Recommendations for Keeping Cancer Patients, Clinicians Safe Amid COVID-19

A special feature published in JNCCN–Journal of the National Comprehensive Cancer Network provided recommendations to keep cancer patients, as well as their caregivers and staff, as safe as possible during the COVID-19 pandemic.

“The unprecedented challenges we are all facing from the COVID-19 pandemic heighten NCCN’s commitment to sharing evidence-based consensus from leading medical experts as rapidly as possible, free-of-charge, to everyone around the world,” said Robert W. Carlson, MD, CEO of NCCN, in a press release. “We are doing everything we can to review and share reliable information that will help keep oncology patients, providers, and staff safe under the new reality of increased risk.”

Lead study author Pelin Cinar, MD, MS, UCSF Helen Diller Family Comprehensive Cancer Center, said that with some knowledge and data, it is possible to continue to provide effective care for patients—safely.

“We can continue to provide our patients with effective and compassionate care, without sacrificing the health and safety of our teams, colleagues, and families, by carefully evaluating any emerging research and modifying our treatment approaches accordingly,” Dr. Cinar said. “People with cancer and their loved ones already go through so much, and now they face new fears around catching COVID-19 or delaying necessary treatment. By sharing these recommendations, we want to reassure the oncology community that there are some aspects of care that we can and will control in order to improve outcomes for people with cancer.”

Keeping Cancer Patients, Caregivers, and Healthcare Workers Safe

The researchers cite data showing that cancer patients may be at an increased risk for contracting COVID-19 compared to the general population, as well a greater risk of sustaining clinically severe events. Cancer patients who recently underwent treatment, compared to patients who did not, were at an additional risk of these events.

The authors recommend both prescreening and screening approaches to keep patients and staff safe. Prescreening in cancer patients is typically performed one to two days prior to a visit. Prescreenings are used to identify factors including:

  • new or worsening cough within the past 14 days
  • shortness of breath
  • muscle aches
  • fever
  • assessment of exposure risk, including travel history or exposure to a COVID-19–positive individual

“If any concerning symptoms are reported, these are further clarified to determine whether patients need to be evaluated, monitored at home, or referred to the emergency department (ED),” explained the researchers. Since cancer patients may be more likely to present some of these symptoms in absence of COVID-19 (perhaps due to certain treatments), patient-specific factors should also be taken into consideration.

Cancer patients should only be exposed to their family and cohabiters due to their high-risk status. If a caregiver is exhibiting signs of COVID-19, it is recommended that they socially distance themselves from their patients, seek care, and get tested if possible.

“In an effort to include caregiver support during patient visits and treatments, telephone or video communication with caregivers should be accommodated,” the researchers said.

Front-line healthcare workers are also considered high risk because of their close contact with patients. Of the estimated 10% of positive COVID-19 cases in Spain, China, and Italy, about 3.8% were in healthcare workers. Healthcare workers should use an N95 or higher respirator, or, alternatively, a mask.

“The distressing global experience with COVID-19 limited and in some cases devastated the healthcare delivery systems we have relied on to provide safe and effective care to our patients. Nonetheless, our healthcare community remains dedicated, resilient and adaptable. Most of all, the commitment we have to the patients we serve will continue to guide our response during these extraordinarily challenging times. With careful evaluation and modification of our approach, we can continue to provide our patients with effective and compassionate care without sacrificing the health and safety of our teams, colleagues, and families,” the paper concluded.

Read the full feature here.