Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus #covid19rftlks

Mehanna, H., Hardman, J. C., Shenson, J. A., Abou-Foul, A. K., Topf, M. C., AlFalasi, M., … & Fagan, J. J. (2020). Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. The Lancet Oncology.

Summary

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

Lancet Oncology: Organisations for patients with cancer feel the brunt of COVID-19 pandemic #covid19rftlks

Nelson, R. (2020). | Organisations for patients with cancer feel the brunt of COVID-19 pandemic|The Lancet Oncology | DOI:https://doi.org/10.1016/S1470-2045(20)30389-2

The ongoing COVID-19 pandemic has disrupted all facets of cancer care, from delaying diagnoses and treatment to halting clinical trials and biomedical research. Patient organisations have not been spared from the impact, with all aspects of their work affected, and in some cases, their very viability.To assess the impact of the pandemic in organisations for patients with cancer, a survey was done by a joint initiative of the World Ovarian Cancer Coalition, the World Pancreatic Cancer Coalition, the Lymphoma Coalition, the Advanced Breast Cancer Global Alliance, and the World Bladder Cancer Patient Coalitions. Responses were received from 157 member organisations located in 56 countries. Most of the responses came from the USA (28 responses) followed by Australia (ten), and then Canada, Italy, and the UK (eight each).

Case 22-2020: A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic #covid19rftlks

Spring, L. M. et al. (2020) |A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic| NEJM |DOI: 10.1056/NEJMcpc2002422

Presentation of Case

Dr. Aditya Bardia: A 62-year-old woman was evaluated at this hospital after she had identified a mass in her left breast, confirmed by her physician on physical examination, during the pandemic of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The patient, who was of Ashkenazi Jewish ancestry, had no known family history of breast or ovarian cancer. Medical history included asthma and a fibroadenoma in the left breast, for which she had undergone excisional biopsy 30 years earlier. Menarche had occurred at 12 years of age and menopause at 54 years of age; she had not received hormone-replacement therapy.

Physical examination revealed a mass, measuring 3 cm in greatest dimension, in the left breast. No other masses or axillary lymph nodes were palpable. The patient underwent imaging studies in accordance with the American College of Radiology guidelines.1 Both breasts were imaged, since the patient’s last mammogram had been obtained 7 years earlier.



Dr. Gary X. Wang:
 Mammography revealed an irregular mass with spiculated margins underlying the skin marker in the left breast, with imaging characteristics highly suggestive of cancer. Subsequent ultrasound examination revealed a solid, irregular mass in the left breast that measured 3.1 cm by 1.5 cm by 1.2 cm and normal left axillary lymph nodes. Tissue sampling with core-needle biopsy under ultrasonographic guidance was performed.

Cancer x Coronavirus: The impact on young people #covid19rftlks

Teenage Cancer Trust | June 2020 | Cancer x Coronavirus: The impact on young people

Coronavirus has disrupted the lives of all young people across the UK.
Schools and universities have shut, interrupting education at a critical time. Family, friends and partners have been cut off, breaking social connections. Those taking their first steps into work have found the jobs market stalled. Facing cancer on top of that feels unimaginably tough. Many young people with cancer are also deemed to be in the group most vulnerable to coronavirus, whilst the current evidence suggests that the majority of people their age are generally at less risk – further setting young people with cancer apart from their peers. Many have had to ‘shield’ – isolating themselves completely from others, for up to three months. They’ve told us how difficult this has been.


Even as schools start to return, rules about meeting others relax, and the rest of us slowly start to return to something approaching normality, young people with cancer face an
uncertain future.
Living with cancer already puts young people’s lives on hold while their peers move on. Living during a global pandemic adds a further layer of uncertainty and isolation.
We’re deeply concerned about the toll this period has taken on young people already going through one of the hardest times of their life.

The Teenage Cancer Trust has adapted its own Teenage Cancer Trust services,
staffed by specialist nurses and support teams, to the best of our ability to meet young people’s changing needs during the pandemic, including providing much more of our
peer support online.
But we wanted to find out how far young people with cancer feel their care has been disrupted by coronavirus.
I’d like to thank every young person who has shared their experiences for this project.
This report includes some clear recommendations for government and healthcare providers to take on board.
We’re also reviewing our own services to see where we can do more to meet some of the clear needs this research has identified. Creativity, determination and going the extra
mile have helped us to keep supporting young people – but we won’t stop there. As the situation evolves, so will our support so we can keep being there for young people
through this crisis and beyond.
Cancer is tough enough on its own. If we don’t get the next steps right, the long-term impact on young people with cancer will be significant.

