Lung Cancer Treatment During the COVID-19 Pandemic: Balancing Risks and Benefits
Posted: Tuesday, April 28, 2020
As the number of cases of the novel coronavirus continues to increase worldwide, a group of experts has developed a tool to support oncologists when making treatment decisions for patients with lung cancer. Their recommendations were published in ESMO Open.
“There is no easy, universal solution to oncological care during this crisis, and, to complicate matters, the duration of this pandemic is hard to predict,” stated Giuseppe Banna, MD, of Ospedale Cannizzaro, Catania, Italy, and colleagues. “It is important to weigh the impact of each of our decisions in these trying times rather than rely on routine automatisms.”
Because patients with lung cancer are at risk of pulmonary complications from COVID-19, and chemotherapy may have a negative impact on outcomes, the risk-to-benefit ratio of systemic anticancer treatment should be considered. According to the experts, all regimens with a survival benefit should be maintained and prioritized whenever possible, while still considering several factors—the extent of the epidemic, the local health-care structure capacity, the risk of infection to individuals, the status of cancer, patients’ comorbidities, age, as well as treatment details. For palliative treatments that are unlikely to improve overall survival or positively impact patients’ quality of life, they recommend specific assessment by treating physicians.
Adjuvant and neoadjuvant treatments require “particular attention,” according to the experts, because the risk-to-benefit ratio may favor not giving adjuvant therapy when the survival benefit is modest. However, neoadjuvant chemotherapy may be worthwhile to delay the need for surgery during the COVID-19 pandemic. They also advised that radiotherapy given concurrently or sequentially with chemotherapy of curative intent should be reserved for those patients with adequate respiratory function.
Disclosure: The authors reported no conflicts of interest.
