In recognition of the critical need for open communication between all stakeholders, including administrators, staff, patients, caregivers, and the general public, at institutions caring for patients with cancer during the COVID-19 pandemic, experts at the Seattle Cancer Care Alliance (SCCA) (part of the National Comprehensive Cancer Network [NCCN]), the Fred Hutchinson Cancer Research Center, and the University of Washington have drafted a peer-reviewed article outlining current best practices to manage the disease. The articles was just published in the Journal of the NCCN.1,2

Describing the implementation of timely and effective responses to the current COVID-19 crisis as “the health care challenge of our generation,” in a press release announcing the publication, lead author, F. Marc Stewart, MD, medical director of SCCA, along with leadership at the NCCN, stressed the importance of creating guidelines and policies reflective of the most up-to-date experiences regarding the organization and management of cancer institutions during the current crisis.

Nevertheless, they also emphasized the need for these institutions to remain flexible so as to be able to respond effectively to the rapidly evolving situation.

In particular, creation of an Incident Command Structure (ICS) “to provide early coordination of institution-wide efforts and to rapidly respond to changing information” was recommended.

An ICS hierarchy chart was provided that described a “uniform command team” composed of 3 incident commanders, 1 general, and 2 others to specifically handle community and inpatient cancer care, respectively. Also included in the ICS leadership team (reporting directly to the main incident commander) are the public information officer; liaison officer; safety officer; medical technology specialist; logistics chief to oversee procurement, labor, staff testing, and the blood supply; planning chief to oversee human resources and health care analytics; finance chief; medical chief; outpatient medical chief; medical chief of bone marrow transplant and immunotherapy; operations chief; and communication chief.

“Forming an ‘Incident Command’ structure is necessary to centralize all information given to staff, patients, and the community, and to consolidate and communicate the work of many individual groups,” the authors noted.

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Referring to the increased vulnerability of immunocompromised patients with cancer in regard to the clinical sequelae of COVID-19 infection, the SCCA authors emphasized the triage of patients with respiratory symptoms, reinforcement of a strict “stay at home when sick” policy for staff and faculty, and the provision of ready access to COVID-19 testing.  

Also noted was the importance of conducting proactive discussions related to “end-of-life” and palliative care for patients with cancer.

Other recommendations included decreasing the number of cancer care team members in a patient’s room at any given time, adopting a no-visitors policy with rare exceptions, rescheduling elective surgeries, deferring second opinions if patients have initiated treatment elsewhere, and conducting “well” visits through use of telemedicine.  

To help mitigate challenges associated with anticipated shortages related to staff and resources, proactive attention to the physical and emotional well-being of staff and faculty members, creation of a back-up labor pool, and extension of cancer center hours to reduce the need for emergency and inpatient services were also recommended.

References

  1. Ueda M, Martins R, Hendrie PC, et al. Managing cancer care during the COVID-19 pandemic: Agility and collaboration toward a common goal [published online March 17, 2020]. J Natl Compr Canc Netw. doi: 10.6004/jnccn.2020.7560
  2. National Comprehensive Cancer Network. JNCCN: How to manage cancer care during COVID-19 pandemic [press release]. Published March 18, 2020. Accessed March 18, 2020