Abstract
Since the Coronavirus Disease 2019 (COVID-19) was identified as a global pandemic, health systems have been severely strained, particularly affecting vulnerable populations such as patients with cancer. In response to the COVID-19 pandemic, a variety of oncology specialty societies are making recommendations for standards of care. These diverse standards and gaps in standards can lead to inconsistent and heterogeneous care among governments, cancer centers, and even among oncologists within the same practice. These challenges highlight the need for a common nomenclature and crisis guidelines. For times of increased scarcity of resources, the National Academy of Medicine developed Crisis Standards of Care, defined as fairness, duty to care, duty to steward resources, transparency, consistency, proportionality, and accountability. However, we believe there is an urgent need to develop cancer-specific guidelines by convening a panel of experts from multiple specialties. These would be Crisis Oncology Standards of Care (COSCs) that are sensitive to both the individual cancer patient and to the broader health system in times of scarce resources, such as pandemic, natural disaster, or supply chain disruptions.
Highlights
In late 2019, the first cases of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2)of zoonotic origin and its human infection, known as Coronavirus Disease 2019 (COVID-19), were identified in the city of Wuhan, China, and spread rapidly across the world in a global pandemic [1].This crisis has added considerable strain to already overtaxed health systems, distinctly impacting points of entry such as emergency departments and intensive care units (ICUs)
Data in US cancer patients and an international multicenter study have demonstrated more severe disease courses, especially after treatment with immunotherapy or surgery [4,6]. These data were contradicted by an 800 patient prospective cohort study by the UK Coronavirus Cancer Monitoring Project (UKCCMP) of patients with cancer and symptomatic COVID-19, which did not demonstrate increased odds of death from COVID-19 associated with anticancer therapies including cytotoxic chemotherapy, immunotherapy, hormone
Additional guidelines published for specific countries and published in other languages, as well as specific disease states, have previously been summarized [22,23,24,25]. These triaged guidelines are mostly non-specific and may have contributed to significant inconsistency between providers and centers. This points to the larger unmet need of true Crisis Oncology Standards of Care (COSCs) that are sensitive to both the individual cancer patient and to the broader health system in times of scarce resources
Summary
In late 2019, the first cases of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2). Of zoonotic origin and its human infection, known as Coronavirus Disease 2019 (COVID-19), were identified in the city of Wuhan, China, and spread rapidly across the world in a global pandemic [1]. This crisis has added considerable strain to already overtaxed health systems, distinctly impacting points of entry such as emergency departments and intensive care units (ICUs). While there are challenges in all fields of medicine under the public health threat of COVID-19, there are unique considerations in caring for the population of individuals with cancer given its older age, suppressed immune system (related to disease and treatment), and linkage to other risk factors such as tobacco smoking [2,3]. We believe the cancer population would benefit greatly from specific guidance on diagnostic, therapeutic, and surveillance management based on the severity of the public health crisis
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