To assist clinicians facing the current and significant challenges providing systemic therapies to cancer patients, the ACP is collating links to key relevant documents for medical oncologists. New and updated documents will be added as they are released but you are advised to familiarise yourself with the following.
Tumour Specific Guidance
Impact on Training in Medical Oncology
NICE have now published rapid guidelines and they plan to update these regularly to reflect the latest evidence and information.
Delivery of systemic anticancer treatments
The rapid guideline on the delivery of systemic anticancer treatments says that where decisions need to be made about prioritising patients for treatment, these need to take into account the level of immunosuppression associated with individual treatments and cancer types, and any other patient-specific risk factors. They should also balance the risk from cancer not being treated optimally versus the risk of becoming seriously ill if they contract COVID-19 because of immunosuppression.
Where changes need to be made to usual care because of system pressures, the guideline says consideration should be given to delivering treatment in different and less immunosuppressive regimens, different locations or via another route of administration.
The guideline on critical care says that all patients on admission to hospital, irrespective of COVID-19 status, should continue to be assessed for frailty using a recognised frailty score (for example, the Clinical Frailty Scale [CFS]).
It also says the risks and benefits and likely outcomes should be discussed with patients, carers or advocates and families using decision support tools (where available) so that they can make informed decisions about their treatment wherever possible.
For patients with confirmed COVID-19, the guideline says decisions about admission to critical care should be made on the basis of medical benefit, taking into account the likelihood that the person will recover to an outcome that is acceptable to them and within a period of time consistent with the diagnosis.
Delivery of Radiotherapy
The purpose of this guideline is to maximise the safety of patients who need radiotherapy and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for radiotherapy to patient needs if services become limited because of the COVID-19 pandemic.
NHS England have published a series of specialty-specific advice for patient management during the coronavirus pandemic, and the guidance for cancer services, particularly regarding decisions around SACT, is here.
ADVICE FOR REMOTE CONSENT FOR TREATMENT
This document has been shared by Lancs Teaching Hospitals Trust and provides some guidance for obtaining consent for treatment by either telephone or videolink.
PAPER ON COVID INFECTIONS IN PATIENTS RECEIVING CHEMOTHERAPY
This important paper (Zhang et al) is a retrospective study of COVID-19 infected cancer patients within Wuhan, China. It is a pre-proof of a publication to appear in Annals of Oncology imminently.
REVIEW OF IMMUNOSUPPRESSANT DRUGS AND COVID-19
A systematic review of current evidence from teams at GSTT and KCL. Published by eCancer.
CORE OUTCOME SETS FOR RESEARCH
This document provides background and contains suggestions for core outcome sets relevant for COVID-19 research and patient care.
VIDEO ON THE CORONAVIRUS PANDEMIC FOR CANCER PATIENTS
Understandably, anxiety amongst cancer patients during the current coronavirus crisis is high. In view of this, the ACP trainees' committee has put together a short message to cancer patients, to try and help allay and alleviate some of the understandable concerns.
It would be appreciated if you were able to share amongst your colleagues and channels/networks, to help disseminate as widely as possible.
The video is published on YouTube here or you can download it here.
Guidelines for the use of radiotherapy in early breast cancer during the COVID-19 pandemic.
UKBCG-endorsed Breast Systemic Therapies Prioritisation Guidelines.
The Association of Breast Surgery have produced a document with some recommendations for breast clinics during the coronavirus pandemic.
Guidelines for follow-up and SACT for melanoma during COVID-19 pandemic (Draft 17 March 2020).
Guidance for the management of patients with lymphoma during the COVID-19 health emergency: a statement from a panel of UK lymphoma experts (coordinated by a subgroup of the NCRI Lymphoma Reaserch Group) (Version 1.5, dated 27 March 2020).
