COVID19 Prevention & Care; A Cancer Specific Guideline

Onco-hematological patient care in times of COVID-19: a scoping review

OBJECTIVE

to identify and map health care aimed at onco-hematological patients in times of Coronavirus 2019.

METHODS

this is a scoping review, anchored in the Joanna Briggs Institute theoretical framework, registered in the Open Science Framework, with searches carried out in June 2021, through searches in the databases.

RESULTS

a final sample consisting of 20 articles was obtained, with emphasis on general care, treatment and stem cell donation. The most reported care was the use of telemedicine, screening for Coronavirus Disease 2019, compliance with prevention practices and, in case of infection, postponing procedures.

CONCLUSIONS

the study gathered the main evidence on care aimed at treating these patients in times of a pandemic. Such measures help in the clinical management with the objective of proceeding with treatment amidst the injuries caused, thus minimizing possible complications.

Epidemiological Algorithm for Early Detection of COVID-19 Cases in a Mexican Oncologic Center

An early detection tool for latent COVID-19 infections in oncology staff and patients is essential to prevent outbreaks in a cancer center. (1) Background: In this study, we developed and implemented two early detection tools for the radiotherapy area to identify COVID-19 cases opportunely. (2) Methods: Staff and patients answered a questionnaire (electronic and paper surveys, respectively) with clinical and epidemiological information. The data were collected through two online survey tools: Real-Time Tracking (R-Track) and Summary of Factors (S-Facts). Cut-off values were established according to the algorithm models. SARS-CoV-2 qRT-PCR tests confirmed the positive algorithms individuals. (3) Results: Oncology staff members (n = 142) were tested, and 14% (n = 20) were positives for the R-Track algorithm; 75% (n = 15) were qRT-PCR positive. The S-Facts Algorithm identified 7.75% (n = 11) positive oncology staff members, and 81.82% (n = 9) were qRT-PCR positive. Oncology patients (n = 369) were evaluated, and 1.36% (n = 5) were positive for the Algorithm used. The five patients (100%) were confirmed by qRT-PCR. (4) Conclusions: The proposed early detection tools have proved to be a low-cost and efficient tool in a country where qRT-PCR tests and vaccines are insufficient for the population.

Risk factors for in-hospital mortality among cancer patients with COVID-19: A cross-sectional study

Background:

Since emerged in December 2019, in China, COVID-19 has become a major concern for people and health-care systems. Patients with medical diseases are at a higher risk of severe disease development and mortality. Cancer patients are more vulnerable to infections. Several studies demonstrated that COVID-19 is associated with a greater risk of morbidity and mortality among cancer patients. However, the risk factors for mortality among these patients are still unknown.

Objective:

This study aimed to identify the risk factors associated with in-hospital death among cancer patients with COVID-19.

Method:

In this cross-sectional study, we analyzed demographic data, clinical characteristics and laboratory parameters of cancer patients with COVID-19 who were hospitalized in three tertiary referral hospitals in Tehran, Iran from February to May 2020. Diagnosis of COVID-19 was confirmed using real-time polymerase chain reaction testing and computed tomography scan findings. Data analysis was performed using SPSS software, version 20. P-value less than 0.05 was considered significant.

Results:

Sixty-six cancer patients with COVID-19 were enrolled in this study. Among participants, 35 (53.03%) patients discharged and 31 (46.97%) patients died in hospital. Thirty-two (48.4%) patients suffered from hematologic and 34 (51.6%) from non-hematologic cancers. The most common comorbidities were hypertension (68.18%) and diabetes (56.06%). The most common symptoms among patients were rhinorrhea (59.1%), fever (54.5%) and dyspnea (48.4%), respectively. Diabetes (p= 0.00), hypoxemia (p= 0.005) and receiving chemotherapy or radiotherapy during the last three months (p= 0.022) were associated with a significantly greater risk of in-hospital mortality.

Conclusion:

Hypoxemia, diabetes and the time interval between chemotherapy/radiotherapy and hospitalization is associated with a higher risk of in-hospital mortality among cancer patients with COVID-19. These risk factors should be considered in clinical management hospitalized COVID19 patients who suffer from cancers. Regarding the risk factors may help to reduce in-hospital mortality and poor outcomes.

