Twelve haematology and oncology groups have endorsed interim consensus guidelines regarding the management of patients during the COVID-19 pandemic.
The guidance, published in the MJA and on the National Centre for Infections in Cancer (NCIC) website, covers a wide range of topics including implications for blood transfusion, stem cell transplantation, palliative care and clinical trials.
It said many cancer patients were at high risk of severe COVID-19 not only because of cancer and treatment-related immunosuppression, but due to their advanced age and comorbidities.
And other disruptions could also influence patient care.
“Patients with cancer could be at elevated risk of severe COVID-19 disease, while delivery of cancer therapies could be disrupted by quarantines, social distancing measures, and disruption to routine healthcare delivery by the pandemic,” it said.
The clinical impact of COVID-19 in children with cancer or haematological malignancy was currently unknown.
The guidelines said management of COVID-19 should be similar for patients with and without cancer with the following considerations:
- alternative and secondary infections – bacterial, viral and fungal – were also a possibility in immunocompromised patients with symptoms of COVID-19
- treatment-related pneumonitis could mimic the clinical and radiological features of COVID-19
- temporary discontinuation of cancer therapies may be warranted for patients with symptoms of COVID-19 to minimise treatment-related immunosuppression and the risk of drug interactions.
The guidelines offer a list of phased local actions to be considered based on level of COVID-19 transmission and healthcare capacity.
The actions scaled up from staff education and advice to patients in the early phase through to plans for alternative treatment settings, treatment prioritisation and treatment modifications as service capacity was exceeded.
The authors noted actions such as social distancing, quarantine and visitor limitations will by default limit opportunities for family support for cancer patients, including those in palliative care, and should be replaced where possible with video and phone contact.
Some other potential impacts of COVID-19 on cancer patient management included:
- Community spread of COVID-19 may reduce the blood donor pool, and threaten blood supplies, due to deferral of donors, blood service staff shortages, or shortages of consumables and reagents.
- While there is no precedent for transfusion transmission of respiratory viruses, donor deferral is the only current mechanism in place to prevent transmission via blood components.
- Iron, folic acid, vitamin B12 or erythropoietin should be considered as alternatives to red cell transfusion for some patients to help limit transfusion requirement.
- Platelets are likely to be impacted by blood supply shortages early due to their short shelf-life.
- Most unrelated donor stem cell products in Australasia come from international donors and are therefore vulnerable to disruption.
- The impact of COVID-19 on international transport may also affect the supply chain for autologous chimeric antigen receptor T-cells.
- It is unclear whether SARS-CoV-2 is transmissible by cellular therapy products.
- It may be necessary to reduce routine follow-up appointments, institute remote or telehealth reviews or modify treatment plans and strategies for treatment delivery in the interest of clinical trial participants as the pandemic progresses.
Co-author Associate Professor Zoe McQuilten, from Monash University, told the limbic the guidance began as a clinical initiative of the Supportive Care Group of the Australasian Leukaemia and Lymphoma Group (ALLG) and the NCIC.
The two organisations had previously collaborated on other recommendations for treatment or prevention of infections in patients with cancer.
“It soon became apparent that the issues covered in the guidance extended beyond haemato-oncology into medical and clinical oncology, bone marrow transplantation and palliative care. Clinicians with expertise in each of these fields were invited to contribute to the document,” she said.
“We also sought feedback from the ALLG consumer representative group, and a clinician was invited to provide a Maori health perspective.”
The guidance has also been endorsed by the Australasian Lung Cancer Trials Group, ANZ Children’s Haematology/Oncology Group, ANZ Society of Palliative Medicine, Bone Marrow Transplantation Society of ANZ, Cancer Society of New Zealand, Clinical Oncology Society of Australia, Haematology Society of ANZ, New Zealand Cancer Control Agency, New Zealand Society for Oncology and Palliative Care Australia.
Associate Professor McQuilten said the intention was to regularly update the guidance as new information became available.
“We are also adopting an electronic system to allow clinicians or other interested parties to log comments or suggested updates to the guidance.”