I S Boon1, T P T Au Yong2, C S Boon3. 1. Department of Clinical Oncology, Leeds Cancer Centre, St James's Institute of Oncology, Leeds, UK. 2. Department of Radiology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK. 3. Department of Clinical Oncology, The Clatterbridge Cancer Centre, Wirral, UK.
Madam — COVID-19 is a global pandemic [1] and poses a significant challenge to cancerpatients. Cancer-specific mortality rates are well established. Conversely, the COVID-19 case fatality rates must be interpreted with caution with regards to the lag time effect [2].Oncologist will have to recognise the uncertainty in quantifying the risks of COVID-19 to cancerpatients. This is no different from routine treatment decisions while acknowledging uncertainties in treatment efficacy and potential side-effects.Liang et al. [3] suggested the postponement of cancer treatments but an alternative approach is to stratify treatment modalities according to treatment intent, effectiveness and individualised risk benefit assessment with careful discussion with patients [4]. Radiotherapy delivery during the COVID-19 pandemic poses logistical challenges. Treatment gaps require mitigation and shorter hypofractionated regimens are recommended [5].No clinical protocols can replace the clinical acumen of oncologists in recommending treatment decisions to patients. The risks of COVID-19 would need to be weighed against the risks of cancer progression and the potential loss of a curative window. Considerations should also account for service disruptions, staff shortages and oncology unit capacity. Frank communication, compassion and honesty in what we as clinicians do and do not yet know about COVID-19 are what we owe to our patients.First they are patients, then they have cancer and third they can contract COVID-19 during cancer treatments. These are all separate statistical events and we must not assume all three events have already occurred.We must take great care when extrapolating data from cohorts of COVID-19patients to the wider cohort of patients with cancer, who may or may not contract COVID-19 subject to the efficacy of global control measures. It is in such uncertain times that oncologists would do well to heed the wisdom of William Osler to ‘cure sometimes, relieve often, comfort always’ without abandoning good clinical reasoning and evidence-based medicine.