NYU Langone Health, Perlmutter Cancer Center, New York University School of Medicine, New York, NY, United States.
Duke Cancer Institute, Duke University Health System, Durham, NC, United States.
Gynecol Oncol. 2020 Jul;158(1):16-24. doi: 10.1016/j.ygyno.2020.04.694. Epub 2020 Apr 23.
OBJECTIVES: The COVID-19 pandemic has consumed considerable resources and has impacted the delivery of cancer care. Patients with cancer may have factors which place them at high risk for COVID 19 morbidity or mortality. Highly immunosuppressive chemotherapy regimens and possible exposure to COVID-19 during treatment may put patients at additional risk. The Society of Gynecologic Oncology convened an expert panel to address recommendations for best practices during this crisis to minimize risk to patients from deviations in cancer care and from COVID-19 morbidity. METHODS: An expert panel convened to develop initial consensus guidelines regarding anti-neoplastic therapy during the COVID-19 pandemic with respect to gynecologic cancer care and clinical trials. RESULTS: COVID-19 poses special risks to patients who are older, have medical co-morbidities, and cancer. In addition, this pandemic will likely strain resources, making delivery of cancer care or conduct of clinical trials unpredictable. Recommendations are to limit visits and contact with health care facilities by using telemedicine when appropriate, and choosing regimens which require less frequent visits and which are less immunosuppressive. Deviations will occur in clinical trials as a result of limited resources, and it is important to understand regulatory obligations to trial sponsors as well as to the IRB to ensure that clinical trial and patient safety oversight are maintained. CONCLUSIONS: The ongoing crisis will strain resources needed to deliver cancer care. When alterations to the delivery of care are mandated, efforts should be taken to minimize risks and maximize safety while approximating standard practice.
目的:COVID-19 大流行消耗了大量资源,并影响了癌症治疗的开展。癌症患者可能存在使他们面临 COVID-19 发病率或死亡率高风险的因素。高度免疫抑制的化疗方案以及治疗期间可能接触到 COVID-19,可能会使患者面临额外的风险。妇科肿瘤学协会召集了一个专家小组,针对这一危机期间的最佳实践提出建议,以尽量减少癌症治疗和 COVID-19 发病率偏差对患者的风险。
方法:召集了一个专家小组,就 COVID-19 大流行期间妇科癌症治疗和临床试验中的抗肿瘤治疗制定初步共识指南。
结果:COVID-19 对年龄较大、有合并症和癌症的患者构成特殊风险。此外,这场大流行很可能会使资源紧张,使癌症治疗或临床试验的开展变得不可预测。建议通过适当使用远程医疗来限制与医疗机构的接触和访问,并选择需要较少频繁访问和较少免疫抑制的方案。由于资源有限,临床试验将出现偏差,了解试验赞助商以及 IRB 的监管义务对于确保临床试验和患者安全监督至关重要。
结论:持续的危机将使提供癌症治疗所需的资源紧张。当需要对护理的提供进行修改时,应努力将风险降到最低,同时最大限度地提高安全性,同时接近标准实践。
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