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ESMO Patient Guides COVID19 1000x250

Outpatient visits

High priority

Your outpatient appointment may be a high priority if:

  • You have recently been diagnosed with intermediate- or high-grade sarcoma, or your doctor thinks you might have sarcoma
  • You have recently undergone surgery for sarcoma and are experiencing complications, such as a haematoma or infection
  • A follow-up appointment has shown that your sarcoma has relapsed

High/medium priority

Your outpatient appointment may be a high/medium priority if:

  • You are scheduled to begin systemic treatment for advanced sarcoma
  • The purpose of your appointment is for treatment administration or for the management of side effects. In these cases, appointments will be conducted via telephone whenever possible. If you are receiving treatment with oral chemotherapy or targeted therapy, your doctor will stay in very close contact to ensure that any side effects are managed effectively

Medium priority

Your outpatient appointment may be a medium priority if:

  • You have recently been diagnosed with low-grade sarcoma
  • You are due to undergo surgery for metastatic sarcoma
  • You have recently undergone surgery for sarcoma and are not experiencing any complications
  • The purpose of your appointment is a follow-up visit because you are at high risk of relapse, or there is reason to think you may have relapsed

Low priority

Your outpatient appointment may be a low priority if:

  • You have recently been diagnosed with a mesenchymal tumour of intermediate malignancy, but you are not experiencing any symptoms
  • You have a very low-risk gastrointestinal stromal tumour, but you are not experiencing any symptoms
  • The purpose of your appointment is for psychological support. In these cases, appointments will be conducted via telephone
  • The purpose of your appointment is to confirm that recent follow-up tests did not show any new findings. In these cases, appointments will be conducted via telephone

Imaging

High/medium priority

Your appointment may be a high/medium priority if:

  • You need imaging because your doctor thinks you might have sarcoma
  • You need imaging or a biopsy to confirm a sarcoma diagnosis
  • You need imaging because your doctor thinks your sarcoma might have relapsed
  • You need imaging or a biopsy to rule out metastatic relapse
  • You need an echocardiogram to check if you can safely receive treatment with anthracyclines
  • You need imaging to assess if your sarcoma is responding to treatment, or to re-stage your cancer. In these cases, your imaging may be delayed, or the interval between imaging tests may be increased

Low priority

Your appointment may be a low priority if:

  • You are scheduled to have imaging to investigate a fatty tumour in your arm/leg or torso, a small superficial soft tissue tumour, small submucosal nodules in the stomach or a bony mass that is not thought to be cancerous
  • You have previously undergone successful surgery to remove a sarcoma and you are scheduled to have follow-up imaging tests (for example, re-staging tests or an echocardiogram). In these cases, your imaging may be delayed, or the interval between imaging tests may be increased. Follow-up appointments will be conducted via telephone when possible 

Surgery

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo surgery for primary localised high-risk soft tissue sarcoma. In these cases, a multidisciplinary team will discuss your specific clinical situation and may consider administering neoadjuvant radiotherapy
  • You are scheduled to undergo surgery for recurrent high-risk sarcoma
  • You are scheduled to undergo surgery for a high-risk gastrointestinal stromal tumour that is not suitable for neoadjuvant treatment with imatinib
  • You are scheduled to undergo surgery for a gastrointestinal stromal tumour of any size that is causing symptoms, and which is not suitable for neoadjuvant treatment with imatinib
  • You are scheduled to undergo surgery for Ewing sarcoma, osteosarcoma or rhabdomyosarcoma
  • You need surgery to resolve complications from previous surgery

High/medium priority

Your appointment may be a high/medium priority if:

  • You have differing results from two separate biopsies and your doctor thinks it is likely that you have sarcoma

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to undergo surgery for primary localised intermediate-risk soft tissue sarcoma. In these cases, a multidisciplinary team will discuss your specific clinical situation and may consider administering neoadjuvant radiotherapy
  • You are scheduled to undergo surgery for recurrent intermediate-risk sarcoma
  • You are scheduled to undergo surgery for an intermediate-risk gastrointestinal stromal tumour that is not suitable for neoadjuvant treatment with imatinib
  • You are scheduled to undergo surgery for any other type of bony malignancy
  • You have limited metastatic disease and are scheduled to undergo surgery to remove an isolated metastasis. In these cases, your doctor might consider a period of active surveillance, whereby you are closely monitored and surgery is only initiated when necessary

Low priority

Your appointment may be a low priority if:

