French Guidelines on Patients With Cancer and SARS-CoV-2 Infection
As reported by You et al in The Lancet Oncology, a representative group of French medical and radiation oncologists formulated guidelines to protect patients with cancer against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Guideline development was overseen by the French High Council for Public Health at the request of the French Health Ministry. The purpose of the guidelines is to protect patients with cancer against SARS-CoV-2 infection, while maintaining the possibility of cancer treatment.
The development of the guidelines was motivated by several lines of evidence indicating the following observations:
- Patients with cancer are at higher risk of infection with SARS-CoV-2 than the general population.
- There is increased risk of severe respiratory complications with SARS-CoV-2 requiring time in the intensive care unit in patients with cancer vs patients without cancer.
- This risk is associated with a history of chemotherapy or surgery in the month preceding infection (a factor including the majority of patients with cancer).
- Patients with cancer develop severe events in a shorter time vs those without cancer.
The guidelines are intended for adult patients with solid tumors only and complement the standard guidelines for the general population.
Key Recommendations From the Guidelines
- Prevention measures should be implemented in oncology departments, with the goal of avoiding any contact of patients with cancer (and oncology and radiotherapy departments) with COVID-19. That is, the goal is to have oncology and radiotherapy departments remain COVID-19–free sanctuaries.
- Admission of patients with COVID-19 to oncology or radiotherapy departments should be avoided. If such patients are admitted to oncology or radiotherapy departments, they should be isolated from other patients with cancer and moved to departments specializing in COVID-19 as promptly as possible.
- The presence of patients with cancer at hospitals should be minimized based on their susceptibility to SARS-CoV-2. Measures allowing management of patients with cancer at home should be encouraged, including the use of telemedicine and phone calls to replace safety visits; replacement of intravenous drugs with oral chemotherapy and hormone therapies; and measures allowing home administration of intravenous and subcutaneous anticancer agents. Further, adjustment of schedules for chemotherapy or radiotherapy treatments should be considered to reduce the frequency of hospital admissions. Patients with slowly evolving metastatic disease could receive temporary breaks in treatment and extended intervals (eg, every 2–3 months) between disease assessments.
- A number of measures are proposed for those patients with cancer who have to be admitted to hospital for systemic treatment or radiotherapy: caregivers should organize daily phone calls to patients planned for admission the following day to ensure the patients do not have symptoms of COVID-19 before being admitted to oncology or radiotherapy wards; those who have symptoms should be referred to departments specialized in COVID-19; and open-space chemotherapy outpatient centers should integrate patient separation measures as well as the wearing of masks by patients and staff.
- If access to hospital cancer care is reduced due to requisition of facilities for the management of patients with COVID-19 or if likelihood of viral infection and life-threatening complications are considered to be too high, prioritization in the selection of patients to be admitted to the hospital for cancer treatment may be required. Prioritization should take into account curative or noncurative intent therapeutic strategy, patient age, life expectancy, time since diagnosis, and symptoms.
- The following priority order is proposed, subject to the discretion of the patient’s clinician and team: (1) patients with cancer managed with curative intent treatments (favoring those patients aged ≤ 60 or with a life expectancy of ≥ 5 years, or both); (2) patients with cancer managed with noncurative intent treatments, and age 60 or younger, or life expectancy of 5 years or more, or both, and in first-line of the therapeutic strategy (early setting); and (3) other patients with cancer managed with noncurative intent treatments, favoring those whose cancerous lesions extend or whose symptoms might jeopardize their lives quickly in the case of treatment discontinuation. Patients who need to be hospitalized for supportive care (eg, pain management, bacterial infection, or palliative care before death) could be referred to nonspecialized cancer departments or home care.
Benoit You, MD, PhD, of Universite Claude Bernard Lyon, is the corresponding author for The Lancet Oncology article.
Disclosure: For full disclosures of the study authors, visit thelancet.com.