key: cord-0049177-2xem8inu
authors: Isea de la Viña, Jesus; Mayol, Julio; Ortega, Ana Laura; Alcázar Navarrete, Bernardino
title: Lung cancer patients on the waiting list in the midst of the COVID-19 crisis: what do we do now?()
date: 2020-08-28
journal: Arch Bronconeumol
DOI: 10.1016/j.arbr.2020.05.003
sha: f76a1503a7864c86b96c3732b03ff127124e7fe3
doc_id: 49177
cord_uid: 2xem8inu

nan

The pandemic caused by the coronavirus and its resulting infection, COVID-19, has had a major impact in all areas of Spanish public health. Despite social distancing and confinement (enforced to varying degrees in different countries), we are still suffering the consequences of the outbreak and will continue to do so for the rest of the year.

Each hospital contends with the pandemic at different levels. Reference centers, which have a greater number of cases, have had to vacate wards and intensive care units to make room for patients infected with the coronavirus, so the impossibility of transferring surgical patients from regional to tertiary hospitals to receive specialized care and the waiting list delays caused by the suspension of scheduled operations will soon have an impact on patients with lung cancer (LC) not infected by this virus.

The American College of Surgeons (ACS), 1 in their recently published guidelines on the management of patients scheduled for thoracic surgery, categorize the general status of hospitals into 3 phases according to the number of COVID-19 patients admitted: phase 1 -preparation; phase 2 -urgent setting; and phase 3 -ଝ Please cite this article as: Isea de la Viña J, Mayol J, Ortega AL, Alcázar Navarrete AN. Pacientes con carcinoma broncogénico en lista de espera en plena crisis del COVID-19: ¿y ahora qué hacemos? Arch Bronconeumol. 2020. https://doi.org/10.1016/j.arbres.2020.05.004 * Corresponding author.

E-mail address: jesusisea@gmail.com (J. Isea de la Viña). extreme emergency (Table 1 ). In these guidelines, priority is given to patients with a life-threatening emergency (perforated cancer, tumor-associated infection or surgical complications), a histological diagnosis of cancer, greater disease extension, symptomatic patients, or patients enrolled in clinical trials. Alternative, nonsurgical treatment approaches should also be considered. As a result of this situation, LC patients will receive non-standard treatment that will lead to uncertainties in terms of overall diseasefree survival.

The Society of Surgical Oncology 2 also issued a message from its president that contained certain recommendations to consider in the treatment of these patients. As in the case of the ACS, hospitals are urged to considerẗriagefor a number of reasons, such as the potential shortage of qualified personnel and the potential lack of materials and beds due to these resources being diverted to treat patients with COVID-19. A very recent retrospective review 3 of COVID-19-affected cancer patients reported that most (25%) of the 28 patients in the series had LC. The symptoms they presented were fever (23, 82.1%), dry cough (22, 81%) and dyspnea (14, 50.0%), together with lymphopenia (23, 82.1%), raised C-reactive protein (CRP) (23, 82.1%), anemia (21, 75.0%), and hypoproteinemia (25, 89.3%). As can be seen, several of these symptoms rule out surgery in waiting list patients. The authors concluded that cancer patients show deteriorating conditions and poor outcomes, and recommend that CB patients receiving antitumor therapy should undergo vigorous screening for COVID-19 infection 4,5 (clinical-epidemiological history, RT-PCR, serology), and that treatments that cause immunosuppression, including surgery, should be avoided. What will happen to our patients who have been on the waiting list for at least 1, 2 or 3 months? Will their cancer be treated at its pre-pandemic stage? Or will supplementary testing need to be updated due to the delays in medical treatment? Will their tumor need to be restaged?

Given the characteristics of public health in our country, many hospitals might look to these recommendations for guidance. However, we believe that although the clinical guidelines published so far give us an idea ofẅhat to doẅith our waiting lists, the circumstances in each hospital will differ, and these guidelines merely offer theoretical recommendations onẅhat to doörḧow to do it in the best possible way. We call for guidelines that allow us to treat all patients in this situation -not only those with LC, but also those with other thoracic tumors that require surgical or multimodal treatment. Such guidelines would help us plan and treat patients currently on the waiting list within a reasonable time frame of less than 3 months.

Certain details need to be taken into account, such as the patient's willingness to undergo surgery at the current time, their family situation, or even the possibility that some patients have or have had COVID-19, in which case the best moment to reschedule surgery must be carefully selected. On the other hand, we may need to screen all waiting list patients for coronavirus infection. What should we do? We urgently need organization, prioritization, and treatment guidelines for the future management of these patients. We need to prioritize, not only on the basis of knowledge, but also in the knowledge that we are doing the right thing.

COVID-19 Guidelines for Triage of Thoracic Patients. American College of Surgeons

Cancer Surgeries in the Time of COVID-19: A Message from the SSO President and President-Elect. Society of Surgical Oncology

Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China

Respiratory Medicine Branch of Chinese Medical Association, Chinese Respiratory Tumor Collaboration Group. Respiratory infectious diseases-guidelines for the diagnosis and treatment of patients with advanced non-small cell lung cancer during the epidemic of new coronavirus pneumonia (trial