New National Comprehensive Cancer Network Guidelines
- The NCCN is now recommending people with cancer be screened for coronavirus symptoms before heading into scheduled appointments
- If possible, treatments should be administered at home, and check-ins should be done via tele-health communication
- Cancer caregivers needs to be aware of any potential symptoms, and seek the appropriate testing if they detect any
“It’s been difficult to universally employ the testing prior to appointments or surgical management, but that’s something that we hopefully should be rolling out fully by the end of the week [or] early next week,” Dr. Jessica Thomas Pepin, a GYN-oncologist at Minnestota Oncology, tells SurvivorNet. “It’s amazing. It’s amazing how the thing just can be recommended and instituted in a matter of three to four days … It’s very important to just constantly be checking and updating with each other.”
While doctors are working around the clock to make sure cancer centers are as safe as possible for patients, there are still precautions people currently in treatment should be considering.
Making Treatment Decisions
In a previous conversation, Dr. Stephen Freedland, head of the Center for Integrated Research in Cancer and Lifestyle at Cedars Sinai, told SurvivorNet that before going into a hospital or cancer center for treatment, patients should be made aware of the risks.
Dr. Stephen Freedland discusses the risks of going in for prostate cancer surgery during the COVID-19 pandemic.
“At the end of the day, it’s about informed decision making, and telling the patients the risks and the benefits,” Dr. Freedland said. “They’re coming into the hospital. They’re going to end up spending the night in the hospital. They’re going to be in the operating room. They’re exposing themselves to everything that’s going on in the hospital environment. They are exposing the hospital workers to whatever they may be bringing in.”
Reports from China, where the coronavirus was first reported, indicate that people with cancer are at a slightly increased risk of being diagnosed with COVID-19 and of suffering complications from the virus, the new NCCN report says. However, the increased risk is likely due to cancer patients being in hospitals more often — increasing their risk of exposure.
The guidelines, as of now, are very general — yet as we learn more about the virus, specifics are beginning the emerge. SurvivorNet has been consulting experts from across the U.S. to get the latest coronavirus updates, and they’ve assured us that while cancer care will not be compromised, patients may have to adjust to some new practices.
The report details how physicians and caregivers can go about protecting both people with cancer and themselves.
Many scheduled appointments are being moved to a tele-health/treat-from-home approach, however, some people with cancer must go into a hospital or cancer center to be treated. In these cases, the NCCN recommends a pre-screening approach, where the patient is screened for any symptoms that may indicate COVID-19 a day or two before they are scheduled to go in for treatment.
“These screenings evaluate for symptoms such as a new or worsening cough within the past 14 days, shortness of breath, muscle aches, or fever and may also include 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),” the NCCN says.
One issue with screening is that many people with cancer may have symptoms similar to the coronavirus as a side effect of treatment, particularly those with lung cancer. So, a thorough pre-screening process, where the possible causes of symptoms are considered, should be performed.
For people with mild symptoms, many cancer centers have screening clinics that are separate from the area where other patients are treated to reduce the risk of infecting other patients and staff.
Guidance for Caregivers
The NCCN urges people with cancer to limit contact to the people they live with, and also notes that if a caregiver is exhibiting any symptoms associated with COVID-19, they should distance themselves from the person with cancer as soon as possible and seek testing to determine whether they are able to return to their caregiving role.
“As an extension of this concept, many if not all cancer centers have implemented limited or no visitor policies with exceptions for patients with disabilities or for those at the end of life,” the NCCN adds. The Network suggests setting up telephone or video communications, if possible, so that a caregiver may be virtually present during patient treatments.
Changes to Cancer Care
For the time-being, the NCCN is essentially recommending that any cancer care that can be moved from a hospital setting to an outpatient setting — or even administered at home — be moved.
While this is not possible for some treatments, such as urgent surgeries, it is an option for many. For example, chemotherapies that were given intravenously may have an oral option that patients can take at home, and some treatments — like hormone therapies — can be given at home with a home nurse. For other treatments, your doctor may want to reduce the frequency that the treatment is given to reduce the amount of time spent in a cancer center.
“Patients whose treatment plan includes radiation therapy may be evaluated for short-course radiation therapy or hypofractionated radiation therapy if this is an appropriate alternative. If restaging scans are routinely obtained to evaluate treatment response, increased time interval between scans or the use of biochemical markers in lieu of scans can be considered,” the Network says.
Despite the changes to cancer care, and the fact that many patients may have to check in with their doctors via tele-health visits for a short time period, the oncologists SurvivorNet regularly consults assure us that cancer care isn’t being compromised.
Dr. Heather McArthur explains how cancer care has changed, but is not compromised, amid the COVID-19 pandemic.
Dr. Heather McArthur, a breast oncologist at Cedars-Sinai, said that despite the coronavirus setback, this is a time of tremendous hope when it comes to cancer care.
“I do want to ensure that my patients — and that any breast cancer patients — don’t lose hope,” Dr. McArthur said. “Our goal is, single-mindedly, to cure patients of there disease wherever possible — and we will not compromise with that long-term view.”