Cancer Patients’ Challenges During COVID-19 Pandemic: An Approach to Decision-Making in Management and Policy-Making

Context: Cancer patients are more susceptible to novel coronavirus infection due to their immune system deficiency and anticancer treatments. During the COVID-19 outbreak, cancer patients have faced many challenges. The present study aimed to review the literature on cancer patients’ challenges during the COVID-19 pandemic to offer an approach to decision-making in management and policy-making. Evidence Acquisition: In this review study, national and international databases were searched. Inclusion Criteria were the risk of COVID-19 in cancer patients, medical services, surgery, and cancer screening during the COVID-19 pandemic, cancer patients’ challenges during the COVID-19 pandemic, and management and policy-making in this pandemic. Results: Cancer patients’ challenges during the COVID 19 pandemic were classified as follows: (1) risk of COVID-19 for cancer patients; (2) access to medical services and screening during the COVID-19 pandemic; and (3) psychological disorders during the COVID-19 pandemic. Studies have revealed that individuals with cancer experience a higher risk of the COVID-19 infection and mortality compared to healthy individuals. Most oncology clinics postpone unnecessary appointments; however, patients with invasive cancer are treated with no delay. Proper management, disease control, and attention to mental health care can prevent psychological disorders. Conclusions: Managing cancer patients’ challenges during the SARS-CoV-2 is of paramount importance. Cancer clinics need to develop new care and follow-up protocols. Moreover, policy-makers should provide appropriate policies to address the challenges of this disease in the future.

Assistência ao paciente onco-hematológico em tempos de COVID-19: revisão de escopo

RESUMO Objetivo: identificar e mapear os cuidados em saúde direcionados aos pacientes onco-hematológicos em tempos de Coronavirus Disease 2019. Métodos: trata-se de uma scoping review, ancorada no referencial teórico do Joanna Briggs Institute, registrada na Open Science Framework, com buscas realizadas em junho de 2021, mediante pesquisas nas bases de dados. Resultados: obteve-se uma amostra final constituída de 20 artigos, com destaque para os cuidados gerais, de tratamento e na doação de células-tronco. Os cuidados mais relatados foram o uso da telemedicina, o rastreio de infecção por Coronavirus Disease 2019, a adesão às práticas de prevenção e, em caso de infecção, adiar os procedimentos. Conclusões: o estudo reuniu as principais evidências sobre os cuidados direcionados ao tratamento destes pacientes em tempos de pandemia. Tais medidas auxiliam no manejo clínico sob o objetivo de prosseguir com tratamento em meio aos agravos causados e, assim, minimizar possíveis complicações.

Caregivers of Individuals with Cancer in the COVID-19 Pandemic: A Phenomenological Study

Caregivers of individuals with cancer in the COVID-19 pandemic are faced with the demands of cancer and the health needs produced by it, along with their own health and self-care needs, and the uncertainties of expectations and risks. A qualitative analytical phenomenological study with caregivers of individuals with cancer registered at the state referral hospital supplying medications, who answered the sociodemographic assessment questionnaires and semi-structured questions about their feelings and perceptions in the COVID-19 pandemic. Bardin's content analysis was used, with methodological quality assessed using SRQR Standards for Reporting Qualitative Research and the MAXQDA software. Most of the caregivers are women, married, Catholic, of low income and education, aged between 30 and 60 years, optimistic, comply with health guidelines regarding social distancing, use of masks, and routine hand hygiene, do not practice regular physical activities, mention concern for their own physical and financial survival, and that of their family. The main need identified in the affective sphere was to reframe contact with family members, seeking to strengthen the bonds of affection. The feeling of emotional vulnerability shows the importance of building effective public policies for social support consistent with the improvement of health care for this population.

The psychological health of patients diagnosed with cancer in Iraq during the COVID-19 pandemic: A single center study

OBJECTIVE

The objective of this study was to assess the psychological health status of patients diagnosed with cancer in Iraq during the COVID-19 pandemic. The study aim was to measure the prevalence of depression, anxiety, and stress among patients diagnosed with cancer. Secondary aims were to assess the association between depression, anxiety, and stress with sociodemographic characteristics, cancer-specific characteristics, patients' experience in healthcare visit, risk perception towards COVID-19, and health concern during the outbreak.

