Palliative care for cancer patients with severe COVID-19: the challenge of uncertainty
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COMMENTARY
Palliative care for cancer patients with severe COVID-19: the challenge of uncertainty Hon Wai Benjamin Cheng 1,2 Received: 12 August 2020 / Accepted: 30 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Cases of coronavirus disease 2019 (COVID-19) are escalating rapidly across the globe, with the mortality risk being especially high among those with existing illness and multi-morbidity. The immunosuppressed status of some cancer patients increases their risk of infection compared with the general population, and cancer treatment within 2 weeks of COVID-19 diagnosis was reported as a risk factor for developing severe events. Palliative care workers have an essential role in the response to COVID-19 by responding rapidly and flexibly; ensuring protocols for symptom management are available, considering redeploying staffs and volunteers to provide psychosocial and bereavement care and using technology to communicate with patients and carers. Keywords COVID-19 . Palliative . SARS . Cancer
Introduction The 2019 coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2). The COVID-19 is primarily an acute viral respiratory disease which can manifest as acute upper or lower respiratory tract syndrome of varying severity, from asymptomatic virus shedding, rhinorrhea, sore throat, conjunctivitis to cough, asymptomatic or silent hypoxia, chest discomfort, respiratory f ailure, or even m ulti-organ failure. Extrapulmonary manifestations include diarrhea, lymphopenia, thrombocytopenia, deranged renal and liver functions, anosmia, multisystem vasculitis, and thromboembolism [1]. The outcome of COVID-19 is largely affected by older age and the presence of obesity and other underlying comorbidities [2]. Severe complications have been reported to occur in 33% of patients with COVID-19 and include acute respiratory distress syndrome, acute renal failure, acute respiratory injury,
* Hon Wai Benjamin Cheng [email protected] 1
Medical Palliative Care Team, Department of Medicine & Geriatrics, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong
2
Medical Palliative Medicine (MPM) Team, Department of Medicine & Geriatrics, R8B Rehabilitation Block, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong SAR, China
septic shock, and severe pneumonia. The crude fatality varies widely for different geographical regions from 0.4 to 10%. [3]
Covid-19 in cancer patients The immunosuppressed status of some cancer patients, whether caused by the disease itself or the treatment, increases their risk of infection compared with the general population. Cancer treatment within 14 days of COVID-19 diagnosis was reported as a risk factor for developing severe events. Acute respiratory distress syndrome (28.6%), septic shock (3.6%), and acute myocardial infarction (3.6%) are among the documented severe complications in the study population [4]. Studies of the SARS outbreak in 2003 showed that interferon beta can be synergistic with ribavirin
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