COVID-19 mortality for cancer patients is high at 19.4 per cent and worse for those with lung cancer. Swiss and Italian oncologists have developed a risk:benefit tool to inform lung cancer treatment. Overall, regimens with a survival benefit should be prioritised, furthermore:
- Cancer patients with COVID-19 positive contacts should be tested before and during treatment. If patients test positive but are asymptomatic, delay treatment 28 days; in case of COVID-19, obtain 2 negative tests at a one-week interval before restarting treatment.
- For adjuvant treatment, if survival benefit is modest, the risk:benefit may favour no treatment.
- Neoadjuvant chemotherapy could help delay surgery.
- Concurrent or sequential radiotherapy should be reserved for patients with adequate respiratory function.
- Stereotactic body radiotherapy outside the lung should be done if it does not require multiple hospital visits. Treatment of the lung should be limited to cases with compression or bleeding.
- Carefully assess palliative treatments which are less likely to improve overall survival or quality of life.
- Reduce hospitals visits through oral regimens with longer intervals (such as immune checkpoint inhibitors), shorter chemotherapy regimens, withholding maintenance chemotherapy or strong neutropenia prevention measures.
Oncologists have to adapt during this pandemic and balance risk versus benefits to “primum non nocere”.