METHODS

A cross-sectional study was conducted between September 1, 2020 and December 1, 2020 at an Oncology clinic in Baghdad. Included in the study were two hundred patients diagnosed with cancer. Data collected included: demographic variables (age, gender, residential location, marital status, education, employment status), clinical characteristics and cancer-specific parameters (duration since cancer diagnosis, cancer type, treatment duration, clinic visits frequency), experience during the pandemic (skipping or postponing treatment or periodical tests, suffering from new body pain, fear of acquiring the infection, fear of health deterioration), as well as psychological health status (depression, anxiety, stress). Pain, risk perception towards COVID-19, and health concern were measured using categorical Likert scale with responses being no, sometimes, and often. The psychological health status was measured by the "Depression, Anxiety, and Stress Scale" (DASS-21). Cut-off scores of the DASS-21 greater than 9, 7, and 14 represent a positive screen of depression, anxiety, and stress, respectively.

RESULTS

The prevalence of patients who screened positive for depression was 22.0%, anxiety 22.0%, and stress 13.5%. The prevalence of depression, anxiety and stress were significantly more in those who had university or higher education (34.3%, p-value <0.0001; 32.3%, p-value <0.0001; 19.2%, p-value = 0.02 respectively). Those were four times more likely to have depression and two times more likely to have anxiety than participants who had school education (OR = 4.40 CI [1.98-9.77], p-value <0.0001; OR = 2.55 CI [1.15-5.65], p-value = 0.02, respectively). The prevalence of anxiety was significantly the highest in the age group 16-39 years (40.9%) compared to 22.3% in the age group 40-64 years and 10.3% in the group ≥65 years (p-value = 0.02). Patients ≥65 years of age were less likely to develop anxiety compared to younger patients (OR = 0.44 CI [0.22-0.89], p-value = 0.02). As for the patients' experience in healthcare visit, 66 patients (33.0%) skipped or postponed their treatment or tests due to the outbreak. Around (8%) sometimes suffered from new body pain. Those who sometimes suffered from new body pain had significantly more depression than patients who did not suffer new pain or often had new pain (50.0% vs. 15.0% vs. 28.1% respectively, p-value = 0.002). Those were two times more likely to be depressed (OR = 2.18 CI [1.29-3.68], p-value = 0.003). Around (50%) of the patients were often afraid that their health would deteriorate during the outbreak. Those were significantly more depressed (31.7%, p-value = 0.002), anxious (30.7%, p-value <0.0001) and stressed (21.8%, p-value = 0.002) than those who did not have fear of losing their health and were two times more likely to have anxiety and stress.

CONCLUSION

These findings, especially the association between developing new pain and depression, raised concerns regarding the psychological health in patients diagnosed with cancer during COVID-19 pandemic. It is crucial to implement psychological health screening for patients diagnosed with cancer during the pandemic to help prevent any psychological health problems. The DASS-21 could be used as a screening tool for distress in these patients.

Novel therapeutic drug strategies to tackle immune-oncological challenges faced by cancer patients during COVID-19

INTRODUCTION

For the clinical treatment of cancer patients, coronavirus (SARS-CoV-2) can cause serious immune-related problems. Cancer patients, who experience immunosuppression due to the pathogenesis and severity of disease, may become more aggressive due to multiple factors such as age, comorbidities, and immunosuppression. In this pandemic era, COVID-19 causes lymphopenia, cancer cell awakening, inflammatory diseases, and a cytokine storm that worsens disease-related morbidity and prognosis.

AREAS COVERED

We discuss all the risk factors of COVID-19 associated with cancer patients and propose new strategies to use antiviral and anticancer drugs for therapeutic purposes. We bring new drugs, cancers and COVID-19 treatment strategies together to address the immune system challenges faced by oncologists.

EXPERT OPINION

The chronic inflammatory microenvironment caused by COVID-19 awakens dormant cancer cells through inflammation and autoimmune activation. Drug-related strategies to ensure that clinical treatment can reduce the susceptibility of cancer patients to COVID-19, and possible counter-measures to minimize the harm caused by the COVID-19 have been outlined. The response to the pandemic and recovery has been elaborated, which can provide information for long-term cancer treatment and speed up the optimization process.

