The approach of oncological patients during the COVID-19 pandemic

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This article was exclusively written for The European Sting by Ms. Bianca de Araújo Sobral, the first author of this article, who was born in São Paulo, Brazil. She is currently in her sixth semester of medicine at the Pontifícia Universidade Católica of Campinas. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Introduction:

Although there are no exact data on the impact of COVID-19 on oncological patients ¹, it is notable that new challenges have arisen in the care of this risk group 2,3. Therefore, medical oncology societies have shared strategies for patient’s approach during this period, including telemedicine ³. The aim is to condense this knowledge into a single work, to mainly assist the clinical practice of oncologists.

Methodology:

On 07/27/2021, in the Medline and Web of Science databases, ‘COVID-19 AND “oncologic patients”‘ were searched, with the following filters: 2011-2021; reviews or meta-analyses; and English. Excluding four duplicates, we obtained six results.

Results:

The COVID-19 pandemic stands out for its rapid spread, with oncological patients being one of the most affected groups, with a higher risk of contracting the virus and worse outcomes, due to immune system compromise, malnutrition, chemotherapy, radiotherapy and surgery, secondary diseases and a higher risk of thrombosis4. Therefore, the routine of this group must be rearranged, including participation in experimental trials, functional management and cardiovascular toxicity surveillance. However, these hospital-based modalities, facilitate SARS-COV-2 infections.

In this sense, remote consultations are indicated for immunosuppressed patients. New guidelines aim to reduce hospitalization time and invasive exams. When surgery is necessary, patients are subjected to tests and safety measures in the preoperative period and doctors must use reinforced personal protective equipment 3,5,6. Neoadjuvant therapies emerge as an alternative to elective surgery.

Telemedicine, essential in this period, faces challenges such as unprepared professionals, regions without infrastructure, difficulties in maintaining medical confidentiality and obtaining physical, as well as imaging exams2. Virtual care is generally indicated for oligo or asymptomatic patients, benefiting them by eliminating the need to travel to the office and the need for caregivers for physically disabled patients 1.

Among the analyzed cancers, gynecological and neurological cancers would be the least affected 2,3,5. In both cases, virtual consultation can be performed, once the description of the symptoms is effective to accurately request for exams, which avoids exposure to contaminated environments. However, the privacy of gynecological patients should be a concern ³. Given that SARS-COV-2 enters the cell through the ACE2 receptor, which is more prevalent in the respiratory and gastrointestinal systems ², there are indications that lung and colorectal cancers may be more affected 4,6.

Conclusion:

The COVID-19 pandemic has brought new challenges for the care of oncological patients. Telemedicine has emerged as an essential tool, however, it faces several challenges that must be overcome, such as unprepared professionals and lack of infrastructure. It is important to adapt the routine of this group, including participation in experimental trials and functional management, while considering the individual characteristics of each patient and the limitations imposed by the pandemic1-6.

References: 

  1. Triantafillou V, Rajasekaran K. A Commentary on the Challenges of Telemedicine for Head and Neck Oncologic Patients during COVID-19. Otolaryngol – Head Neck Surg (United States). 2020;163(1):81-82. doi: 10.1177/0194599820923622.
  2. Mancebo G, Solé-Sedeño JM, Membrive I, Taus A, Castells M, Serrano L, et al. Gynecologic cancer surveillance in the era of SARS-CoV-2 (COVID-19). Int J Gynecol Cancer. 2021;31(6):914-919. doi: 10.1136/ijgc-2020-001942.
  3. Di Marzo F, Fiori E, Sartelli M, Cennamo R, Coccolini F, Catena F, et al. SARS-CoV-2 pandemic: Implications in the management of patients with colorectal cancer. New Microbiol. 2020;43(4):156-160.
  4. Daggubati LC, Eichberg DG, Ivan ME, Hanft S, Mansouri A, Komotar RJ, et al. Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic. World Neurosurg. 2020;139:e859-e863. doi: 10.1016/j.wneu.2020.05.140.
  5. Asokan I, Rabadia S V., Yang EH. The COVID-19 Pandemic and its Impact on the Cardio-Oncology Population. Curr Oncol Rep. 2020;22(6). doi: 10.1007/s11912-020-00945-4.
  6. Apostolou K, Vogli S, Frountzas M, Syllaios A, Tolia M, Papanikolaou IS, et al. Upper Gastrointestinal Cancer Management in the COVID-19 Era: Risk of Infection, Adapted Role of Endoscopy, and Potential Treatment Algorithm Alterations. J Gastrointest Cancer. 2021;52(2):407-413. doi: 10.1007/s12029-020-00557-y.
  7. About the author
  8. Bianca de Araújo Sobral, the first author of this article, was born in São Paulo. She is currently in her sixth semester of medicine at the Pontifícia Universidade Católica of Campinas. She has always shown an interest in scientific production since the beginning of her academic life, and has participated in the direction of the Scientific Research Nucleus of the local IFSMA PUC-Campinas committee in 2022. Furthermore, she has also worked as a liaison for the academic leagues of Neurology and Neurosurgery, as well as the Image Diagnosis League in 2021, where she assumed the position of director in 2022.

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