Eric A Coomes1, Humaid O Al-Shamsi2, Brandon M Meyers3, Waleed Alhazzani4, Ahmad Alhuraiji5, Roy F Chemaly6, Meshari Almuhanna7, Robert A Wolff8, Nuhad K Ibrahim9, Melvin L K Chua10, Sebastien J Hotte3, Tarek Elfiki11, Giuseppe Curigliano12, Cathy Eng13, Axel Grothey14, Conghua Xie15. 1. Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada. 2. Medical Oncology Department, Alzahra Hospital Dubai, Dubai, United Arab Emirates; Department of Medicine, University of Sharjah, Sharjah, United Arab Emirates; Emirates Oncology Society, Dubai, United Arab Emirates. 3. Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Canada. 4. Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, Canada. 5. Department of Hematology, Kuwait Cancer Control Center, Kuwait City, Kuwait. 6. Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 7. Min-Sheng General Hospital, Taoyuan District, Taoyuan City, Taiwan. 8. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 9. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 10. Divisions of Radiation Oncology and Medical Sciences, National Cancer Center Singapore, Singapore; Oncology Academic Program, Duke-National University of Singapore Medical School, Singapore; Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China. 11. Windsor Regional Cancer Center, Windsor, Canada; Department of Oncology, Schulich School of Medicine, University of Western Ontario, London, Canada. 12. Department of Oncology and Hemato-Oncology and Division of Early Drug Development for Innovative Therapy, University of Milan, Milan, Italy; European Institute of Oncology, IRCCS, and University of Milano, Milan, Italy. 13. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA. 14. West Cancer Center, University of Tennessee, Memphis, Tennessee, USA. 15. Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.
We agree with Souadka et al. that health care systems and oncology centers must prepare for the possibility for subsequent epidemic waves, as intensive societal control measures are relaxed [2]. In the acute phase, out of necessity we have had to make adjustments to typical treatment protocols to account for anticipated disruptions of health system capacity. For example, in the short term, should significant delay in operative intervention be unavoidable, then consideration may be given to using chemotherapy in the neoadjuvant setting.Unfortunately, during the early phases of the pandemic, due in part to fear of infection, patients may have even avoided health care settings for acute medical conditions; this has been hypothesized as an explanation for the significant decrease in admissions for acute coronary syndrome during the Italian outbreaks of COVID‐19 [3]. However, in the long term we need to optimize ongoing access to care to ensure safe delivery of therapy for both acute and chronic medical conditions; the large‐scale implementation of virtual and telemedicine is one such intervention that has been rapidly deployed to maintain continuity of care [4, 5].Although marked shortages of personal protective equipment have occurred during the initial pandemic wave, as governments and corporations attempt to scale‐up production of personal protective equipment, health care systems may be better situated to prepare and respond for subsequent waves of COVID‐19. We fully agree that personal protective equipment plays a critical role in effective infection prevention and control programs, and ongoing efforts are essential to ensure the appropriate personal protective equipment is available as needed for patient care. Furthermore, oncologic surgeries that include aerosol generating procedures will further necessitate the use of N95 respirators.We recognize that hospitals have implemented triage processes, dedicated staffing, and isolation or cohorting for patients under investigation and with confirmed COVID‐19. However, we must also recognize the challenges in clearly defining “COVID‐free” space (s) given the high burden of subclinical or asymptomatic COVID‐19 [6]. In light of the potential for presymptomatic transmission and the presence of asymptomatic and atypical presentations of COVID‐19, in high‐incidence regions it may be prudent to assume that all patients are potentially incubating SARS‐CoV‐2, regardless of the presence of symptoms. Further studies are required to determine the role of universal microbiologic screening for patients requiring regular health care contact, recognizing the limitations of polymerase chain reaction sensitivity for identifying SARS‐CoV‐2. Some centers have already begun implementing such universal screening prior to scheduled surgeries [7, 8].Furthermore, should COVID‐19 become endemic, then more longstanding structural changes will be required in oncology institutions to ensure uninterrupted delivery of care. However, the ultimate course of the COVID‐19 pandemic remains to be seen, and the interventions required will be influenced by the degree and duration of protective immunity from prior infection, the availability and implementation of novel vaccines, and identification of effective therapies [9].