The effect of anxiety and spiritual well-being on the care burden of caregivers of cancer patients during the COVID-19 pandemic

Objectives

The COVID-19 pandemic has adversely affected the caregivers of people with all chronic diseases, including people with cancer (PWC). This study was conducted to determine the impact of anxiety and spiritual well-being on the care burden of caregivers of PWC during the COVID-19 pandemic.

Design

This cross-sectional descriptive study included 250 caregivers of hematology and oncology patients registered with a cancer support association. All participants completed the following self-report questionnaires: the Spiritual Well-Being Scale (SWBS), Generalized Anxiety Disorder 7-item scale (GAD-7), and the Zarit Caregiver Burden Interview (ZBI).

Results

Most (82.4%) of the caregivers expressed fear that their patient may contract COVID-19, and 42.0% stated that they had difficulty getting to the hospital. The caregivers’ mean ZBI score was 21.06 ± 14.64, their mean GAD-7 score was 14.51 ± 6.02, and their mean SWBS score was 111.50 ± 16.84. According to the results of regression analysis, SWBS and GAD-7 scores had a significant effect on the ZBI score (p < 0.05).

Conclusion

In this study, anxiety explained most of the care burden during COVID-19. Therefore, during the COVID-19 pandemic, it may be beneficial to implement practices to promote spirituality and reduce anxiety in caregivers of PWC.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06611-0.

Research trends related to childhood and adolescent cancer survivors in South Korea using word co-occurrence network analysis

PURPOSE

This study analyzed research trends related to childhood and adolescent cancer survivors (CACS) using word co-occurrence network analysis on studies registered in the Korean Citation Index (KCI).

METHODS

This word co-occurrence network analysis study explored major research trends by constructing a network based on relationships between keywords (semantic morphemes) in the abstracts of published articles. Research articles published in the KCI over the past 10 years were collected using the Biblio Data Collector tool included in the NetMiner Program (version 4), using "cancer survivors", "adolescent", and "child" as the main search terms. After pre-processing, analyses were conducted on centrality (degree and eigenvector), cohesion (community), and topic modeling.

RESULTS

For centrality, the top 10 keywords included "treatment", "factor", "intervention", "group", "radiotherapy", "health", "risk", "measurement", "outcome", and "quality of life". In terms of cohesion and topic analysis, three categories were identified as the major research trends: "treatment and complications", "adaptation and support needs", and "management and quality of life".

CONCLUSION

The keywords from the three main categories reflected interdisciplinary identification. Many studies on adaptation and support needs were identified in our analysis of nursing literature. Further research on managing and evaluating the quality of life among CACS must also be conducted.

Scientometric analyzing the output of researchers and organizations on COVID-19 for better conducting the scientific efforts: with a glance to endocrinology

Purpose

As COVID-19 spreads rapidly and could affect the people and also lead to their death, especially individuals with underlying diseases, such as diabetes, the research community is also active in publishing novel research about it. Analyzing scientific outputs in this topic can represent an overview of publications. For this purpose, this study was conducted to determine status of publishing research works related to COVID-19 and analyzing the all documents published and indexed in Web of Science database and illustrate the co-occurrence and co-authority of hot papers in this documents.

Methodology

Our search strategy was based on using the related key terms including COVID-19, coronavirus, SARS2, etc., to find out all the published scientific works related to coronavirus disease indexed in web of science (WoS) in 2020. We then extracted the all hot papers and especially hot papers in endocrinology category and analyzed them. The data saved and imported in VOSviewer and ScientoPy programs for analysis and illustration of our data. We have shown our analysis in the tables, figures and maps.

Results

Totally, 56,402 records and 309 hot papers were retrieved. 3 of these hot papers were in endocrinology category. The most common type of publication was original papers followed by editorial papers in the second rank. The country with the most published documents was the USA followed by China. The journals of "British Medical Journal" and "Journal of Medical Virology" were ranked as the first and second sources, respectively. The "Harvard University" was the top organization with high proportion of scientific publications and "the Lancet" was the top-ranked journal that published highly-cited papers.

Conclusion

The literature on COVID-19 is increasing with a high and fast growth. In this regard, there is a need to evaluate these publications once in a while and their results should be published to use this information for more effective management of future research works with emphasizes on the gaps of researches and more citable documents and allocation of budgets on more needed research and don't carry out the duplicates research. This would be helpful for prevention, control, and treatment of COVID-19 that is now among the most common topics in the world.

