The tiered approach of ESMO in delivering a guidance for cancer patients during the COVID-19 pandemic is designed across three levels of priorities, namely: tier 1 (high priority intervention), 2 (medium priority) and 3 (low priority) – defined according to the criteria of the Cancer Care Ontario, Huntsman Cancer Institute and ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS), incorporating the information on the value-based prioritisation and clinical cogency of the interventions
- High priority: Patient's condition is immediately life threatening, clinically unstable, and/or the magnitude of benefit qualifies the intervention as high priority (e.g. significant overall survival [OS] gain and/or substantial improvement in quality of life [QoL]);
- Medium priority: Patient's situation is non-critical but delay beyond 6 weeks could potentially impact overall outcome and/or the magnitude of benefit qualifies for intermediate priority;
- Low priority: Patient's condition is stable enough that services can be delayed for the duration of the COVID-19 pandemic and/or the intervention is non-priority based on the magnitude of benefit (e.g. no survival gain with no change nor reduced QoL).
Priorities for prostate cancer patients
Outpatient visit priorities
Priorities for imaging
Priorities for surgical oncology
See guidelines of the European Association of Urology (EAU) on “Considerations in the triage of urologic surgeries during the Covid-19 pandemic”
Priorities for radiation oncology
Priorities for medical oncology – advanced disease (systemic treatment: chemotherapy and AR-targeted agents)
- ADT has a low frequency of application and is therefore much easier to apply than chemotherapy with less relevant potential side effects concerning the COVID-19 disease, so there is rarely a situation where it cannot be given
- Prefer AR-targeted agents over chemotherapy in metastatic HSPC and metastatic CRPC whenever possible, consider home delivery if feasible
- Minimising the number of chemotherapy cycles or prolonging cycle length may be justified
- Reduce steroids as concomitant treatment if possible
List of abbreviations: ADT, androgen deprivation therapy; AR, androgen receptor; COVID-19, severe acute respiratory syndrome coronavirus 2-related disease; CRPC, castration-resistant prostate cancer; CT, computed tomography; G-CSF, granulocyte colony-stimulating factor; HSPC, hormone-sensitive prostate cancer; MRI, magnetic resonance imaging; PSA, prostate-specific antigen; RT, radiotherapy.