Treatment Decisions for Lung Cancer During COVID-19 Require Balancing Exposure Risk, Effective Care

Because patients with lung cancer have the highest reported mortality rate due to coronavirus disease 2019 (COVID-19), oncology teams may struggle to balance effectively caring for these patients while avoiding exposure risks and safety.¹

To give some guidance on the subject, a team of specialists published a review of treatments for patients with lung cancer and COVID-19 in the Journal of Thoracic Oncology.

“The purpose of this manuscript is to present a practical multidisciplinary and international overview to assist in treatment for lung cancer patients during this pandemic, with the caveat that evidence is lacking in many areas,” said lead author Chandra Belani, MD, chief science officer for the International Association for the Study of Lung Cancer, in a statement.¹

Overall, the authors noted that patients with lung cancer are typically older and have an increased risk of relative immunosuppression, due to both their illness and the treatments. These patients may also have additional comorbidities, which can often include a history of smoking or pre-existing lung disease. Because of these considerations, balancing needs and risks is vital.¹

The rapid onset of the COVID-19 virus also requires careful consideration, according to the authors. When making treatment decisions, multidisciplinary discussions and inclusion of caregivers and patients is important in order to consider safety and necessary treatments. Because the duration and severity of the pandemic is still undefined, the authors said treatment delays alone will not be enough to provide optimal treatment.¹

“In combination with determining a treatment path for lung cancer, physicians should educate patients to help them prevent further spread of COVID-19 according to WHO and CDC guidelines,” Belani said.¹

The authors recommended limiting in-person visits with providers as much as possible for patients with lung cancer and COVID-19. Patients who must come into the hospital should be screened and tested for the infection if there are any of the typical symptoms.²

Patients undergoing any invasive procedure or systemic chemotherapy/immunotherapy should be tested for the infection as well, according to the authors.²

Finally, the pandemic further complicates care by forcing patients to self-isolate for their own protection.¹

“Self-isolation goes against best practices for treating cancer patients, which often calls for joining support groups, reaching out to loved ones and family members for assistance, and remaining active,” Belani said in the statement. “The decision regarding immediate vs. delayed treatment during the COVID-19 pandemic should balance the delay of treatment in presence of existing co-morbidities vs. the possible harm from COVID-19.”¹

REFERENCES

• Treatment guidance for lung cancer patients during the COVID-19 pandemic [news release]. EurekAlert!; May 15, 2020. https://www.eurekalert.org/pub_releases/2020-05/iaft-tgf051520.php. Accessed May 21, 2020.
• Dingemans A, Soo R, Jazieh A, et al. Treatment guidance for lung cancer patients during the COVID-19 pandemic. Journal of Thoracic Oncology; May 7, 2020. https://www.jto.org/article/S1556-0864(20)30382-8/pdf. Accessed May 21, 2020.