinar. Patients with cancer and their loved ones already go through so much, and now they face new fears regarding COVID-19 or delaying necessary treatment. However, by sharing these recommendations NCCN hopes to reassure the oncology community that there are some aspects of care that can be controlled to improve outcomes for those undergoing treatment for cancer.
Best Practices Recommendations
Although the special feature presented the most current information at the time of publication, the authors note that recommendations regarding public safety and practice may change rapidly. Currently, the NCCN Best Practices Committee recommends prescreening and screen for COVID-19 symptoms and exposure history via telephone calls or digital platforms. Develop screening clinics to allow for patients with symptoms to be evaluated and tested in a dedicated unit with dedicated staff. Converting in-person visits to telemedicine visits when possible, and adopt a limited or no visitor policy.
The recommendations call for considering alternative dosing schedules to allow for fewer in-person visits to the cancer center and/or the infusion center, and switching from infusional therapy to oral oncolytics if equivalent formulation is available. The committee recommends transitioning outpatient care, such as pump disconnections, administration of growth factors, and delivering hormone therapy, to care-at-home whenever possible. It also recommends increasing interval times between scans or using biochemical markers in lieu of scans.
“The most important take-home message is to keep up with the ever-changing recommendations made by CDC, local agencies, and institutional guidelines. We are continuing to learn about COVID-19, and this is allowing the experts to evolve the guidelines and recommendations accordingly,” said Dr Cinar. “As leaders in cancer centers, we are responsible for keeping abreast of these recommendations, adopting them in our own institutions and making certain that our healthcare provider communities are aware of the algorithms and workflows.”