Improving cancer care during COVID-19 pandemic: NCCN guidance

PLYMOUTH MEETING, PA - The National Comprehensive Cancer Network® (NCCN®)--an alliance of leading cancer centers--is continuing to share new resources for optimal cancer management amid new and changing challenges related to the Coronavirus Disease 2019 (COVID-19). The nonprofit organization's Best Practices Committee has published a new article online-ahead-of-print in JNCCN--Journal of the National Comprehensive Cancer Network detailing their recommendations for keeping cancer patients, caregivers and staff as safe as possible.

"The unprecedented challenges we are all facing from the COVID-19 pandemic heighten NCCN's commitment to sharing evidence-based consensus from leading medical experts as rapidly as possible, free-of-charge, to everyone around the world," said Robert W. Carlson, MD, Chief Executive Officer, NCCN. "We are doing everything we can to review and share reliable information that will help keep oncology patients, providers, and staff safe under the new reality of increased risk."

"We can continue to provide our patients with effective and compassionate care, without sacrificing the health and safety of our teams, colleagues, and families, by carefully evaluating any emerging research and modifying our treatment approaches accordingly," said lead author Pelin Cinar, MD, MS, UCSF Helen Diller Family Comprehensive Cancer Center. "People with cancer and their loved ones already go through so much, and now they face new fears around catching COVID-19 or delaying necessary treatment. By sharing these recommendations, we want to reassure the oncology community that there are some aspects of care that we can and will control in order to improve outcomes for people with cancer."

The JNCCN article contains the most current information at the time of publication, but notes that recommendations regarding public safety and practice may change rapidly; individuals can also keep up with the most up-to-date information via the CDC website.

The NCCN Best Practices Committee recommendations can be summarized as follows:

Patient Safety

• Prescreen and screen for COVID-19 symptoms and exposure history via telephone calls or digital platforms
• Develop screening clinics to allow for patients with symptoms to be evaluated and tested in a dedicated unit with dedicated staff
• Convert in-person visits to telemedicine visits when possible
• Limited or no visitor policy
• Limit surgeries and procedures to only essential, urgent, or emergent cases
• Consideration of alternative dosing schedule to allow for fewer in-person visits to the cancer center and/or the infusion center
• Switch from infusional therapy to oral oncolytics if equivalent formulation is available
• Transition outpatient care to care-at-home whenever possible (e.g. pump disconnection, administration of growth factors, hormone therapy)
• Increase interval between scans or use biochemical markers in lieu of scans
• Provide resources for wellness and stress management for patients

Healthcare Worker Safety

• Assure availability and use of appropriate personal protective equipment (PPE) per guidelines
• Create a centralized resource or website to communicate recommendations to the healthcare workers around PPE and workflows
• Implement daily screening tools and/or temperature checks
• Telecommute when possible, with limited onsite staff participating in rotations on a daily basis
• Establish clear stay-at-home and return-to-work guidelines
• Provide resources for wellness and stress management for healthcare workers
• The full article can be found at: https://jnccn.org/page/May Special Feature on COVID-19 /new-special-feature-on-covid19.

In addition to Dr. Cinar, the article includes authors from Abramson Cancer Center at the University of Pennsylvania, Duke Cancer Institute, Fred & Pamela Buffett Cancer Center, Mayo Clinic Cancer Center, Moffitt Cancer Center, Ohio State Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Seattle Cancer Care Alliance (including Fred Hutchinson Research Center and University of Washington), University of Colorado Cancer Center, and Yale Cancer Center/Smilow Cancer Hospital.

Meanwhile, NCCN continues to add to, and update, the growing list of free resources available at NCCN.org/covid-19. Recently-published items include:

General

• Asymptomatic Testing Strategy (UAB Medicine)
• Cancer Patients Factsheet (Huntsman Cancer Institute)
• Communicating Changes in Delivery of Care (University of Michigan Rogel Cancer Center)
• N95 Respirator Decontamination and Re-Use Process (University of Nebraska Medical Center)
• Patient Scheduling Recommendations (Huntsman Cancer Institute)
• Providing Oncology Treatments in the Outpatient Setting
• PPE Conservation Plan (University of Colorado Cancer Center)
• Self Screen Signs All Translations (UCSF)
• Universal Masking Guidelines (Huntsman Cancer Institute)
• Utah Crisis of Standards 2010 Influenza Pandemic Algorithm
• Visitor Policy Letter (Huntsman Cancer Institute)
• Treatment of Cancer by Site

• Breast Cancer
• Colorectal Cancer
• Melanoma
• Non-Melanoma Skin Cancer
• Prostate Cancer
• T-Cell and Primary Cutaneous Lymphomas

Screening and Early Detection

• Prostate Cancer

Supportive Care

• Hematopoietic Growth Factors
• Self-Care and Stress Management (Providers)
• Self-Care and Stress Management (Patients/Caregivers)

NCCN remains committed to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives under any circumstances. The organization has continued posting new updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®)--which contain optimal recommendations for normal resource levels in the United States--while also sharing new shorter term guidance for adjusting cancer care during the COVID-19 pandemic. NCCN's Global Program also provides guidelines to account for differing regional resource levels and non-English languages, while the NCCN Foundation® provides funding for versions in non-medical language for patients and caregivers. The NCCN Guidelines® are always available free-of-charge for non-commercial use at NCCN.org (free registration required) or via the Virtual Library of NCCN Guidelines® App.