Department of Legal and Forensic Medicine, University of Genoa, Genoa, Italy.
Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy.
Front Public Health. 2020 Dec 18;8:602988. doi: 10.3389/fpubh.2020.602988. eCollection 2020.
The COVID-19 outbreak rapidly became a public health emergency affecting particularly the frail category as cancer patients. This led oncologists to radical changes in patient management, facing the unprecedent issue whether treatments in oncology could be postponed without compromising their efficacy. To discuss legal implications in oncology practice during the COVID-19 pandemic. Treatment delay is not always feasible in oncology where the timing often plays a key role and may impact significantly in prognosis. During the COVID-19 pandemic, the oncologists were found between the anvil and the hammer, on the one hand the need to treat cancer patients aiming to improve clinical benefits, and on the other hand the goal to reduce the risk of COVID-19 infection avoiding or delaying immunosuppressive treatments and hospital exposure. Therefore, two rising scenarios with possible implications in both criminal and civil law are emerging. Firstly, oncologists may be "accused" of having delayed or omitted the diagnosis and/or treatments with consequent worsening of patients' outcome. Secondly, oncologists can be blamed for having exposed patients to hospital environment considered at risk for COVID-19 transmission. During the COVID-19 pandemic, clinical decision making should be well-balanced through a careful examination between clinical performance status, age, comorbidities, aim of the treatment, and the potential risk of COVID-19 infection in order to avoid the risk of suboptimal cancer care with potential legal repercussion. Moreover, all cases should be discussed in the oncology team or in the tumor board in order to share the best strategy to adopt case by case.
COVID-19 疫情迅速成为影响癌症患者等脆弱人群的公共卫生紧急事件。这导致肿瘤学家对患者管理进行了彻底改变，面临着前所未有的问题，即肿瘤学治疗是否可以推迟而不影响其疗效。 讨论 COVID-19 大流行期间肿瘤学实践中的法律问题。 在肿瘤学中，治疗延迟并不总是可行的，因为时机通常起着关键作用，并可能对预后产生重大影响。在 COVID-19 大流行期间，肿瘤学家发现自己处于两难境地，一方面需要治疗癌症患者，以提高临床效益，另一方面需要降低 COVID-19 感染风险，避免或延迟免疫抑制治疗和医院暴露。因此，出现了两种可能对刑法和民法都有影响的新兴情况。首先，肿瘤学家可能会因诊断和/或治疗延误而被“指控”，从而导致患者病情恶化。其次，肿瘤学家可能会因将患者暴露于被认为有 COVID-19 传播风险的医院环境而受到指责。 在 COVID-19 大流行期间，应通过仔细检查患者的临床表现状态、年龄、合并症、治疗目的和 COVID-19 感染的潜在风险，在临床性能、年龄、合并症、治疗目的和 COVID-19 感染的潜在风险之间进行仔细权衡，以避免因癌症治疗不佳而产生潜在的法律后果。此外，所有病例都应在肿瘤学团队或肿瘤委员会中进行讨论，以分享逐个病例的最佳策略。
