Palliative care provision at a tertiary cancer center during a global pandemic
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ORIGINAL ARTICLE
Palliative care provision at a tertiary cancer center during a global pandemic Breffni Hannon 1,2 & Ernie Mak 1,3 & Ahmed Al Awamer 1,3 & Subrata Banerjee 1,3 & Christopher Blake 1,3 & Ebru Kaya 1,2 & Jenny Lau 1,3 & Warren Lewin 1,3 & Brenda O’Connor 1,2 & Alexandra Saltman 1,2 & Camilla Zimmermann 1,2 Received: 21 May 2020 / Accepted: 8 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract COVID-19 was first reported in Wuhan, China, in December 2019; it rapidly spread around the world and was declared a global pandemic by the World Health Organization in March 2020. The palliative care program at the Princess Margaret Cancer Centre, Toronto, Canada, provides comprehensive care to patients with advanced cancer and their families, through services including an acute palliative care unit, an inpatient consultation service, and an ambulatory palliative care clinic. In the face of a global pandemic, palliative care teams are uniquely placed to support patients with cancer who also have COVID-19. This may include managing severe symptoms such as dyspnea and agitation, as well as guiding advance care planning and goals of care conversations. In tandem, there is a need for palliative care teams to continue to provide care to patients with advanced cancer who are COVID-negative but who are at higher risk of infection and adverse outcomes related to COVID-19. This paper highlights the unique challenges faced by a palliative care team in terms of scaling up services in response to a global pandemic while simultaneously providing ongoing support to their patients with advanced cancer at a tertiary cancer center. Keywords COVID-19 . Palliative care . Pandemic . Cancer . Supportive care
Background COVID-19, caused by the novel coronavirus SARSCoV2, was first reported in Wuhan, China, in December 2019 [1]. It has spread rapidly and was declared a global pandemic by the World Health Organization on March 11, 2020 [2]. High-risk patients, including those with advanced cancer, can experience severe symptoms including pneumonia, severe acute respiratory syndrome, and renal failure [1, 3]. Mortality rates among patients with ad-
* Breffni Hannon [email protected] 1
Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
2
Department of Medicine, University of Toronto, Toronto, Canada
3
Department of Family & Community Medicine, University of Toronto, Toronto, Canada
vanced cancer have been estimated to be up to three times higher than among the general population [4]. Several papers have described potential challenges to cancer care in the context of COVID-19. These have focused primarily on decision-making around the initiation or continuation of anticancer therapies; delays in cancer surgery; enrollment in clinical trials; and the importance of clearly documented goals of care discussions for patients with cancer who may become infected with COVID-19 [5, 6]. The literature around palliative care provision in response to COVID-19 has mainly fo
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