Disclosures
Eric A. Coomes: Toronto COVID‐19 Action Initiative, Thistledown Foundation (RF); Brandon M. Meyers: Amgen, AstraZeneca, Bristol‐Myers Squibb, Eisai, Ipsen, Merck, Roche, Sanofi Genzyme, Taiho (C/A), Eisai, Roche (ET), Eisai, Merck (other—travel), Sillajen (RF—individual), AstraZeneca, H3/Eisai, Galera, GlaxoSmithKline, Exelixis (RF—institution); Giuseppe Curigliano: Roche/Genentech, Novartis, Pfizer, Eli Lilly & Co., Foundation Medicine, Samsung, Daichii‐Sankyo (C/A), Ellipses Pharma (H), Roche/Genentech, Pfizer (other—travel). The other authors indicated no financial relationships.(C/A) Consulting/advisory relationship; (RF) Research funding; (E) Employment; (ET) Expert testimony; (H) Honoraria received; (OI) Ownership interests; (IP) Intellectual property rights/inventor/patent holder; (SAB) Scientific advisory board
Authors: Humaid O Al-Shamsi; Waleed Alhazzani; Ahmad Alhuraiji; Eric A Coomes; Roy F Chemaly; Meshari Almuhanna; Robert A Wolff; Nuhad K Ibrahim; Melvin L K Chua; Sebastien J Hotte; Brandon M Meyers; Tarek Elfiki; Giuseppe Curigliano; Cathy Eng; Axel Grothey; Conghua Xie Journal: Oncologist Date: 2020-04-27
Authors: Daniel F Gudbjartsson; Agnar Helgason; Hakon Jonsson; Olafur T Magnusson; Pall Melsted; Gudmundur L Norddahl; Jona Saemundsdottir; Asgeir Sigurdsson; Patrick Sulem; Arna B Agustsdottir; Berglind Eiriksdottir; Run Fridriksdottir; Elisabet E Gardarsdottir; Gudmundur Georgsson; Olafia S Gretarsdottir; Kjartan R Gudmundsson; Thora R Gunnarsdottir; Arnaldur Gylfason; Hilma Holm; Brynjar O Jensson; Aslaug Jonasdottir; Frosti Jonsson; Kamilla S Josefsdottir; Thordur Kristjansson; Droplaug N Magnusdottir; Louise le Roux; Gudrun Sigmundsdottir; Gardar Sveinbjornsson; Kristin E Sveinsdottir; Maney Sveinsdottir; Emil A Thorarensen; Bjarni Thorbjornsson; Arthur Löve; Gisli Masson; Ingileif Jonsdottir; Alma D Möller; Thorolfur Gudnason; Karl G Kristinsson; Unnur Thorsteinsdottir; Kari Stefansson Journal: N Engl J Med Date: 2020-04-14 Impact factor: 91.245
Authors: P Ivanyi; T Park-Simon; H Christiansen; R Gutzmer; A Vogel; M Heuser; H Golpon; P Hillemanns; J Haier Journal: Clin Exp Metastasis Date: 2021-03-23 Impact factor: 5.150
Authors: Katie Maurer; Anna Saucier; Haesook T Kim; Utkarsh Acharya; Clifton C Mo; Julie Porter; Cindy Albert; Corey Cutler; Joseph H Antin; John Koreth; Mahasweta Gooptu; Rizwan Romee; Catherine J Wu; Robert J Soiffer; Sarah Nikiforow; Caron Jacobson; Vincent T Ho Journal: Blood Adv Date: 2021-02-09