EHS-COVID (376) Impact of COVID-19 on cancer services (7)

4 June, 2021

Below is the WHO guidance on maintaining cancer services during COVID-19, from the publication 'Maintaining essential health services: operational guidance for the COVID-19 context interim guidance'

https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-essential...

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COVID-19 can negatively impact NCD outcomes for adults and children through several pathways including the higher susceptibility to COVID-19 infection and higher case fatality rates among people with NCDs; delays in

diagnosis of NCDs resulting in more advanced disease stages; delayed, incomplete or interrupted therapy (treatment, rehabilitation, palliation) of NCDs; and increases in behavioural risk factors, such as physical inactivity

and increased use of harmful substances. Examples include... worsened cancer prognosis as a result of a delayed diagnosis...

Cancer early diagnosis programmes:

- Initiate or increase campaigns to encourage the general public to seek consultation for possible symptoms of cancer.

- Utilize virtual consultations to minimize delays in diagnosis.

- Maintain in-person clinical appointments, as needed, for time-sensitive services (e.g. evaluation of abnormal bleeding) and decision-making...

Diagnosis of cancer

- Prioritize cancer imaging studies that can inform time-sensitive decision-making about treatment...

Specialist care of cancer

- Prioritize timely initiation of cancer treatment for cancers in which delays impact outcomes.

- Because cancer patients with advanced disease who are diagnosed with COVID-19 are at a higher relative risk for a poorer outcome, adaptations to treatment plans may be required.

- Prioritize the treatment of cancers for which the benefits of early initiation of therapy outweigh the risks of initiating therapy in the pandemic context, taking into account exposure risks and the extent to which the patient is

immunocompromised.

- Tailor and modify to individual circumstances and service context:

-- treatment sequence (such as the use of chemotherapy or radiotherapy before surgery);

-- treatment regimens (such as the duration of therapy for patients in deep remission); and/or

-- treatment plan (such as candidates for allogenic hematopoietic stem cell transplantation).

For people with cancer who are diagnosed with COVID-19, consider immediately changing their cancer treatment plans, including potentially suspending immunosuppressive therapies.

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WHO is planning to update the guidance. How might it be improved?

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org