key: cord-0720303-tqi0v1w8
authors: Boon, Ian S.; Au Yong, Tracy P.T.; Boon, Cheng S.
title: Effect of COVID-19 pandemic on cancer clinician decision making: Known knowns and known unknowns
date: 2020-04-25
journal: Clin Oncol (R Coll Radiol)
DOI: 10.1016/j.clon.2020.04.010
sha: 04ebfb2287e60db45c47a0667447c47e999a6d9b
doc_id: 720303
cord_uid: tqi0v1w8

nan

Madam -COVID-19 is a global pandemic [1] and poses a significant challenge to cancer patients. 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 cancer patients. 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-19 patients 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.

Case-fatality estimates for COVID-19 calculated by using a lag time for fatality

Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China

Clinical guide for the management of cancer patients during the coronavirus pandemic

RCR position on coronavirus (COVID-19) for clinical oncology

The authors declare no conflicts of interest I.S. Boon *, T.P.T. Au Yong †, C.S. Boon ‡

Please update publication details, if possible, once known C:\pdfconversion\WORKuthordoc\Authors contribution.doc All authors contribute to the writing of this correspondence and agreed on the final manuscript.

☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: