17 March 2020
The RCR recognises the work that all departments are doing to mitigate the risk of COVID-19 for staff and patients and to continue to provide safe cancer treatments. Knowledge and advice are changing rapidly and the situation is very likely to get worse before it improves. All clinicians need to work together to support each other, our teams and our patients in this time of great uncertainty.
Services are very likely to need to depart from established treatment pathways and protocols. There have been several discussion threads on our clinical oncology forums and on social media about potential valid changes and the evidence base to support them. The RCR will work to collate these resources so that they can be shared widely, contributed to and discussed. Please share your documents via the clinical oncology (COVID-19) discussion forum. We will add links to relevant documents on the COVID-19 resources section of the website in the coming days.
The statement below posted on 13 March remains current. We would advise you to:
- Review the NHS-E guidance on treatment of cancer patients (PDF)
- Discuss and agree proposed changes to current treatment pathways with your cancer multidisciplinary teams. Consider possible changes to diagnostic and surgical services in planning cancer treatment.
- Discuss with the patient any change to an individual treatment plan and the reason for that change. Document these discussions.
- Discuss a treatment escalation plan with every patient. Record this in the patient record and ensure the patient and other healthcare professionals have access to it.
We will review this advice on a regular basis.
Published 17 March 2020. Updated 18 March 2020
The coronavirus epidemic represents a significant challenge to providing care for cancer patients. The RCR recognises the pressure that this places on all oncologists and departments. Clinicians may need to depart from established protocols and procedures at this time in line with recent national communications (PDF). Departments already have business continuity plans. These must be reviewed and updated regularly in the light of central and local NHS and public health advice.
Departments should consider the following:
Outpatient and acute oncology services (AOS)
- For patients at risk of neutropenia who meet the current Government case definition for possible COVID-19 infection, ensure there is an appropriate local AOS pathway and assessment area.
- For all outpatient appointments consider telephone/video clinics rather than face-to-face visits.
- For patients who are self-isolating, discuss the risk/benefit of attending for treatment with your local infection control team, considering the latest government guidance.
- When capacity is limited, consider evidence-based shorter fractionation schedules and deferring radiotherapy for some groups.
- For patients with suspected or confirmed COVID-19 infection, consider cohorting on one machine or in one part of the department.
- Where gaps in treatment occur, try to compensate as per the RCR guidelines. We recognise that despite this, gaps in treatment may affect outcomes.
Systemic Anti-Cancer Therapy (SACT)
- For patients who have not yet started SACT, assess the risk/benefit of treatment and discuss this with the patient. This may mean deferring or not recommending treatment. Record all discussions as part of the informed consent process.
- For patients currently having SACT, re-assess the appropriateness of treatment. This may mean stopping treatment.
- For patients continuing on SACT, provide information on what to do if they develop symptoms of possible COVID-19 infection.
This is a rapidly evolving situation. Clinicians should review the latest government advice. We will update this statement as new or modified information becomes available.
Please note, links from the RCR website to external websites and material are provided for information only and do not constitute endorsement or approval. The RCR is not responsible for the accuracy, legality or content of any external sources referenced on this website.
Published 13 March 2020. Page last updated 18 March 2020