Development of a Patient-Centered Framework for Oncology Clinicians to Address Uncertainty in Cancer Care During the COV
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Invited Commentary
Development of a Patient-Centered Framework for Oncology Clinicians to Address Uncertainty in Cancer Care During the COVID-19 Pandemic Natasha Dhawan, MD1 Eric Prommer, MD2 Christian T. Sinclair, MD3 Ishwaria M. Subbiah, MD4,* Address 1 Department of Hematology and Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA 2 Division of Hospice and Palliative Medicine, Veterans Affairs/University of California Los Angeles, Los Angeles, CA, USA 3 Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA *,4 Division of Palliative Rehabilitation and Integrative Medicine, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX, 77030, USA Email: [email protected]
Published online: 29 October 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020
Keywords Communication strategies I Prognostication I COVID-19 I Pandemic I Shared decision-making
A Note from the Editor-in-Chief: Clearly, we are living through extraordinary and challenging times as we confront the COVID-19 pandemic. Although we rarely publish commentaries within Current Treatment Options in Oncology, I felt that it was very important to include this particular Commentary as it reflects on the many additional challenges faced by cancer patients and their caregivers as a result of COVID-19. It also explores the possibility of long-term
positive impact on patient care arising from efforts to address those challenges. It is our hope that readers of this Commentary will find it helpful as they seek to explore productive paths through the complexities of COVID-19 in an at-risk population. –Dr. David S. Ettinger, MD
Curr. Treat. Options in Oncol. (2020) 21: 99
99 Page 2 of 6
Impact of COVID-19 on cancer care The SARS coronavirus 2 and the associated disease, Coronavirus Disease 2019 (COVID-19), have brought about an unprecedented level of disruption to the healthcare delivery models. In the context of oncology, clinicians and patients face decisions regarding oncologic care that require them to reconcile the impact of the risk of exposure and development of COVID-19 on the life-altering diagnosis of cancer. Initially, there was significant concern that patients undergoing active cancer therapy who later contracted COVID-19 would have worse outcomes compared with the general population. Indeed, the TERAVOLT study demonstrated a mortality rate of 34.6% (66/191) in patients with thoracic malignancies who contracted COVID-19, although many of these patients were not admitted to the intensive care unit (and thus did not receive ventilator support) for unknown reasons [1]. However, additional data demonstrated that patients admitted with COVID-19– related illnesses had a mortality rate of 14.6% among the cohort of patients who had cancer when compared with those who did not [2]. In light of these outcomes, clinical stakeholders are rapidly developing strategies to deliver oncologic care safely with minimal exposure [3–
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