Simultaneous development of COVID-19 pneumonia and pulmonary metastasis in a known case of chondrosarcoma: a case report

Background

The outbreak of coronavirus disease 2019 (COVID-19) started in December 2020, and is a global problem now. There are several sets of established data regarding computed tomography (CT) findings in COVID-19 pneumonia with many differential diagnoses. During the early days of the pandemic, there was little data regarding lung CT features of COVID-19 in a cancer patient. In this paper, we described a rare case of simultaneous presentation of COVID-19 with pulmonary metastasis.

Case presentation

A Persian patient with a history of chondrosarcoma presented to our clinic during the COVID-19 pandemic with a new-onset cough. He had experienced no recurrence during previous follow-up visits. Chest CT scan revealed numerous bilateral small peripheral and perilymphatic pulmonary nodules, unilateral ground-glass patch, and nodular interlobular septal thickening. Biopsy of the pulmonary nodules established pulmonary metastasis of chondrosarcoma origin, and pharyngeal reverse transcription polymerase chain reaction (RT-PCR) was positive for COVID-19.

Conclusion

Pulmonary metastasis should be considered as a differential diagnosis of COVID-19 features in cancer patients in the pandemic era.

Prostate cancer management in the era of COVID-19: Recommendations from the Hong Kong Urological Association and Hong Kong Society of Uro-oncology

Aim

In response to the fast‐developing coronavirus disease 2019 (COVID‐19) pandemic, special arrangement and coordination are urgently required in the interdisciplinary care of patients across different medical specialties. This article provides recommendations on the management of different stages of localized or metastatic prostate cancer (PC) amid this pandemic.

Methods

The Hong Kong Urological Association and Hong Kong Society of Uro‐oncology formed a joint discussion panel, which consisted of six urologists and six clinical oncologists with extensive experience in the public and private sectors. Following an evidence‐based approach, the latest relevant publications were searched and reviewed, before proceeding to a structured discussion of relevant clinical issues.

Results

The joint panel provided recommendations for PC management during the pandemic, in terms of general considerations, diagnostic procedures, different disease stages, treatment modules, patient support, and interdisciplinary collaboration. The overall goal was to minimize the risk of infection while avoiding unnecessary delays and compromises in management outcomes. Practical issues during the pandemic were addressed such as the use of invasive diagnostic procedures, robotic‐assisted laparoscopic prostatectomy, hypofractionated radiotherapy, and prolonged androgen deprivation therapy. The recommendations were explicated in the context of Hong Kong, a highly populated international city, in relation to the latest international guidelines and evidence.

Conclusion

A range of recommendations on the management of PC patients during the COVID‐19 pandemic was developed. Urologists, oncologists, and physicians treating PC patients may refer to them as practical guidance.

Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review

Background

The aim of the study was to identify strategies adopted by radiotherapy centres in low- and middle-income countries (LMICs) to mitigate the effects of COVID-19. Studies summarising COVID-19 mitigation strategies designed and implemented by radiotherapy centres in LMICs to avoid delays, deferrments and interruptions of radiotherapy services are lacking.

Materials and methods

A systematic review was conducted and reported in accordance with the preferred reporting items for systematic review and meta-analysis guideline. Ovid Embase, Ovid MEDLINE and CINAHL were searched for peer-reviewed articles that reported measures adopted by radiotherapy centres in LMICs to reduce the risk of COVID-19. Information on different strategies were extracted from the included studies and textual narrative synthesis was conducted.

Results

Of 60 articles retrieved, eleven were included. Majority of the studies were conducted in China. Ten of the included studies employed a qualitative design. Four themes were identified: preparing and equipping staff; reinforcing infection prevention and control policies; strengthening coordination and communication; and maintaining physical distancing. Studies reported that radiotherapy centres had: formed COVID-19 response multidisciplinary team; maximised the use of telehealth; adjusted the layout of waiting areas; divided staff into teams; dedicated a room for isolating suspected cases; and adopted triage systems.

Conclusions

Local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed radiotherapy leaders to continue to deliver radiotherapy services to cancer patients in LMICs during the COVID-19 crisis. Robust data collection must be encouraged in LMICs to provide an evidence-based knowledge for use in the event of another pandemic.

