Medical Oncology Department, Alzahra Hospital Dubai, Dubai, United Arab Emirates.
Department of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
Oncologist. 2020 Jun;25(6):e936-e945. doi: 10.1634/theoncologist.2020-0213. Epub 2020 Apr 27.
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.
2019 年冠状病毒病(COVID-19)的爆发自被确定为国际关注的突发公共卫生事件以来,已在全球迅速蔓延,并已被世界卫生组织(WHO)宣布为大流行。2019 年 12 月,在中国武汉发现了一种新型非典型肺炎,称为 COVID-19。新发现的人畜共患冠状病毒,严重急性呼吸系统综合症冠状病毒-2(SARS-CoV-2),其特征是迅速在人与人之间传播。许多癌症患者经常因治疗和疾病监测而前往医院。由于潜在的恶性肿瘤或抗癌治疗,他们可能会免疫功能低下,并且更有可能发生感染。有几个因素会增加感染的风险,而癌症患者通常具有多种风险因素。癌症患者感染 SARS-CoV-2 的风险估计比普通人群高两倍。随着世界卫生组织宣布新型冠状病毒爆发为大流行,迫切需要解决大流行对癌症患者的影响。这包括资源分配、临床护理以及大流行期间的同意程序的改变。目前,由于数据有限,尚无国际指南来解决任何传染病大流行期间癌症患者的管理问题。在这篇综述中,将讨论在 COVID-19 感染大流行期间管理癌症患者所涉及的潜在挑战,并提出一些实用方法的建议。对实践的影响:在 COVID-19 流行期间治疗癌症患者的主要管理策略包括关于手部卫生、感染控制措施、高危暴露和 COVID-19 症状的明确沟通和教育。必须对癌症人群中的积极干预的风险和获益进行个体化考虑。对于进展风险低的癌症患者,应考虑对择期手术或辅助化疗进行延期。尽量减少门诊就诊有助于减轻暴露和可能的进一步传播。可以使用远程医疗来支持患者以尽量减少就诊次数和暴露风险。需要进行更多的研究以更好地了解 SARS-CoV-2 的病毒学和流行病学。
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