ESMO Experts Recommend to Not Discontinue, Delay Cancer Treatment That Impacts Overall Survival During COVID-19 Pandemic

Medical oncologists globally should not discontinue or delay anti-cancer treatment that may potentially impact overall survival during the coronavirus disease 2019 (COVID-19) pandemic, according to experts from the European Society for Medical Oncology (ESMO).

Published in Annals of Oncology, this recommendation was made in an interdisciplinary consensus paper written by experts from ESMO. They explained that it is not only important to not delay cancer treatment during the pandemic, but it is also important to not label patients with cancer as vulnerable to COVID-19 infection because this may lead to inappropriate care and potentially negative outcomes.

The COVID-19 pandemic has been challenging oncologists to find methods to continue delivering quality care while also protecting patients from exposure to infection. For this reason, earlier this year, ESMO published adapted guidelines for prioritizing aspects of cancer care across different tumor types in order to mitigate the effects of the pandemic on cancer care.

In order to support the establishment of further cancer care standards during the pandemic, ESMO established an international consortium to discuss current research and provide expert advice on significant questions, such as diagnosis or surgery related to cancer management.

The panel consisted of 64 experts and 1 voting patient advocate. Together, they were able to agree on 28 statements.

One such statement is the counsel to continue anti-cancer treatment during the pandemic.

"The general advice is that whenever an anti-cancer treatment can impact overall survival of the patient, it should not be discontinued or delayed," said first author of the consensus paper, Giuseppe Curigliano, MD, PhD, a professor at the European Institute of Oncology, in a press release.

The authors of the consensus paper explained further that this recommendation is based on the lack of convincing evidence that the use of immune checkpoint inhibitors, non-cytotoxic targeted therapies, and types of adjuvant or neoadjuvant systemic therapies is detrimental or associated with a greater risk of complications or mortality.

"Of course, case-by-case discussions run by multidisciplinary teams remain pivotal to balance the risk of being infected against tumor control, as stated in our previous work," Curigliano said.

The panel also noted the importance of not labeling all patients with cancer as vulnerable to COVID-19, regardless of their individual risk factors. The experts explained that although 5 to 7 patients with cancer at the beginning of the pandemic were reported to be at an increased risk of contracting COVID-19, the evidence collected by the experts suggests that many patients with solid tumors are not more vulnerable to severe outcomes from COVID-19 than the general population.

"Although it was reasonable to adopt over-protective measures for our patients at the outbreak of a novel infective disease which was not previously observed in humans, we now need to step away from the assumption that all cancer patients are vulnerable to COVID-19," Curigliano said. "The implications have been important, because for some patients, treatment was delayed or interrupted over the last few months, and I believe that we will see the impact of this over-precautionary approach in the next future."

Curigliano notes that some patients with cancer do remain at higher risk for COVID-19 infection, and these are patients who are elderly, have multiple comorbidities, and are receiving chemotherapy.

“In this population, before starting any treatment, we recommend to test patients for COVID-19 with a real-time RT-PCR (reverse transcription polymerase chain reaction), the current gold standard for diagnosis, in order to exclude that the patient is infected by the coronavirus,” Curigliano said.

REFERENCE

ESMO experts: Do not discontinue or delay cancer treatment impacting on overall survival. European Society for Medical Oncology; July 31, 2020. eurekalert.org/pub_releases/2020-07/esfm-eed073020.php. Accessed August 18, 2020.