  • You have differing results from two separate biopsies and your doctor thinks it is unlikely that you have sarcoma
  • You are scheduled to undergo surgery for primary localised low-risk sarcoma or mesenchymal tumour of intermediate malignancy
  • You are scheduled to undergo surgery for recurrent low-grade sarcoma or mesenchymal tumour of intermediate malignancy
  • You are scheduled to undergo surgery for a low- or very low-risk gastrointestinal stromal tumour and you are not experiencing any symptoms

Radiotherapy

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo neoadjuvant or adjuvant radiotherapy for high- or intermediate-risk soft tissue sarcoma. In these cases, your doctor may consider using a hypo-fractionated regimen to reduce the number of hospital visits
  • You are already receiving radiotherapy
  • You need urgent palliative radiotherapy; for example, to treat spinal cord compression or brain metastases that are causing symptoms

High/medium priority

Your appointment may be a high/medium priority if:

  • You need palliative radiotherapy to treat a bleeding/painful mass that cannot be removed surgically and cannot be treated with drugs

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to undergo neoadjuvant or adjuvant radiotherapy for low-risk soft tissue sarcoma. In these cases, your doctor may consider using a hypo-fractionated regimen to reduce the number of hospital visits
  • You are scheduled to undergo radiotherapy to treat an isolated metastasis. In these cases, your doctor might consider a period of active surveillance, whereby you are closely monitored and radiotherapy is only initiated when necessary

Medical management of primary sarcoma

High priority

Your appointment may be a high priority if:

  • You are scheduled to receive neoadjuvant or adjuvant chemotherapy for osteosarcoma, Ewing sarcoma or rhabdomyosarcoma
  • You are scheduled to receive neoadjuvant or adjuvant imatinib for a primary localised high-risk gastrointestinal stromal tumour
  • You have locally-advanced soft tissue sarcoma and are scheduled to receive neoadjuvant or cytoreductive anthracycline-based chemotherapy with the intention of shrinking the tumour to enable surgical resection
  • You are receiving treatment as part of a clinical trial. In these cases, your doctor will ensure that the benefits of participating in the clinical trial outweigh the risks of infection with COVID-19. The planned conduct of clinical trials may be adjusted during the COVID-19 pandemic

High/medium priority

Your appointment may be a high/medium priority if:

  • You are scheduled to receive anthracycline-based chemotherapy for high-risk localised soft tissue sarcoma. In these cases, the additional risk of infection with COVID-19 will be considered when making decisions about your treatment 

Medical management of metastatic sarcoma

High priority

Your appointment may be a high priority if:

  • You are scheduled to receive imatinib, sunitinib or regorafenib as first-, second- or third-line treatment for a gastrointestinal stromal tumour
  • You are receiving treatment as part of a clinical trial. In these cases, your doctor will ensure that the benefits of participating in the clinical trial outweigh the risks of infection with COVID-19. The planned conduct of clinical trials may be adjusted during the COVID-19 pandemic

High/medium priority

Your appointment may be a high/medium priority if:

  • You are scheduled to receive first-line or later-line treatment with chemotherapy or targeted therapy for advanced sarcoma, and the treatment is expected to provide clinical benefit. In these cases, the additional risk of infection with COVID-19 will be considered when making decisions about your treatment 

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to begin receiving treatment as part of a clinical trial. In these cases, your doctor will ensure that the benefits of participating in the clinical trial outweigh the risks of infection with COVID-19. The planned conduct of clinical trials may be adjusted during the COVID-19 pandemic

Low priority

Your appointment may be a low priority if:

  • You are scheduled to undergo systemic treatment for a tumour that is causing few or no symptoms
  • You are due to have follow-up tests, but you are not experiencing any symptoms. In these cases, tests such as re-staging assessment or echocardiograms may be delayed, or the interval between tests may be increased 

Additional considerations for the management of sarcoma

  • Chemotherapy schedules may be adjusted to reduce the number of hospital visits. For example, treatment may be administered every 3 weeks rather than weekly. Prophylactic growth factors may be given to help boost the immune system and reduce the risk of neutropenia. Treatment with dexamethasone will be limited to minimise the use of immunosuppressive drugs
  • Oral systemic therapies (such as pazopanib) should be used whenever possible and will be prescribed for multiple courses to minimise the need for face-to-face follow up visits
  • For patients with metastatic sarcoma who have already received several lines of therapy, options such as drug holidays, delayed treatment, reductions in maintenance therapy regimens and best supportive care may be considered. This should follow discussion within a multidisciplinary team and should take the patient’s wishes into account
  • For patients with bone metastases, treatment with bone modifying drugs will be administered with minimal time spent in hospital
  • Follow-up appointments to monitor treatment side effects and to provide support for symptom control will be conducted via telephone whenever possible
  • Whenever possible, imaging appointments and blood tests will be conducted at local clinics rather than in hospital

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