The Seattle Cancer Care Alliance (SCCA) is sharing insights and advice in a peer-reviewed article on how to continue providing ideal cancer care during the novel coronavirus (COVID-19) pandemic.
The article stresses first and foremost the importance of keeping channels of communication open between administrators and staff, patients, caregivers, and the general public.
“The COVID-19 pandemic is impacting every facet of our global and domestic societies and health care systems in unprecedented fashion,” Robert W. Carlson, MD, chief executive officer at the National Comprehensive Cancer Network (NCCN), said in a press release. “People with cancer appear to be at increased risk of COVID-19, and their outcomes are worse than individuals without cancer. The NCCN Member Institutions are rapidly gaining experience in preventing and managing COVID-19. As is the nature of the NCCN Member Institutions, they are sharing their experience in organizing and managing institutional and care systems responses and best practices in this rapidly evolving global effort.”
The authors recommended forming an Incident Command Structure in order to provide early coordination of institution-wide efforts and to quickly respond to changing information. They also highlight the need to remain flexible and ready for new challenges.
Some of the expected challenges include:
- Staff shortages caused by potential exposure and/or school closings.
- Limitations of resources such as hospital beds, mechanical ventilation, and other equipment.
- Impact on treatment due to travel bans, including reduced access to international donors for allogeneic stem cell transplantation.
In order to mitigate some of these concerns through proactive measures, the authors recommendations include:
- Providing patient information via handouts, signs, web-based communication, and a dedicated phone line for questions and triage.
- Rescheduling “well” visits and elective surgeries and deferring second opinion consultants (where care is already suitably established).
- Increasing hours of general hospital operations to curtail the unnecessary use of emergency department resources.
- Reinforcing a strict “stay at home when ill” policy and ensuring staff are able to obtain testing readily.
- Restricting travel and enabling work-from-home whenever possible.
- Limiting the number of members who enter a patient’s room, including hospital staff.
- Considering lower thresholds for blood transfusions.
- Moving some procedures from inpatient to outpatient.
- Enacting a no visitor policy with rare exceptions such as end-of-life circumstances.
- Having upfront, proactive palliative and end-of-life conversations with patients who have cancer who could become infected with COVID-19.
Also addressed within the article is the importance of self-care within and outside of the medical community. The authors indicated that individuals should prioritize measures to protect their health and frontline staff and assure a safe work environment in order to prevent burnout. This includes compensation policies, reassignments to administrative roles for immunocompromised staff, and the adoption of a back-up labor pool.
“Responding quickly and confidently to the COVID-19 crisis is the health care challenge of our generation,” co-lead author F. Marc Stewart, MD, medical director at the SCCA, said in a press release. “Our overarching goal is to keep our cancer patients and staff safe while continuing to provide compassionate, high-quality care under circumstances we’ve never had to face before. We are working around the clock to develop new guidelines and policies to address situations that we couldn’t have imagined several weeks ago. When the pandemic ends, we will all be proud of what we did for our patients and each other in this critical moment for humanity.”
The article will be available for free online-ahead-of-print via open access at JNCCN.org. NCCN is also collecting documents and links from the cancer centers that comprise the alliance and sharing them online at NCCN.org/covid-19.
JNCCN: How to Manage Cancer Care during COVID-19 Pandemic. Plymouth Meeting, Pennsylvania. Published March 17, 2020. Accessed March 17, 2020.