The European Society for Medical Oncology (ESMO) has published guidelines for managing patients with gastrointestinal cancers during the COVID-19 pandemic, helping clinicians identify patients who require immediate care and those for whom treatment can wait.
The guidelines are part of an ESMO-led initiative to address pandemic-related clinical issues. ESMO has released recommendations for solid tumors and hematologic malignancies that were drafted by leading experts representing almost 60 research centers.
According to Florian Lordick, MD, PhD, ESMO director of education and professor of oncology at the University of Leipzig Medical Center, Germany, the effort was a response to clinician requests from around the world.
“Many physicians … in their centers, in their countries, would appreciate some guidance [regarding] how to act and how to react in this crisis,” Dr. Lordick said in an interview.
“This situation is very heterogenous,” he noted. “Even within Europe, even within some countries, some [health care providers] have very limited resources. ... Others can almost do their job as usual, so it’s not easy to give recommendations today that are exactly valid for everyone.”
Prioritizing patients and interventions
To account for disparities across countries, the ESMO guidelines are categorized by patient tiers, including low, medium, and high priority, as determined by the Cancer Care Ontario, Huntsman Cancer Institute and Magnitude of Clinical Benefit Scale. The scale incorporates both patient factors and benefits of intervention.
High-priority patients are in life-threatening condition, and delaying care would jeopardize their survival and/or quality of life. Medium-priority patients are noncritical, but delaying intervention beyond 6 weeks could affect outcomes. Low-priority patients are clinically stable, and delaying intervention would not affect their quality of life and/or survival.
ESMO’s guidelines for gastrointestinal cancers include recommendations for colorectal cancer, hepatocellular carcinoma, gastroesophageal tumors, and pancreatic cancer. The recommendations encompass outpatient visits, imaging and radiological/endoscopic interventions, surgical procedures, medical oncology, and radiotherapy.
According to Dr. Lordick, many patients with pancreatic cancer or gastroesophageal tumors have clinical needs that cannot wait, and the guidelines reflect that.
“We are dealing here with two cancer types that are highly aggressive, that have high mortality if not treated adequately,” Dr. Lordick said. “So we have to say that whenever there is a suspicion for one of these cancers, we put the diagnosis and staging – including imaging of these cancers – into high priority. We think, with these cancers, people cannot wait. We know that it may be difficult in some systems, but if there is a suspicion [of a pancreatic tumor], then it’s not a situation where you could wait for 6 or 8 weeks.”
Radiological diagnostic workup of suspected hepatocellular carcinoma is also a high priority, according to the guidelines. However, diagnostic imaging and endoscopy are considered medium-priority interventions for clinically suspected colorectal cancer or for patients at high risk of colorectal cancer.
The lowest-priority patients are those in the survivorship group without symptoms, Dr. Lordick said, noting that these patients are eligible for delayed or remote consultation.
Professionalism, preparedness, and patient empowerment
More generally, Dr. Lordick urged oncologists to maintain a high level of professionalism and preparedness during the pandemic.
“I think a good center really tries to create areas that are COVID-free for their cancer patients,” he said. “They try to see as soon as possible if someone is at risk of having an infection, to test these patients early, to isolate them from the other patients.”
Dr. Lordick also emphasized the importance of patient empowerment.
“Really give [patients] all the information – what they can do to protect themselves from infection, including all the things that are usually recommended, like hygiene of the hands, avoiding social contact, reporting quickly if they have symptoms,” he said. “That is something we find really important – the patient empowerment.”
To that end, the ESMO team also created a comprehensive patient guide to help those with cancer navigate the pandemic.
All of these resources are the result of a major collaboration by guideline experts from around the world, Dr. Lordick said. He expressed gratitude for their work, which was performed without pay, under a tight deadline, and often following a full day in the clinic. From concept to publication, the recommendations were completed in 14 days.“To be honest, I’m a bit surprised, even a bit proud of what people did in a short period of time,” Dr. Lordick said.He reported no conflicts of interest.
SOURCE: ESMO. April 2020. Cancer Patient Management During the COVID-19 Pandemic