On 25 March 2020, a group of medical and radiation oncologists from the academic and private settings in France, reported in The Lancet Oncology that based on request of the French Ministry of Health, the French High Council for Public health tasked them to prepare guidelines to protect patients with cancer against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while ensuring the continuum of cancer treatment.
The group finalised the guidelines on 10 March 2020. Dr Benoit You, Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon, Université Claude Bernard Lyon in Lyon, France, who coordinated the group activities, has been interviewed by the French High Council for Public health on 11 March 2020. The guidelines were adopted and published on 14 March 2020.
Patients with cancer should be closely monitored due to their susceptibility to the infection. The guidelines are applicable to adult patients with solid tumours and are complementary to the standard rules adopted by the French health authorities in terms of protection of the general population.
The authors wrote that the patients with cancer are at a higher risk of SARS-CoV-2 infection and to develop severe respiratory complications, requiring admission to intensive care unit, than the general population. The risk is associated with a history of cancer treatment preceding infection. Patients with cancer also tend to develop severe events in a shorter time.
The guidelines emphasise the implementation of prevention measures. Medical oncology and radiotherapy departments should ideally remain COVID-19-free facilities. Patients with cancer and COVID-19 disease should be isolated from other patients with cancer and if hospitalisation is required, they should be referred to specialised COVID-19 departments. In patients with cancer and COVID-19 disease, systemic anticancer treatments should be discontinued until complete resolution of symptoms.
In patients with cancer without COVID-19, measures that enable home management should be encouraged, including telemedicine and phone calls replacing physical visits, replacement of intravenous drugs with oral drugs, home administration of intravenous and subcutaneous anticancer agents –where possible, and adjustment of treatment schedules to reduce the frequency of hospital admissions. Some patients with slow growing metastases could be given temporary treatment breaks. Disease assessment extension is a further measure to avoid hospital admissions.
For patients who should be still admitted for systemic treatment or radiotherapy, a phone call a day prior to admission should be organised. To protect the patients, open-space chemotherapy outpatient facilities should implement separation measures.
If facilities for care are limited, prioritisation in the management of patients with cancer should integrate factors such as curative or non-curative intent of treatment, age, life expectancy, disease setting (early, first-line treatment, or late in case of multiple lines of treatment), and presence of symptoms. Priority orders for provision of anticancer treatment were proposed but they remain at the discretion of the oncology team.
Patients with cancer who need supportive care could be referred to non-specialised cancer departments, or home care.
You B, Ravaud A, Canivet A, et al. The official French guidelines to protect patients with cancer against SARS-CoV-2 infection. The Lancet Oncology; Published online 25 March 2020. DOI: https://doi.org/10.1016/S1470-2045(20)30204-7