Cancer care during the pandemic requires assessment of several factors that are specific to each patient as well as the curve of the pandemic in a particular location and the infrastructure capabilities at the center offering care. As a general approach, we consider continuation of cancer care unless postponement of such care is not impacting the expected oncologic outcome for the specific patient. As Interventional Oncologists our goal is to use our expertise to customize care in a way that can maximize benefits and minimize risks. Several factors will determine whether an IO therapy can wait or it is best for a particular patient to proceed with therapy.
The most important involve the individual patient risk determined by the performance status, immune response capabilities, disease biology and specific tumor progression behavior. It is imperative that these discussions are made in collaboration with all experts from different specialties that know and treat the relevant patient. In addition, a very detailed discussion with the patient and his family is needed to make sure that all facets of interventional therapy are well understood and that the risk of possible exposure to COVID is minimized. Precautionary measures according to the CDC and local institutional guidelines must be in place in order to provide the best possible cancer care and minimize the additional risks from the pandemic.
Some general principles on how to minimize risks and still offer the best Interventional Oncology Care possible are listed below:
- Biopsy only when needed for clinical decision making that cannot wait until the end of the expected peak of the pandemic in each geographic area.
- Postpone local or locoregional therapies until the end of the pandemic peak unless such delay will impact patient’s oncologic outcomes.
- Postpone enrollment to research trials that require sequential biopsies or other interventions or frequent hospital visits and do not offer potential direct oncologic benefit to the patient.
- Consider less invasive and short course, equivalent interventions for local cancer control: For example ablation or radiation segmentectomy over resection or multiple fraction SBRT.
- Elective procedures such as routine Mediport or Filter removal should be postponed.
The above list is only intended as frame for further discussion and formation of tailored care for each patient. It is also meant as a summary of thoughts for further discussion. It is, of course, important to understand that many times cancer care cannot be placed on hold. As in every decision making process the patients’ benefit is placed first and all discussions are centered on this principle.