The National Comprehensive Cancer Network (NCCN), an alliance of leading cancer centers, released an evidence-based consensus from leading medical experts on how best to provide optimal cancer management during the COVID-19 pandemic. The nonprofit organization’s Best Practices Committee detailed specific recommendations for keeping cancer patients, caregivers, and staff as safe as possible in a special feature published in the Journal of the National Comprehensive Cancer Network.
Adjusting Care Delivery
Lead author Pelin Cinar, MD, clinical assistant professor of gastrointestinal oncology, University of California San Francisco (UCSF), and medical director of Quality & Safety, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, said providing patients with effective and compassionate care without sacrificing the health and safety of oncology teams, colleagues, and families is possible. However, it is only possible by carefully evaluating all emerging research and modifying treatment approaches accordingly.
“The biggest change has been in how we are delivering care. With continued focus on our patient’s well-being, visits have in general moved to telemedicine (video or telephone visits), except for cases in which patients need to present to the cancer center for infusional anticancer therapy, radiation therapy, procedures, or tests,” Dr Cinar explained (personal communication, April 2020).
Cancer cases are evaluated very carefully and surgeries are still being offered to patients whose outcomes would be affected by a treatment delay. “There are often multidisciplinary conversations on how we can continue to provide the best possible care in a safe manner and without jeopardizing patient outcomes,” explained Dr Cinar. Patients with cancer and their loved ones already go through so much, and now they face new fears regarding COVID-19 or delaying necessary treatment. However, by sharing these recommendations NCCN hopes to reassure the oncology community that there are some aspects of care that can be controlled to improve outcomes for those undergoing treatment for cancer.
Best Practices Recommendations
Although the special feature presented the most current information at the time of publication, the authors note that recommendations regarding public safety and practice may change rapidly. Currently, the NCCN Best Practices Committee recommends prescreening and screen for COVID-19 symptoms and exposure history via telephone calls or digital platforms. Develop screening clinics to allow for patients with symptoms to be evaluated and tested in a dedicated unit with dedicated staff. Converting in-person visits to telemedicine visits when possible, and adopt a limited or no visitor policy.
The recommendations call for considering alternative dosing schedules to allow for fewer in-person visits to the cancer center and/or the infusion center, and switching from infusional therapy to oral oncolytics if equivalent formulation is available. The committee recommends transitioning outpatient care, such as pump disconnections, administration of growth factors, and delivering hormone therapy, to care-at-home whenever possible. It also recommends increasing interval times between scans or using biochemical markers in lieu of scans.
“The most important take-home message is to keep up with the ever-changing recommendations made by CDC, local agencies, and institutional guidelines. We are continuing to learn about COVID-19, and this is allowing the experts to evolve the guidelines and recommendations accordingly,” said Dr Cinar. “As leaders in cancer centers, we are responsible for keeping abreast of these recommendations, adopting them in our own institutions and making certain that our healthcare provider communities are aware of the algorithms and workflows.”
Implications for Nurses
Oncology nurses should continue to follow the recommendations that are made at their institutions regarding screening protocols, personal protective equipment (PPE) guidance, and stay-at-home or return-to-work policies. There are high rates of distress, anxiety, and insomnia among healthcare workers due to COVID-19. This is something that must be addressed.
“I think that in general we are so concerned about our patients and their loved ones, as well as our own loved ones, that we do not take care of ourselves as diligently,” Dr Cinar noted.
There are many resources and toolkits that are currently available and some recommendations include taking breaks during shifts and finding time to do things that brings one joy. Balanced diet, adequate sleep and reaching out to support services or mental health providers are also important.
The committee recommends establishing clear stay-at-home and return-to-work guidelines. With no “play book” for health care institutions, all centers struggled in the early weeks of coping with the pandemic, noted Anne Jadwin, MSN, RN, vice president of Nursing and chief nursing officer at Fox Chase Cancer Center, Philadelphia, Pennsylvania. At her institution, resources and new processes based on evidence and expert recommendations were mobilized very quickly to keep patients and staff safe. However, it was an overwhelming time for staff.
“It was realized early that providing frequent, factual information to staff was important in minimizing the disruption to clinical operations, and in allaying staff fears,” Ms Jadwin explained (email communication, April 2020). “Reassuring staff that the administration was doing everything possible to secure adequate supplies of PPE was also crucial in reducing panic in staff, especially in light of stories in the media.”
Rounds conducted by senior leaders and nursing professional development practitioners helped reinforce the new expectations for employee/patient screening and universal masking practices. The team also recognized the strain on staff and mobilized mental health resources and counseling services, and instituted an administrative leave policy. Those deemed nonessential were permitted to work from home. The staff also accepted donations of food and snacks, which were greatly appreciated.
“We also encouraged creative solutions in addressing social isolation, leveraging technology to connect patients with their healthcare providers and family members. We even hosted a wedding in the hospital for a seriously ill woman, permitting the groom to come into the hospital, and connecting the minister through Zoom,” said Ms Jadwin.
Cinar P, Kubal T, MD, Freifeld A, et al. Safety at the time of the COVID-19 pandemic: how to keep our oncology patients and healthcare workers safe [published online April 15, 2020]. J Natl Compr Cancer Netw. doi: 10.6004/jnccn.2020.7572
This article originally appeared on Oncology Nurse Advisor