The methodological quality is insufficient in clinical practice guidelines in the context of COVID-19: systematic review

Objectives

The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19.

Study Design and Setting

Rapid systematic review from February 1 until April 27, 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting.

Results

There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline.

Conclusion

Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.

Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic

Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.

Covid-19: What is the best approach in gynecological oncology patient management during the coronavirus pandemic?

Coronavirus (COVID-19) infection is a new major concern and a global emergency in almost all countries worldwide; due to the higher sensibility of cancer patients, they are more susceptible to severe and fatal infections, being nearly 10 times more likely than in healthy individuals infected with this virus. Although the aggressive nature of a cancer is a matter of concern, our exact role as oncologists in this time of restricted resources is not fully clarified. Regarding some consensus recommendation for postponing surgery, there is still an essential need for a single approved protocol regarding each type of malignancy. Iran, as one of the first involved countries in this crisis in Asia, which also has a high prevalence of gynecological malignancies, will certainly require an individualized decision-making schedule based on the most accepted global consensus opinion. Considering our restricted health system resources, herein we tried to introduce a logical gynecologic cancer management protocol based on the stage and survival expectancy of each tumor, along with reviewing all recent recommendations. The limited statistics published in this short period of time have obliged us to mainly focus on expert opinions, and the individualized clinical judgments should be agreed upon by multidisciplinary tumor board consensus. In conclusion, the COVID-19 pandemic overshadows all aspects of medicine, and decision making in gynecological oncology patients requires precise and appropriate judgment based on the available local resources.

Oncological care organisation during COVID-19 outbreak

Background

COVID-19 appeared in late 2019, causing a pandemic spread. This led to a reorganisation of oncology care in order to reduce the risk of spreading infection between patients and healthcare staff. Here we analysed measures taken in major oncological units in Europe and the USA.

Methods

A 46-item survey was sent by email to representatives of 30 oncological centres in 12 of the most affected countries. The survey inquired about preventive measures established to reduce virus spread, patient education and processes employed for risk reduction in each oncological unit.

Results

Investigators from 21 centres in 10 countries answered the survey between 10 April and 6 May 2020. A triage for patients with cancer before hospital or clinic visits was conducted by 90.5% of centres before consultations, 95.2% before day care admissions and in 100% of the cases before overnight hospitalisation by means of phone calls, interactive online platforms, swab test and/or chest CT scan. Permission for caregivers to attend clinic visits was limited in many centres, with some exceptions (ie, for non-autonomous patients, in the case of a new diagnosis, when bad news was expected and for terminally ill patients). With a variable delay period, the use of personal protective equipment was unanimously mandatory, and in many centres, only targeted clinical and instrumental examinations were performed. Telemedicine was implemented in 76.2% of the centres. Separated pathways for COVID-19-positive and COVID-19-negative patients were organised, with separate inpatient units and day care areas. Self-isolation was required for COVID-19-positive or symptomatic staff, while return to work policies required a negative swab test in 76.2% of the centres.

Conclusion

Many pragmatic measures have been quickly implemented to deal with the health emergency linked to COVID-19, although the relative efficacy of each intervention should be further analysed in large observational studies.

A Review of Clinical Practice Guidelines and Treatment Recommendations for Cancer Care in the COVID-19 Pandemic

The COVID-19 pandemic has inevitably caused those involved in cancer care to change clinical practice in order to minimize the risk of infection while maintaining cancer treatment as a priority. General advice during the pandemic suggests that most patients continue with ongoing therapies or planned surgeries, while follow-up visits may instead be delayed until the resolution of the outbreak. We conducted a literature search using PubMed to identify articles published in English language that reported on care recommendations for cancer patients during the COVID-19 pandemic from its inception up to 1st June 2020, using the terms "(cancer or tumor) AND (COVID 19)". Articles were selected for relevance and split into five categories: (1) personal recommendations of single or multiple authors, (2) recommendations of single authoritative centers, (3) recommendations of panels of experts or of multiple regional comprehensive centers, (4) recommendations of multicenter cooperative groups, (5) official guidelines or recommendations of health authorities. Of the 97 included studies, 10 were personal recommendations of single or multiple independent authors, 16 were practice recommendations of single authoritative cancer centers, 35 were recommendations provided by panel of experts or of multiple regional comprehensive centers, 19 were cooperative group position papers, and finally, 17 were official guidelines statements. The COVID-19 pandemic is a global emergency, and has rapidly modified our clinical practice. Delaying unnecessary treatment, minimizing toxicity, and identifying care priorities for surgery, radiotherapy, and systemic therapies must be viewed as basic priorities in the COVID-19 era.

