NICE: Cancer care during COVID-19 outbreak

  • National Institute for Health and Care Excellence

  • Oncology guidelines update
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Guidelines on the delivery of systemic anticancer treatments during the current pandemic were released earlier this week amid a flurry of NICE guidelines related to COVID-19.

Key recommendations are as follows:

  1. Systemic treatment should be prioritised according to the follow treatment categories:
  • Curative with >50% chance of success.
  • Curative with 15%-50% chance of success.
  • Non-curative with >50% chance of >1 year extension to life.
  • Curative with 1 year extension to life.
  • Non-curative with >50% chance of palliation or temporary tumour control and
  • Non-curative with 15%-50% chance of palliation or temporary tumour control and

2. Try to deliver systemic treatment in different and less immunosuppressive regimens, different locations or via another route of administration. Options include:

  • Switching intravenous treatments to subcutaneous or oral alternatives.
  • Using shorter treatment regimens.
  • Decreasing the frequency of immunotherapy regimens.
  • Providing repeat prescriptions of oral medicines or other at-home treatments without patients needing to attend hospital.
  • Deferring treatments that prevent long-term complications such as bone disease.
  • Using home delivery of oral medicines where possible depending on the resilience of home care providers.
  • Using treatment breaks for long-term treatments (possibly >6 weeks).

3. Ensure each patient is considered on an individual basis by the multidisciplinary team. Record the reasoning behind each decision.

4. Discuss the risks and benefits with patients, their families, and carers.

5. Cancer Drugs Fund (CDF) and non-CDF treatment break policy will not apply during the outbreak.

6. Where a treatment break is needed, indicate that the break was caused by COVID-19 when filling out the restart treatment form. The request will be approved even if disease has progressed, providing there is a reasonable chance that control can be regained.