Table 1 General consensus measures taken by CCE centers during the COVID-19 pandemic
Category | Measure |
|---|---|
Hospital wide | Construct a hospital-wide crisis team responsible for coordinating measures between departments. |
Encourage patients not to arrive early. Offer to text patients when you are ready to see them, so they can wait outside or in the car. | |
Instruct patients not to visit the hospital if they have symptoms indicative of possible COVID-19 (unless urgent attention is required). | |
Call patients the day before planned hospital admissions, to discuss the presence of any COVID-19-related symptoms. | |
Screen patients at the entrance for symptoms of COVID-19 and fever. | |
Quickly isolate patients with COVID-19 in specialized departments, with the intent of relocation to regional collaborating hospitals (if possible). | |
Reduce preclinical research activities to a bare minimum. | |
Stop patient inclusion for clinical studies or trials requiring additional actions and/or visits. Consider a tumor type–specific ‘exception list’ of particularly successful studies for which inclusion continues. | |
Discuss each patient with a multidisciplinary team to consider alternative treatment modalities with the fewest visits or lowest capacity problems or that are the shortest in duration. | |
Therapeutic adjustments (versus regular guidelines) should be discussed in a multidisciplinary team meeting. | |
Conduct multidisciplinary team consultations remotely if possible or include only one representative of each discipline to limit the number of people participating in the meetings. | |
Inform patients about a possibly increased risk associated with anticancer therapy during the COVID-19 pandemic. | |
Enable telephone or video consultations for healthcare professionals who need to self-isolate. | |
When postponing procedures or contact moments, anticipate future capacity problems. | |
Do not prescribe corticosteroids as anti-emetics (if avoidable), and limit their use in patients treated with immune-checkpoint blockade, to reduce vulnerability to COVID-19. | |
With each patient, discuss resuscitation status to anticipate future decisions about intensive care. | |
Outpatient clinic | Critically triage second opinions. |
Do all follow up appointments by phone (except when physical examination is necessary). | |
When possible, reduce or delay the number of radiological-response evaluations. | |
Prioritize oral or subcutaneous treatments above infusion-based treatments to reduce time spent in the hospital. | |
Perform blood tests outside the hospital (e.g., at a general practice or at home), when possible. | |
Have oral medications delivered to the patient’s home, rather than being picked up at the pharmacy. | |
Day care | Consider omitting supportive treatments (e.g., no bisphosphonate infusion, except in the case of hypercalcemia). |
When possible, organize the administration of intravenous maintenance treatments at home. | |
When administration at home is impossible, consider temporary breaks or reductions in the frequency of intravenous maintenance treatments for less-aggressive metastatic cancers on a per-patient basis. | |
Radiotherapy | Consider hypofractionated regimens for patients with limited additional benefit of regular regimens. |
Create capacity for radiation as replacement of surgery. | |
Surgery | Consider postponement of surgeries with high morbidity and mortality during the pandemic. |
Consider other treatment modalities with equal benefit (e.g., radiation for prostate cancer, curative chemoradiation for other tumor types, or brain irradiation for metastases). | |
Other | Consider outsourcing of interventions (e.g., follow-up endoscopies) to private clinics. |