Management of cancer patients during COVID-19 pandemic at developing countries

Cancer patient care requires a multi-disciplinary approach and multiple medical and ethical considerations. Clinical care during a pandemic health crisis requires prioritising the use of resources for patients with a greater chance of survival, especially in developing countries. The coronavirus disease 2019 crisis has generated new challenges given that cancer patients are normally not prioritised for admission in critical care units. Nevertheless, the development of new cancer drugs and novel adjuvant/neoadjuvant protocols has dramatically improved the prognosis of cancer patients, resulting in a more complex decision-making when prioritising intensive care in pandemic times. In this context, it is essential to establish an effective and transparent communication between the oncology team, critical care, and emergency units to make the best decisions, considering the principles of justice and charity. Concurrently, cancer treatment protocols must be adapted to prioritise according to oncologic response and prognosis. Communication technologies are powerful tools to optimise cancer care during pandemics, and we must adapt quickly to this new scenario of clinical care and teaching. In this new challenging pandemic scenario, multi-disciplinary work and effective communication between clinics, technology, science, and ethics is the key to optimising clinical care of cancer patients.

Recommendations on Management of Locally Advanced Rectal Cancer During the COVID-19 Pandemic: an Iranian Consensus

Purpose

Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era.

Methods

In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran.

Results

We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19.

Conclusion

Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.

COVID-19 pandemic and patients with cancer: The protocol of a Clinical Oncology center in Tehran, Iran

Aim

To provide recommendations for the management of patients with cancer in the COVID-19 era.

Background

The current global pandemic of COVID-19 has severely impacted global healthcare systems. Several groups of people are considered high-risk for SARS-CoV-2 infection, including patients with cancer. Therefore, protocols for the better management of these patients during this viral pandemic are necessary. So far, several protocols have been presented regarding the management of patients with cancer during the COVID-19 pandemic. However, none of them points to a developing country with limited logistics and facilities.

Methods

In this review, we have provided a summary of recommendations on the management of patients with cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran.

Results

We recommend that patients with cancer should be managed in an individualized manner during the COVID-19 pandemic.

Conclusions

Our recommendation provides a guide for oncology centers of developing countries for better management of cancer.

Surgical Management Strategy for Breast Cancer Patients During the COVID-19 Outbreak

In December 2019, a new coronavirus pneumonia began to break out globally. COVID-19 pandemic challenges the health systems worldwide and influences the treatments for other diseases. The incidence rate of breast cancer ranks first among all malignant tumors among women. During the pandemic, medical workers should strictly monitor the condition of patients and strengthen the management and prevention measures to make sure patients can be operated safely. This article will discuss the arrangements and management of surgical treatment for patients with breast cancer.

Management of cancer patients during the COVID-19 pandemic: A comprehensive review

The novel 2019 corona virus disease also called severe acute respiratory syndrome coronavirus 2 has caused a global pandemic and more than 2.5 million people have been affected globally with over 100000 deaths. The disease has caused an escalation in hospitalization with growing need for hospital beds and intensive care unit for severe cases. Recent evidence has shown that a significant proportion of cancer patients affected by the corona virus present with severe respiratory pneumonia-like illness with need for subsequent intensive care unit ventilation and higher mortality risk. This susceptibility may be due to the immunosuppressive state of patients with malignancy confounded by chemotherapy, immunotherapy and targeted therapy. Many solid tumors (lung cancer, pancreatic cancer) as well as hematological malignancies (leukemias) may require prompt diagnosis and treatment based on the disease aggression and progression. Many centers lack clear guideline on the management of cancer during the pandemic. The objective of this review is to synthesize the available literature and provide recommendations on the management of various soft tissue and hematological malignancies. The review will also assess the management guidelines for hospitalized cancer patients; cancer patients in the outpatient setting as well as available modalities for follow-up.