EMAIL RE IMPACT ON TRAINING IN MEDICAL ONCOLOGY AND USEFUL RESOURCES
The message below was circulated to ACP members on 19 March:
RE: COVID-19 and impact on training in medical oncology
It is an extraordinary time and we are sure you will all have questions and concerns, many of which have already been raised, some of which will have been answered and for many, these answers remain unclear given the limited knowledge base, rapidly changing situation and competing demands on those making contingency plans whilst maintaining clinical and other activities.
As the situation of COVID-19 develops so will the advice, as well as the government and subsequent NHS response.
As doctors, we have a professional responsibility and duty of care to support the wider NHS if needed. Currently, the NHS is aiming to continue to provide cancer treatments where safe and feasible, despite the COVID19 situation. So for the moment, as medical oncologists, our main priority is likely to be ensuring that we adapt to national and local guidance in maintaining our usual areas of practice under unusual circumstances. However, this could change and we need to be flexible in applying our transferable skills outside of our usual remit if required and appropriately supervised and supported to do so.
The JRCPTB Medical Oncology Specialty Advisory Committee is due to meet this week. The potential impact of COVID-19 on training and how medical oncology trainees might reasonably be expected to contribute to the wider NHS during this crisis will be discussed. It has been emphasised by the JRCPTB that every measure possible will be taken to ensure that the impact of this crisis on training will be minimised or mitigated.
We hope to provide a summary of the outcome of this meeting at the end of this week.
We have circulated a letter from HEE sent to NHS trusts last week which provides some information of what may be expected of trainees and HEE's stance. Additionally, we have included a letter from the heads of the London school of medical specialties, and a further communication from HEE to trainees in research. Please familiarise yourself with their contents.
NHS England have published specific advice regarding patients with cancer, particularly regarding decisions around SACT. You can find this guidance along with the general internal medicine guidance here.
This website provides a significant amount of educational material, summarising the evidence base (with links to referenced papers) regarding the presentation and management of COVID-19.
The trainees' committee have also set up an online Google Groups forum specifically for COVID-19 where trainees can freely share resources, ideas, discuss good vs bad experiences etc. It is a closed group by invitation only.
If you would like to join, please email Dan or Anna with your gmail email address and we will add you.
Please find below a list of additional resources that we are sure you will find helpful:
1) RCP Trainee FAQ page
2) Academy of Medical Royal Colleges -- great signposting, with several letters of support and information for trainees.
3) UK Gov.uk website and website
4) Travel advice - refer to the Foreign Commonwealth Office website, but healthcare professionals should consider if travel is necessary, as well as the risk posed to self or others by doing so. The majority of forthcoming conferences/meetings are being postponed, cancelled or being delivered remotely. Please check with individual organisations before registering and/or making travel and accommodation arrangements.
5) Public Health England PPE videos - these videos are a reminder of the donning and doffing of PPE for suspected and confirmed COVID-19 cases. Whilst we are sure everyone is familiar with this protocol, reminding ourselves is especially important at this time. Remember: staff should not enter a patient's room with confirmed COVID-19 without an FFP3 respirator mask; you must be fit tested according to local arrangements.
6) ASCO resources page - some very useful information, notably the FAQs provide some helpful information about SACT in this situation and evidence reviewed.
7) Association of Anaesthetists webinar - You can access a great webinar titled - 'COVID-19 update: what you need to know on the frontline' with some very useful clinical information by registering with the association for free.
8) Boston Medical Grand Round - this online educational session is an extremely useful overview covering the history and epidemiology, as well clinical presentation, manifestation and management of COVID-19.
Please do engage with the medical oncology trainee forum. Importantly, we must all take extra care of each other during these difficult times - the #HowYouDoing campaign launched on Twitter reminds us all of the responsibility we have to our colleagues in oncology and beyond.
We will continue to update you, both via email through the ACP and the forum.
Professor David Cunningham
Dr Jackie Newby
Dr Daniel Hughes
ACP Trainee Com. Chair and SAC rep
Dr Anna Olsson-Brown
ACP Trainee Com. Rep and SAC Rep