With a combination of evidence-based research and clinical experience, experts at Penn Medicine’s Abramson Cancer Center have stepped up to offer guidance to specialists managing cancer patients during the novel coronavirus outbreak.
Spanning a variety of oncological disease states, including breast, lung and skin cancers, a key refrain in these reports and consensus statements is the need for clinicians to weigh the patient’s risk of infection against their need for treatment on an individualized basis.
Below are brief summaries of these reports, which appear in the nation’s leading clinical journals.
Management of Lung Cancer during the COVID-19 Pandemic
Published in the Journal of Clinical Oncology-Oncology Practice by a multi-disciplinary team from Penn’s Divisions of Hematology-Oncology and Pulmonary, Allergy, and Critical Care along with the Departments of Radiation Oncology and Surgery, these guidelines focus on efforts to standardize management of patients with lung cancer across the healthcare system and to guidance to the larger oncology community.
Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report
Issued in CHEST by an expert panel that included pulmonary medicine specialist Anil Vachani, MD, of Penn Medicine, this report offers guidance to clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.
In all, 12 statements related to baseline and annual lung cancer screening, surveillance of a previously detected lung nodule, evaluation of intermediate and high risk lung nodules, and management of clinical stage I non-small cell lung cancer are included as consensus statements.
How I Practice Now: Lung Cancer and the COVID-19 Climate (podcast)
In a recent podcast for the Oncology Learning Network, medical oncologist Joshua Bauml, MD, discussed the protocols put in place at Penn Medicine and the Abramson Cancer Center to manage and protect patients with lung cancer in the wake of the COVID-19 pandemic, including workflows to minimize risk to patients while continuing necessary life sustaining treatments and clinical research, and access to the LUNGevity Foundation patient advocacy helpline.
Management of primary skin cancer during a pandemic: Multidisciplinary Recommendations
Soon to appear in the journal Cancer, this multi-center statement features expert contributions from co-authors Jeremy R. Etzkorn, MD, and Christopher Miller, MD, of Penn Dermatology. The report contains multi-disciplinary recommendations on the timing of local therapy for early-stage skin cancers during the pandemic, (including Merkel cell, melanoma, basal cell and cutaneous squamous cell carcinoma) and an age- and comorbidity-based assessment of the impact of treatment delays on oncologic outcomes. These statements focus on the management of primary non-anogenital early-stage skin tumors in presumed COVID-19 negative patients.
Management of Melanoma During the COVID Era: From Diagnosis to Treatment (webinar)
In this webinar from June 2020, an expert panel of dermatologists, surgeons, and oncologists from Penn Medicine discussing the improved protocols to manage melanoma patients at Penn Medicine and in the community during the COVID-19 era. Features Christopher J. Miller, MD, and Lynn Schuchter, MD, et al, who elaborate on screening, safety during treatment, and technology to enhance melanoma care.
United States Cutaneous Lymphoma Consortium Recommendations for Treatment of Cutaneous Lymphomas During the COVID-19 Pandemic
Featured in the Journal of the American Academy of Dermatology, this article was generated by a multi-center effort from the U.S. Cutaneous Lymphoma Consortium, including member Ellen J. Kim, MD. Dr. Kim is Medical Director of the Dermatology Clinic at the Perelman Center for Advanced Medicine. The authors propose strategies for treating patients with primary cutaneous lymphomas by dividing both the disease and the type of immunosuppressive treatment into low, intermediate, and high-risk categories, with risk definitions for each patient grouping and recommendations for each treatment.
Breast Cancer Recommendations for Prioritization, Treatment, and Triage of Breast Cancer Patients during the COVID-19 Pandemic
From the COVID-19 Pandemic Breast Cancer Consortium, and appearing in Breast Cancer Research and Treatment, this Special Communication was co-authored by Lawrence N. Shulman, MD, medical oncologist and Deputy Director of Clinical Services at the Abramson Cancer Center. This study defines which cancer patients require more urgent care and which patients can wait for treatment until the pandemic is over. The Consortium categorizes breast cancer patients into three priority levels for urgency of care across all specialties and provides treatment recommendations for each of these patient scenarios.
Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID-19 Pandemic
In the Journal of Clinical Oncology, Chief of the Division of Medical Ethics at the Perelmen School of Medicine, Steven Joffe, MD, MPH, co-authored the American Society of Clinical Oncology recommendations on the rationing of ventilators, critical and intensive care beds, medications, and other clinical resources during the COVID-19 pandemic. The aim of the document is to provide general guidance to the ASCO community as they develop and adapt to altered standards affecting care for their patients, including the allocation of scarce resources.
Patient Safety
In addition to providing guidance for breast cancer patients, Dr. Lawrence N. Schulman of the Abramson Cancer Center co-authored a report from the National Comprehensive Cancer Network that documented the measures available for the protection of both cancer patients and providers facing the coronavirus during a time of pandemic.
This report includes considerations for the care of patients with hematological malignancies and stem cell transplants, as well as direction for all oncology patients with active COVID-19 infection.
