Leading European cancer centres share guidance on making their operations ‘pandemic proof’

The centres, which include the Cancer Research UK Cambridge Cancer Centre, form an alliance known as Cancer Core Europe (CCE), and together represent around 60,000 newly diagnosed cancer patients each year and conduct more than 1,500 clinical trials.

In a Perspective published in Nature Medicine, CCE researchers describe how their centres have been forced by the current pandemic to drastically revise and reorganise their patient care and scientific research, while maintaining the same high quality of care.

The specialist centres not only want to prevent the spread of the virus in general, but also to protect patients with cancer whose disease and treatment make them especially vulnerable to complications if infected.

“COVID-19 has created a unique challenge: how to adjust cancer management to minimise the disruption caused to cancer care by the pandemic,” said Professor Carlos Caldas, co-lead author of the article, member of the senior management team of the Cancer Research UK Cambridge Centre, and Group Leader at the Cancer Research UK Cambridge Institute.

“Our medical staff across all disciplines have been truly amazing at very quickly producing COVID-19-adjusted treatment guidelines.”

The researchers have identified several factors that medical institutions need to consider to ensure continuity in cancer care as the COVID-19 pandemic unfolds. These include:

• Clinical activities
  Given the high transmissibility rate of SARS-Cov2, it is the responsibility of all health care professionals to make sure patients are not exposed to COVID-19. For CCE centres, this means that face-to-face consultations are now, whenever possible, taking place via web consulting or by telephone calls, and non-urgent appointments are postponed.
   
• Adaptation of standard-of-care treatment regimens
  Across all centres, standard-of-care treatment regimens have been adapted to minimize the number of hospital visits and hospitalizations, and to prevent complications of COVID-19 caused by anticancer treatments.
   
• Patient information and psychosocial care
  Addressing patients’ concerns relating to their treatment and how it may be affected by COVID-19 poses a challenge to CCE centres and has required urgent attention.
   
• Support of qualified personnel
  In order to ensure the continuity of cancer care, the presence of sufficient qualified personnel to treat cancer patients is essential. This involves the whole chain of hospital caregivers, from the operating theatre, to the ward, day clinic, and intensive care unit (ICU). Every CCE has faced a similar problem: the absence of a rapid diagnostic system for COVID-19 for caregivers. This frequently leads to unnecessary self-isolation of health professionals, further reducing the health workforce in a time when demand is peaking.
   
• Capacity of cancer care facilities
  In many hospitals, the COVID-19 pandemic is a major stress test for the capacity of the various treatment or support units: radiation, medical oncology, imaging, surgery and ICUs. With increasing severity of the pandemic, health care systems will become overwhelmed and prioritization will be necessary. To prepare for this, CCE centres have established decision rules to categorize and prioritize patients for anticancer therapies or surgery.
   
• Research activities​
  CCE centres have large research facilities and together employ thousands of preclinical scientists. One of the first measures taken was to downscale these preclinical research activities to a minimum in accordance with social distancing guidelines and the ‘lockdown’ local policy. Clinically trained scientists and research fellows are frequently going back to clinical work to support their healthcare system.
  
  The authors acknowledge that the current crisis will have major ramifications to the progress of cancer research. However, public health measures in place to curtail the COVID-19 pandemic have to be prioritized at the moment, and the damage to the scientific enterprise will be repairable in time if safeguards and resources are put in place.

The team outline a set of practical measures that have been implemented in their respective centres and could be considered by other medical centres. These range from instructing patients where possible not to visit the hospital if they have possible symptoms of COVID-19 to reducing preclinical research activities to a bare minimum, and from informing patients about a possibly increased risk associated with anticancer therapy during the pandemic through to considering non-surgery-based treatments, such as radiation for prostate cancer.

Professor Caldas added: “We hope that our collective experiences will help guide others and will also reassure cancer patients that we are doing everything we can to avoid compromising their care.

“This COVID-19 crisis is making us rethink care, and some of the changes might in the long run have positive effects, for example minimising hospital visits and face-to-face consultations or delivering care using telemedicine.”

The Cancer Core Europe (CCE) alliance of seven leading European cancer centres was founded in 2014 to accelerate the development of innovative cancer therapies through close collaboration in translational and clinical research. Its seven member centres collectively treat approximately 350,000 patients annually.

The Cancer Research UK Cambridge Centre acknowledges funding from Cancer Research UK, the National Institute for Health Research Cambridge Biomedical Research Centre, and The Mark Foundation for Cancer Research. Its clinical cancer services are provided by Cambridge University Hospitals (CUH) and Royal Papworth Hospital.

Reference
Caring for patients with cancer in the COVID-19 era. Nat Med; 16 Apr 202; DOI: 10.1038/s41591-020-0874-8