Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Department of Gynecologic Oncology, European Institute of Oncology, Milano, Italy.
ESMO Open. 2020 Jul;5(Suppl 3). doi: 10.1136/esmoopen-2020-000827.
The rapid spread of severe acute respiratory syndrome coronavirus 2 infection and its related disease (COVID-19) has required an immediate and coordinate healthcare response to face the worldwide emergency and define strategies to maintain the continuum of care for the non-COVID-19 diseases while protecting patients and healthcare providers. The dimension of the COVID-19 pandemic poses an unprecedented risk especially for the more vulnerable populations. To manage patients with cancer adequately, maintaining the highest quality of care, a definition of value-based priorities is necessary to define which interventions can be safely postponed without affecting patients' outcome. The European Society for Medical Oncology (ESMO) has endorsed a tiered approach across three different levels of priority (high, medium, low) incorporating information on the value-based prioritisation and clinical cogency of the interventions that can be applied for different disease sites. Patients with gynaecological cancer are at particular risk of COVID-19 complications because of their age and prevalence of comorbidities. The definition of priority level should be based on tumour stage and histology, cancer-related symptoms or complications, aim (curative vs palliative) and magnitude of benefit of the oncological intervention, patients' general condition and preferences. The decision-making process always needs to consider the disease-specific national and international guidelines and the local healthcare system and social resources, and a changing situation in relation to COVID-19 infection. These recommendations aim to provide guidance for the definition of deferrable and undeferrable interventions during the COVID-19 pandemic for ovarian, endometrial and cervical cancers within the context of the ESMO Clinical Practice Guidelines.
严重急性呼吸综合征冠状病毒 2 感染及其相关疾病(COVID-19)的迅速传播,要求立即采取协调一致的医疗应对措施,以应对全球紧急情况,并制定策略,在保护患者和医护人员的同时,维持非 COVID-19 疾病的护理连续性。COVID-19 大流行的规模带来了前所未有的风险,尤其是对那些更为脆弱的人群。为了充分管理癌症患者,保持最高质量的护理,需要定义基于价值的优先事项,以确定哪些干预措施可以安全地推迟而不影响患者的结局。欧洲肿瘤内科学会(ESMO)已经在三个不同的优先级别(高、中、低)上采用了分层方法,纳入了基于价值的优先排序和干预措施的临床相关性信息,这些干预措施可应用于不同的疾病部位。妇科癌症患者由于年龄和合并症的普遍存在,面临着 COVID-19 并发症的特殊风险。优先级别定义应基于肿瘤分期和组织学、癌症相关症状或并发症、治疗目的(治愈性 vs 姑息性)和肿瘤干预的获益程度、患者的一般状况和偏好。决策过程始终需要考虑特定疾病的国家和国际指南以及当地的医疗保健系统和社会资源,以及与 COVID-19 感染相关的情况变化。这些建议旨在为卵巢癌、子宫内膜癌和宫颈癌在 ESMO 临床实践指南背景下,在 COVID-19 大流行期间确定可推迟和不可推迟的干预措施提供指导。
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