Care of aggressive cancers during COVID-19 pandemic
The novel coronavirus (COVID-19) pandemic has struck the entire healthcare system including the care for patients with cancer. There are aggressive cancers including pancreatic cancer that require continuation of oncological care during the pandemic. But pursuing care may expose both healthcare professionals and vulnerable patients to COVID-19.
A new research published in Annals of Surgery from the University of Colorado Department of Surgery at the Anschutz Medical Campus provides guidance on clinical decision-making in regards to treating pancreatic cancer patients during the COVID-19 pandemic.
"The inability to receive medical or surgical care during a pandemic can be an equal or sometimes worse threat for pancreatic cancer patients," said Marco Del Chiaro, MD, PhD, FACS, Chief of Surgical Oncology and Director of the National Pancreas Foundation Center of Excellence at the Anschutz Medical Campus..
Del Chiaro continues, "The goal of our research is to optimize safety for patients and clinicians, as well as safeguard healthcare capacity. Given the aggressive biology of pancreatic cancer, it's critical that there is a strategy to support healthcare professionals in decision-making during this time."
The researchers sent an online survey to members of seven international pancreatic associations and study groups to investigate the impact of the current pandemic on pancreatic surgery. In April of 2020, 337 respondents from 267 centers and 37 countries spanning five continents completed the survey.
Nearly all of the respondents were surgeons who worked in an academic center. The biggest takeaway from the surgeons was that pancreatic surgery should be prioritized for patients with non-COVID-19 pancreatic diseases during the pandemic.
Other key findings:
The majority of centers (62 percent) performed less pancreatic surgery because of the COVID-19 pandemic.
Prior to pancreatic surgery, most centers screened their patients for symptoms of COVID-19. However, no consensus was reached to recommend COVID-19 preoperative testing/screening.
Based on consensus, patients who undergo pancreatic surgery should be informed about the following additional risks: COVID-19 infection during hospitalization, possible non-optimal postoperative management (i.e. shortage of ICU beds), increased risk of COVID-19 related mortality due to surgery or the cancer condition.
Furthermore, this survey convincingly recommends that operating room (OR) personnel have to wear adequate protective features during surgery, considering their increased risk for COVID-19 infection during surgical procedures.
Additionally, prioritization of COVID-19 patients with a better prognosis over pancreatic cancer patients, adhering to the process of triage for hospital resources and ICU beds, did not reach 60 percent agreement. On the other hand, the difficulty to prioritize between patients with severe COVID-19 or resectable pancreatic cancer is conceivable.
"The era of the COVID-19 pandemic underlines the need for an international survey with clear statements, aiming to guide clinicians in their clinical decision-making," said Atsushi Oba, MD, PhD, research associate for surgical oncology, University of Colorado Department of Surgery, and co-author of the paper. "This survey revealed several consensus statements as well as statements that need further discussion."
The survey consisted of 36 questions on baseline characteristics, the local impact of the COVID-19 pandemic on pancreatic surgery (i.e. number of pancreatic resections, triage, and screening), and 21 statements about the role of pancreatic surgery in the current era of the COVID-19 pandemic.
"This project is an example of how to be strategic and appropriately use resources during a pandemic to keep our patients as safe as possible," said, Richard Schulick, MD, MBA, FACS, Chair of the Department of Surgery and Director of the University of Colorado Cancer Center on the campus. "I could not be prouder of the members of the Department of Surgery on the Anschutz Medical Campus, who continue to provide appropriate world-class cancer care to our patients during a pandemic -- sometimes even risking their own health."
Atsushi Oba, Chiara Croce, Patrick Hosokawa, Cheryl Meguid, Robert J. Torphy, Mohammed H. Al-Musawi, Steven Ahrendt, Ana Gleisner, Richard D. Schulick, Marco Del Chiaro. Prognosis Based Definition of Resectability in Pancreatic Cancer. Annals of Surgery, 2020;