COVID-19: implications for people receiving cancer treatment
The National Institute for Health and Care Excellence has published new guidance about cancer care during the COVID-19 pandemic
The new coronavirus (SARS-CoV-2) that causes COVID-19 has spread rapidly around the world since it was first identified in the city of Wuhan in China in late 2019.
COVID-19 can make anyone seriously ill, but some people with cancer have been classed as extremely vulnerable by Public Health England.
Be aware that patients with COVID-19 are at risk of severe disease following systemic anticancer treatment and such treatment should be delayed if possible, new guidance from the National Institute for Health and Care Excellence (NICE) has warned. It has produced rapid guidance for healthcare professionals on patients receiving systemic anticancer treatment and radiotherapy. The guidance says if a patient has COVID-19, chemotherapy should only go ahead if it is needed for urgent control of the cancer. The guidance sets out how to decide who receives chemotherapy or radiotherapy if patients needs to be prioritised, and how to modify services during the pandemic.
Signs and symptoms
Causes and risk factors
Among those who are considered extremely vulnerable are those with cancer who are undergoing chemotherapy, people with lung cancer who are undergoing radical radiotherapy and people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment. People having immunotherapy or other continuing antibody treatments for cancer, people having other targeted cancer treatments which can affect the immune system – such as protein kinase inhibitors or PARP inhibitors – and people who have had bone marrow or stem cell transplants in the past six months or who are still taking immunosuppression drugs, are also on this list.
How you can help your patients
- Communicate with patients and support their mental well-being, signposting to charities and support groups, to help alleviate any anxiety and fear they may have about COVID‑19.
- Ask patients to attend appointments without family members or carers, if they can, to reduce the risk of contracting or spreading the infection.
- For patients with known or suspected COVID‑19, do not use this alone as a reason to cancel radiotherapy.
- For patients who are immunosuppressed and have fever (with or without respiratory symptoms), suspect neutropenic sepsis because this can be rapid and life-threatening.
- Where decisions need to be made about prioritising patients for systemic treatment, these need to take into account the level of immunosuppression associated with individual treatments and cancer types, and any other patient-specific risk factors. They should also balance the risk from cancer not being treated optimally against the risk of becoming seriously ill if they contract COVID-19 because of immunosuppression.
Charlotte Dawson is a nurse adviser for Bowel Cancer UK
‘This new NICE guidance is helpful as it ensures nurses are aware of current policy in light of the pandemic, as well as ensuring they are acting within the agreed guidelines. Multidisciplinary teams are facing immensely difficult decisions. This is an unprecedented situation where decision-making about treatment, which is often already a complex process, is further complicated by limited hospital capacity and the need to reduce risk to patients and staff of contracting COVID-19. There is also a push to reduce the burden on the NHS, but this is not the main factor in deciding whether to go ahead with treatment.
‘Patients are extremely anxious. The threat of having cancer treatment postponed or potentially completely withheld is extremely frightening. Their usual lines of help and support – their nurse specialist or consultant – are being deployed in other areas to help support the NHS. Nurses need to have quick, reliable, up-to-date guidance readily available to help them support patients as best they can during this time. The NHS, government and cancer charities are working hard to provide clear concise guidance as well as offering other avenues of support while hospital teams are being redeployed elsewhere.’
Find out more
- Bowel Cancer UK – Information on coronavirus
- National Institute for Health and Care Excellence (2012) Neutropenic sepsis: prevention and management in people with cancer
- National Institute for Health and Care Excellence (2020) COVID-19 rapid guideline: delivery of systemic anticancer treatments
- National Institute for Health and Care Excellence (2020) COVID-19 rapid guideline: delivery of radiotherapy
- Public Health England (2020) Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19