Focusing on Lung Cancer Management and Palliative Care During the COVID-19 Pandemic

Web Exclusives —April 2, 2021

Categories:

Lung Cancer

There have been many challenges to the distribution of healthcare resources due to the COVID-19 pandemic. Because there has been a surge in cases, with a high volume of patients requiring hospitalization and treatment in the intensive care unit, clinicians have been redeployed to oversee COVID-19 treatment and have moved beyond the purview of their original area of expertise and training. Oncology patients’ care has therefore potentially been compromised.

Patients with multiple comorbidities, as well as cancer patients and the elderly, are at high risk of developing COVID-19–related morbidity and mortality. Reported mortality rates vary; according to a 1-month, retrospective review of 1878 medical records of COVID-19 patients who had detectable cumulative evidence of lung cancer, patients with lung cancer have a higher mortality rate than the general population, as demonstrated by the fact that patients with lung cancer and a COVID-19 diagnosis died disproportionately (52.3%).1

Numerous severe COVID-19 risk factors can be observed in the cluster of patients with lung cancer: cancer itself, treatment is often immunosuppressive, a high median age (>70 years), frequent history of smoking, as well as a high proportion of comorbidities.

Further exacerbating the risk of contracting COVID-19 is the fact that outpatient clinics, daycare, and hospital visits serve as potential vectors for the spread of the virus.

To reduce COVID-19 risk, it is therefore critical for clinicians to evaluate the risk and benefit for all lung cancer treatments, particularly intravenous systemic anticancer therapies that generally require a team of healthcare providers to administer.2

There is a clear need to define the risks and benefits of diagnostic and treatment strategies for lung cancer, particularly in light of the coronavirus pandemic. Additionally, during the COVID-19 pandemic, palliative care for non-COVID lung cancer patients is a critical concern.

From a psychological perspective, COVID-19 has increased anxiety generally, but also regarding potential treatment changes required due to hospital and clinical priorities. Furthermore, the pandemic has increased social isolation and depression, and minimized face-to-face contact between patients and physicians. Telemedicine has played a role in assisting clinicians with overcoming psychological concerns for patients. Video applications have been used to support patients who lacked social networks and were challenged by social distancing guidelines.

Patients who have been challenged spiritually and lost a sense of meaning in life may be encouraged to seek local spiritual counselors or partners.

The coronavirus pandemic has impacted healthcare systems, reducing face-to-face contact, and caused a shortage of resources globally. This has been particularly challenging in the palliative care setting for patients with lung cancer. Clinicians have tried to maintain the best possible scenario, considering these particularly challenging circumstances, by rapidly modifying their guidelines based on the changing conditions and deploying new communication tools, such as telemedicine.

Maintaining resilience and flexibility of the healthcare system as well as healthcare providers, has been a critical take-away message that will extend well beyond the pandemic.

Source

Schoenmaekers JJAO, Hendriks LEL, van den Beuken-van Everdingen MHJ. Palliative care for cancer patients during the COVID-19 pandemic, with special focus on lung cancer. Front Oncol. 2020;10:1405.

References

  1. Rogado J, Pangua C, Serrano-Montero G, et al. Covid-19 and lung cancer: a greater fatality rate? Lung Cancer. 2020;146:19-22.
  2. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21:335-337.
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Last modified: April 2, 2021

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