Oncology, Ospedale Cannizzaro, Catania, Italy.
Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
ESMO Open. 2020 Apr;5(2):e000765. doi: 10.1136/esmoopen-2020-000765.
New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to rise worldwide. A few reports have showed that mortality due to SARS-CoV-2 is higher in elderly patients and other active comorbidities including cancer. To date, no effective treatment has been identified and management for critically ill patients relies on management in intensive care units. Patients with lung cancer are at risk of pulmonary complications from COVID-19. Furthermore, the use of chemotherapy might have a negative impact in patient's outcome. Therefore, the risk/benefit ratio of systemic anticancer treatment (SACT) has to be considered. For each patient, several factors including age and comorbidities, as well as the number of hospital visits for treatment, can influence this risk. Each hospital around the world has issued some internal policy guidelines for oncologists, aiming to limit risks during this difficult time. We hereby propose a tool to support oncologists and physicians in treatment decision for patients with lung cancer. There are several variables to consider, including the extent of the epidemic, the local healthcare structure capacity, the risk of infection to the individual, the status of cancer, patients' comorbidities, age and details of the treatment. Given this heterogeneity, we have based our suggestions bearing in mind some general factors There is not easy, universal solution to oncological care during this crisis and, to complicate matters, the duration of this pandemic is hard to predict. It is important to weigh the impact of each of our decisions in these trying times rather than rely on routine automatisms.
新型冠状病毒(SARS-CoV-2)的新发病例继续在全球范围内上升。一些报告显示,SARS-CoV-2 导致的死亡率在老年患者和其他活跃的合并症(包括癌症)中更高。迄今为止,尚未发现有效的治疗方法,重症患者的治疗依赖于重症监护病房的管理。肺癌患者有患 COVID-19 肺部并发症的风险。此外,化疗的使用可能对患者的预后产生负面影响。因此,必须考虑全身性抗癌治疗(SACT)的风险/获益比。对于每个患者,包括年龄和合并症在内的几个因素,以及因治疗而住院的次数,都会影响这种风险。世界各地的每家医院都为肿瘤学家发布了一些内部政策指南,旨在限制这一困难时期的风险。我们在此提出一种工具,以支持肿瘤学家和医生为肺癌患者做出治疗决策。有几个变量需要考虑,包括疫情的严重程度、当地医疗保健结构的能力、个人感染的风险、癌症状况、患者的合并症、年龄和治疗细节。考虑到这种异质性,我们提出的建议考虑了一些一般因素。在这场危机期间,癌症护理没有简单、普遍的解决方案,而且更复杂的是,这场大流行的持续时间很难预测。在这些艰难的时期,权衡我们每项决策的影响很重要,而不是依赖常规的自动机制。