Whether patients with cancer are at increased risk of acquiring COVID-19 infection compared to the general population remains unclear, but if they do contract the infection, they are at high risk of morbidity and mortality.¹ Furthermore, patients with cancer are exposed to multiple other risks that may impact their outcome during the pandemic and beyond. Since the pandemic may drag on for a long time, may become a recurrent crisis, or a new pathogen may drive new outbreaks, health care providers should plan for the long haul. To be able manage cancer care during the pandemic and far into the future, oncologists need to understand the problem well enough to make a proper plan to mitigate it.

What are the risks posed by the COVID19 pandemic to patients with cancer?

The risks to patients with cancer can be divided into three categories: infection exposure, receiving suboptimal care, and emotional disorders. Each type of risk carries potential harms that require specific strategies and approaches to alleviate or eliminate them.

Exposure to the viral infection is the most imminent risk representing an immediate threat to a patient’s life and, through potential transmission to others, to the lives of those around them. Due to the widespread prevalence of COVID-19 infection, patients may contract the disease in the community or in health care facilities.

Receiving suboptimal care may occur in two different ways. Some patients with cancer require acute care for different reasons, be it a complication of the cancer or its treatment or a non-cancer related condition that requires immediate interventions, hospitalization, or procedures. The potential harm is not from the exposure to COVID-19 only, but from not receiving the optimal care. A health care system overwhelmed by patients with COVID-19 will divert many of its resources and manpower toward critically ill infected patients, preventing other patients in need of acute care, including those with cancer, from receiving optimal care they would get in normal circumstances.

The other risk of suboptimal care is related to the delay of cancer treatment, whether the delay is planned per physician discretion, or unplanned due to the closure of the treatment center, the patient’s choice to decline treatment or their inability to come in for treatment, or other reasons. This delay in treatment may have a negative impact on patient outcome such as disease progression, disease relapse, clinical deterioration, or even death.

The third risk is the decline in emotional and mental health that may develop in patients with cancer because of social distancing and isolation, stress from the fear of infection or missing treatment, and uncertainty about their future. All these factors, in addition to societal and economic effects, may predispose patients to mental health issues that could last well beyond the pandemic.

Are oncology staff at risk too?

Like their patients, oncology staff are also exposed to significant risks which include contracting the infection, physical exhaustion, and deteriorating emotional and mental health (including stress, burnout, depression, and other conditions).² Plans to prevent, detect, and manage these risks are very critical.

What should oncologists do?

Oncology professionals face a compound challenge: providing timely, safe, and appropriate care to their patients while taking care of themselves and their staff. Therefore, it is very critical to have a systematic approach to tackle these issues to navigate through the crisis effectively.³ How should we do that?

• The first goal should be making a plan. Take time to think through a management plan that is suitable for your practice setting, even if that means closing shop totally for couple of days to set this issue in order. The management plan should have two main components: Patient care plan and staff management. The patient care plan should include a process of patient screening for infection, triage and flow, and prioritizing of cancer therapy. Develop or adapt guidelines/algorithms from national entities and professional societies.
• The staff management plan should include changes to roles or work processes, staff protection from infection, and other hazards mentioned above. An essential part of the plan is the maintenance of the physical and mental well-being of the entire staff. This involves minimizing the physical risk of exposure to infection, and having resources in place for staff experiencing exhaustion, burnout, anxiety, depression, and other mental health challenges. Looking after your team members for any sign of stress is as important as making sure they use PPE properly. If staff are protected, they will be able to help more people and do their jobs better.
• Once the plan is set, clear and transparent communication is very critical for its success. Because of the nature of the pandemic requiring social distancing and the advances in communication technology, you can use one of many popular digital teleconference platforms to keep your staff informed, engaged, and encouraged.
• Because of numerous uncertainties related to the pandemic, oncologists should establish a professional support system to provide help and guidance. This support system can be an informal group of local experts in oncology, infectious diseases, and others, or a professional society that offers resources and help. Enlist the help of other health care professionals and staff such as psychologists, social workers, chaplains, and others to support the patient—everyone has a role to play and, now more than ever, we must all work together. Have a list of relevant resources for the COVID-19 pandemic handy and update continuously.
• Virtual technology and telehealth are game-changers and they are here to stay. Oncology professionals should employ this technology to support and care for patients.

Finally, there is an overwhelming belief that health care will change forever due to this pandemic with more emphasis on telehealth, remote care, and technology-based practice. Oncology care is a one part of this complex health system. It is paramount to work together with policy- and decision-makers, professional societies, community organizations, governmental entities, and payers to make sure that legislation, policies, reimbursement, credentialing, and accreditations are updated to be in line with the new norms.

References

1. Sidaway P. COVID-19 and cancer: what we know so far. Nat Rev Clin Oncol. April 2020:1-1.
2. Adams JG, Walls RM. Supporting the Health Care Workforce during the COVID-19 Global Epidemic. JAMA. Epub 12 Mar 2020.
3. Jazieh A-R, Alenazi TH, Alhejazi A, et al. Outcome of Oncology Patients Infected With Coronavirus. JCO Glob Oncol. 2020;6:471-5.