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ESMO Patient Guides COVID19 1000x250

Outpatient visits

High priority

Your outpatient appointment may be a high priority if:

  • You are due to have your first appointment for advanced renal cell carcinoma
  • You are experiencing troublesome side effects from your treatment
  • You have tumours that are causing symptoms such as haematuria or pain
  • You need an appointment to investigate symptoms of a suspected cancer-related emergency, such as brain metastases or spinal cord compression

Medium priority

Your outpatient appointment may be a medium priority if:

  • You have low-risk renal cell carcinoma and are due to undergo evaluation for starting systemic treatment
  • You are receiving targeted therapy with a vascular endothelial growth factor (VEGF) inhibitor and your doctor is satisfied that you are responding to and tolerating the treatment. In some cases, your doctor may consider prescribing two cycles of treatment at each appointment
  • You have undergone surgery for renal cell carcinoma within the past 6 months, or you are at high risk for relapse
  • The purpose of your appointment is to undergo assessment following surgery for metastatic disease

Low priority

Your outpatient appointment may be a low priority if:

  • You have been receiving targeted therapy with a VEGF inhibitor for more than a year and you are tolerating the treatment very well. In these cases, appointments may be conducted via telephone
  • You underwent surgery for renal cell carcinoma more than 6 months ago, or you are at low/medium risk for relapse
  • The purpose of your appointment is a routine follow-up visit for metastatic disease that has responded to treatment

Imaging

High priority

Your appointment may be a high priority if:

  • You need imaging to investigate urgent symptoms, such as bleeding, bone fracture or neurological symptoms
  • You need imaging to evaluate metastatic disease before starting treatment or undergoing surgery
  • You need imaging to investigate possible immune-related side effects of treatment, such as pneumonitis, encephalitis or gastrointestinal system symptoms

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to have imaging that may lead to a change in your treatment plan

Low priority

Your appointment may be a low priority if:

  • You are scheduled to have imaging to re-stage your cancer, but your condition is currently considered to be stable
  • You are scheduled to have imaging as part of a long-term follow up plan after surgery or in advanced disease

Surgery

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo nephrectomy for renal cell carcinoma that has spread to nearby major veins or surrounding tissues 

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to undergo partial or radical nephrectomy for a tumour that is confined to the kidney and is 7 cm or smaller in diameter. In these cases, your surgery may be delayed, or your doctor may consider using an alternative approach, such as ablation
  • You are scheduled to undergo partial or radical nephrectomy for a tumour that is confined to the kidney and is larger than 7 cm in diameter. In these cases, your surgery may be delayed. Your doctor will discuss the potential benefit of surgery versus the risk of COVID‑19 infection and will advise on the best approach for you 

Low priority

Your appointment may be a low priority if:

  • You are due to undergo a cytoreductive nephrectomy. In these cases, your surgery may be postponed
  • You are due to undergo surgery for metastatic disease. In general, surgery for metastatic disease will be avoided during the COVID-19 pandemic

Radiotherapy

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo stereotactic radiotherapy for a brain metastasis that is causing symptoms

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to undergo radiofrequency ablation

Medical management of advanced renal cell carcinoma

High priority

Your appointment may be a high priority if:

  • You are scheduled to receive first-line treatment for intermediate- or high-risk metastatic disease. In these cases, immunotherapy combinations or immunotherapy in combination with a VEGF inhibitor are the standard treatments. However, best supportive care may be discussed as an option for patients with high-risk disease and poor general health, if the benefits of treatment are likely to be limited
  • You are scheduled to receive second-line treatment for renal cell carcinoma that is progressing and is causing symptoms. In these cases, your doctor may decide to use oral VEGF inhibitors rather than injected immunotherapy to reduce the number of hospital visits and minimise the risk of infection with COVID-19

Medium priority

Your appointment may be a medium priority if:

  • Your cancer is progressing and your systemic treatment needs to be changed, but you are not currently experiencing any symptoms
  • You are scheduled to receive first-line treatment for low-risk metastatic disease. In these cases, systemic treatment will be delayed whenever possible, and oral VEGF inhibitors may be chosen rather than injected immunotherapy to reduce the number of hospital visits and minimise the risk of infection with COVID-19
  • You have been receiving systemic therapy for more than 2 years. In these cases, a break or delay in your treatment may be possible during the COVID-19 pandemic

Low priority

Your appointment may be a low priority if:

  • You are scheduled to receive third-line or later-line therapy for refractory disease and there is a low chance of treatment response

Additional considerations for the medical management of advanced renal cell carcinoma

  • If immunotherapy is administered, a regimen with a long interval between treatments will be considered whenever possible
  • The risk of lung-related side effects with immunotherapy should be considered when planning treatment, as these may affect outcomes if a patient becomes ill with COVID-19

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