Friday Frontline: Cancer Updates, Research and Education on March 27, 2020

Patients with cancer are grappling with the new reality of the COVID-19 pandemic as some are being forced to miss chemotherapy appointments.

Janet Glass, a patient with late-stage pancreatic cancer in New Jersey, received a phone call informing her that her chemotherapy appointment would have to be cancelled. Janet is not the only patient to receive this type of call. Patients with cancer across the United States are having their treatments postponed up to a month or altered due to coronavirus concerns.

“Once someone is on treatment, it’s almost always a bad decision to stop in the middle,” said Dr. Wui-Jin Koh, the chief medical officer for The National Comprehensive Cancer Network, in an interview. New guidelines are being issued for various institutions and patients are being assessed on a case-by-case basis.

The American Cancer Society has announced that it will close all of its Hope Lodge locations across the U.S. as more states issue shelter-in-place orders.

“This was the absolute last thing we wanted to do, but when we start getting shelter-in-place orders, we just have to pay attention to that for all concerned,” Dr. Len Lichtenfeld, the deputy director of the American Cancer Society, said in an interview. “We had no choice.”

The Hope Lodges provide patients with cancer receiving treatment at facilities away from their homes a place to stay during treatment. But, with COVID-19 becoming a global pandemic, it became impossible to ensure the safety of everyone.

The National Health Service in the United Kingdom has issued a new protocol amidst the COVID-19 outbreak.

“We need to consider the small possibility that the facility for cancer services may be compromised due to a combination of factors including staff sickness and supply chain shortages among others,” the authors of the protocol wrote.

The new protocol prioritizes and rations treatment to patients with cancer who have the highest chances of survival in the event the center becomes compromised due to the outbreak.

This comes in the wake of the United Kingdom’s nationwide lockdown as it faces its own crisis of the health care system being overwhelmed like Italy and the U.S. According to the protocol, patients in hospitals under pressure from the virus will be grouped into six categories ranging from those that can receive curative therapy with a greater than 50% chance of success to non-curative therapy with less than 50% chance of success. Patients in the lower categories of treatment have been informed their treatments will be delayed, in some cases up to three months. In other cases, doctors are being urged to provide patients with treatment that will last for a longer time period requiring fewer clinic visits.

As cases of COVID-19 increase in the U.S., clinical trials for various drugs are being suspended or altered, including those for new cancer therapies.

“It’s hard to believe that just a month ago, I’d never seen cancer clinical trials better,” Dr. Roy Herbst said in an interview. “Now the whole process has really ground to a halt, and I feel bad because there are patients who might have benefited from those trials.”

However, he also emphasized that these are necessary measures to help keep patients with cancer safe from being infected as hospitals begin to rapidly see more cases of patients with COVID-19. Furthermore, many employees in the cancer centers like the Yale University Cancer Center are being asked to stay home and work from home, in hopes to minimize the spread of the virus where possible.

The Food and Drug Administration has issued renewed guidelines on how to handle the changes and continue trials where possible. But researchers are worried not only for the safety of patients and themselves but the data as well, without access to their typical resources.