Cancer and COVID-19: French Recommendations for Oncologists

  • Liang W & al.
  • Lancet Oncol
  • 1 Mar 2020

  • curated by Ben Gallarda
  • Univadis Clinical Summaries
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This article was translated from Cancers solides et COVID-19 : les recommandations du HCSP on the French Medscape website, and contains a summary of French Health Authorities' provisional recommendations for solid tumors and COVID-19.

Patients with cancer are among the groups most vulnerable to COVID-19. In this context, the French High Committee of Public Health (HCSP) issued recommendations for oncologists on March 15.1 They recommend the isolation of oncology and radiotherapy departments or units. But is this a realistic goal? Dr Manuel Rodrigues, Oncologist at the Curie Institute and President of the French Cancer Society (Société Française du Cancer, SFC) offers these comments.

High-risk patients
As a preamble, the HCSP reminds us that, based on recent Chinese experience,2 the rate of COVID-19 infection is higher in patients with cancer than in the general population (1% vs 0.29%), although this could be explained by more medical surveillance in these patients.

More worryingly, among infected patients, the risk of severe respiratory complications requiring ventilation is higher in patients with cancer than those without cancer (39% vs 8%; P=.0003). An important prognostic criterion for the risk of developing severe respiratory complications is a history of chemotherapy or surgery in the preceding months (OR, 5.34; P=.0026).

Finally, the rate of respiratory deterioration is faster in patients with cancer, averaging 13 vs 43 days (HR, 3.56; 95% CI, 1.65-7.69).

“Departments to ‘Sanctuarize’”?
“In total, patients with solid tumors, especially those recently treated with surgery or chemotherapy in the preceding months, were at greater risk than the general population of rapidly developing severe lethal forms of the disease. They should therefore be kept as far away from the risk of infection as possible,” says the HCSP.

According to the HCSP, the general rule is therefore that “departments be ‘sanctuarized’!”

  • Medical oncology and radiotherapy departments should not receive patients infected with COVID-19 whether they have cancer or not.
  • Medical oncology and radiotherapy departments/units should not receive patients with symptoms that suggest COVID-19 infection.
  • If the management of patients infected with COVID-19 is required, the isolation of these patients in specific areas would be necessary.

When asked about this issue, Dr Rodrigues comments: “In regions heavily affected by the epidemic, there are already COVID-19 patients in the wards. It is now impossible to provide isolation. We have to think quickly about how to protect patients and caregivers. Not to mention the ethical problems that will arise related to the ventilation facilities for these patients, which will become very serious, very quickly, but also concerning the support of the patients and their families. Finally, we are going to have to clearly identify what procedures can be postponed, with deterioration of protocols, a lack of blood products...”.
 
Prioritization of care
On the question of prioritization of care, the HCSP states that “prioritization in the choice of patients to be managed should take into account the nature of the therapeutic strategy (curative versus palliative), the age of the patients, the probable life expectancy, and whether the diagnosis is recent or not.”

Prioritization could follow the following descending order:

  1. Patients with cancer for which the therapeutic strategy is curative, giving priority to patients
  2. Patients with cancer whose therapeutic strategy is palliative at a young age (
  3. Patients with cancer whose therapeutic strategy is palliative at the beginning of treatment (first therapeutic line).
  4. Other patients with cancer whose therapeutic strategy is palliative.

In order to limit the need for hospital visits, the use of oral treatments, home administration, and even therapeutic breaks should be preferred in patients undergoing noncurative treatment.

Cancer patients with COVID-19
For infected patients, unless an exception is made, cancer treatments should be stopped while the viral infection is being managed. If hospitalization is necessary, patients will be managed in other medical departments or units involved in the fight against the virus. They should be given priority as they are at higher risk of developing severe forms of the disease.

Members of the Recommendations Working Group:
Coordinator: Prof Benoit YOU (CHU de Lyon, HCL)
Dr Anne CANIVET (CLCC François Baclesse, Caen)
Dr Thomas GRELLETY (Centre Hospitalier de la Côte Basque, Bayonne)
Dr Gérard GANEM (Centres Privés de l’Ouest)
Dr Laure KALUZINSKI (CHG de Cherbourg)
Pr Ivan KRAKOWSKI (ex CLCC Institut Bergonié Bordeaux, AFSOS)
Pr Jean-Pierre LOTZ (CHU Paris, APHP)
Dr Didier MAYEUR (CLCC GF Leclerc, Dijon, AFSOS)
Pr Alain RAVAUD (CHU de Bordeaux)
Pr Rosine GUIMBAUD (CHU de Toulouse)