The Lancet Oncology v21(7) E339-E340, 1 July 2020. DOI:https://doi.org/10.1016/S1470-2045(20)30340-5
"Cancer is a major cause of morbidity and mortality, made acutely worse by the COVID-19 pandemic, and requires sustained investment and coordinated planning in a COVID-19 world. Health leaders now need to safeguard capacity and regain lost progress in cancer control. Available resources should be directed to those most likely to benefit. National media campaigns should be used to boost screening uptake and help-seeking behaviour for potential cancer symptoms, addressing the current delays and barriers in access to health care. Investment in cancer diagnostic workforces will be key, particularly in building up provisions for tests and biopsy procedures and shortening diagnosis-to-treatment intervals. The pandemic has also created opportunities to improve efficiencies in care, such as virtual consultations and visits. Facilitating multidisciplinary team meetings digitally is one of many potential changes requiring long-term investment in technology and infrastructure."
This article presents a series of recommendations to inform policies which deal with a new cancer burden in a post-COVID-19 environment and to mitigate a potential crisis in excess deaths due to cancer.
Recommendations:
- Run media campaigns to boost screening uptake and encourage patients to seek help for potential cancer symptoms
- Resume evidence-based screening programmes and other early diagnosis initiatives as soon as possible
- Implement risk stratification tools and effective triage assessments to account for restricted diagnostic capacity and to prioritise patients with concerning symptoms or requiring staging over those in follow-up
- Mitigate the risks of nosocomial SARS-CoV-2 infection, including testing all patients admitted for major cancer surgery and by using relatively COVID-19-free institutions (designated stand-alone diagnostic and treatment facilities) or isolating within sites
- Investing in technology and infrastructure to facilitate virtual consultations, multidisciplinary team meetings, and other innovations
- Prioritise cancer surgery over elective and less urgent operations, and among these cancer cases, prioritise patients according to urgency of surgical care and patient benefit
- Anticipate increased volumes of cancer surgery with appropriate workforce and resource planning in a slower throughput environment, including theatre space, surgeon capacity, and postoperative surveillance resources, potentially to levels higher than before COVID-19
- Maintain increased levels of intensive care unit capacity and standards to ensure prioritisation of patients with cancer and other time critical and life-threatening conditions
- Adopt evidence-based perioperative pathways such as enhanced recovery after surgery to improve recovery of patients with cancer after surgery, allowing for increased throughput of patients and capacity of the health-care system
- Capture data and track of the number of cases, patient stage, and treatment in real-time to benchmark performance and respond to system stresses
- Support cancer health-care teams and administrative staff to minimise and respond to burnout
- Prepare and plan for subsequent waves of COVID-19 and other pandemics to reduce future effects on cancer care
- Benchmark international and regional cancer outcomes in the new context of COVID-19