Cancer x Coronavirus: The impact on young people

The impact on outcomes from cancer surgery of the COVID-19 pandemic

The NHS must ensure cancer-surgery delays do not cost more lives than the number of Covid-19 patients saved | Annals of Oncology

  • Lockdown and re-deployment due to the COVID-19 pandemic is causing significant disruption to cancer diagnosis and management.
  • 3-month delay to surgery across all Stage 1-3 cancers is estimated to cause >4,700 attributable deaths per year in England.
  • The impact on life years lost of 3-6 month to surgery for Stage 1-3 disease varies widely between tumour types.
  • Strategic prioritisation of patients for diagnostics and surgery has potential to mitigate deaths attributable to delays.
  • The resource-adjusted benefit in avoiding delay in cancer management compares favourably to admission for COVID-19 infection.

Full article: Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic | Annals of Oncology (2020)

See also: Coronavirus: Cancer surgery delays risk ‘thousands’ of deaths | BBC News

Coronavirus disease 2019 (COVID-19): Cancer care during the pandemic

Uzzo, R. G., Kutikov, A., & Geynisman, D.M. (2020). Coronavirus disease 2019 (COVID-19): Cancer care during the pandemic. UpToDate. Retrieved from: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-cancer-care-during-the-pandemic

UpToDate has made their information available during COVID-19, this topic looks at cancer care during the pandemic, to discuss issues related to balancing the risk from treatment delay versus harm from COVID-19, ways to minimize the compromise of social distancing during care delivery, how limited healthcare resources can be appropriately and fairly allocated, and reviews the recommendations for cancer care during the COVID-19 epidemic from expert groups.

UpToDate Coronavirus disease 2019 (COVID-19): Cancer care during the pandemic

Unpicking the COVID-19 extremely vulnerable category for people affected by cancer

In conjunction with NHS England and the One Voice Cancer charities, Gateway C the online cancer education platform has produced the resource: Unpicking the COVID-19 extremely vulnerable category for people affected by cancer

People with certain cancers and those who have received or are receiving certain treatments are at risk of severe illness if they catch coronavirus (COVID-19). One Cancer Voice charities (in partnership with NHS England) have confirmed the extremely vulnerable people category includes:

  • Every patient undergoing active chemotherapy
  • Patients with blood disorders who are immunocompromised but not receiving chemotherapy
  • Patients having radiotherapy for metastatic lung tumours
  • Patients having any targeted treatments (more than just antibody treatments) and anti-angiogenesis targeted drugs
  • Transplant patients (if they have had a transplant within the last 6 months, and if they are taking any immunosuppression)
  • Patients with a rare disease and that disease significantly increases their risk of infection

Full details fromGatewayC

NICE Guideline: COVID-19 rapid guideline: delivery of systemic anticancer treatments

NICE | March  2020 |COVID-19 rapid guideline: delivery of systemic anticancer treatments

NICE guideline [NG161]

The purpose of this guideline is to maximise the safety of patients with cancer and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for cancer treatment to patient needs if services become limited because of the COVID-19 pandemic.

On 3 April 2020, NICE added 2 recommendations on when to offer and continue systemic anticancer treatment for patients with COVID-19. NICE also amended the table on prioritising treatments in line with new advice from NHS England.

 

This guideline is for:

  • health and care practitioners
  • health and care staff involved in planning and delivering services
  • commissioners

Further information availlable from NICE 

NICE has also produced a COVID-19 rapid guideline on delivery of radiotherapy.

COVID-19 rapid guideline: delivery of radiotherapy

NICE | March 2020| COVID-19 rapid guideline: delivery of radiotherapy

The purpose of this guideline is to maximise the safety of patients who need radiotherapy and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for radiotherapy to patient needs if services become limited because of the COVID-19 pandemic.

NICE has also produced a COVID-19 rapid guideline on delivery of systemic anticancer treatments.

This guideline is for:

  • health and care practitioners
  • health and care staff involved in planning and delivering services
  • commissioners

Full details from NICE

Leeds jointly launches first cancer corona virus registry

University of Leeds | April 2020 | Leeds jointly launches first cancer corona virus registry

Cancer experts at three universities in the UK have launched a cancer corona virus registry; the monitoring scheme is a national project between oncologists at the universities of Birmingham, Oxford and Leeds. The project will pioneer the use of clinician-led reporting to track cancer patients and inform treatment pathways. It has been developed to ensure that high quality cancer care is being delivered across the country to safeguard patients.With the key objective being to identify and learn from every case of COVID-19 in cancer patients in the UK through comprehensive reporting.

The scheme will relay real-time daily updates back to individual cancer centres, providing valuable insights to inform key decision makers. Crucially, it will enable national monitoring of the impact of COVID-19 on cancer patients and cancer centres (Source: University of Leeds)

News release: Leeds jointly launches first cancer coronavirus registry

See also:

The UK Coronavirus cancer monitoring project A COVID-19 Live Clinical Data Dissemination System for patients with cancer

You can follow on Twitter @UKCORONACANCER