A leading cancer charity says ‘incredibly tough decisions’ lie ahead for cancer patients and their doctors as they balance the need for treatment against the additional risks for some patients posed by covid-19.

Guidance issued by the Scottish government’s newly-formed national cancer treatment response group is advising that everything possible is done to protect vulnerable cancer patients from covid-19, but says clinicians may need to prioritise treatment to those who need it most.

Some services, such as CT scanning, that are essential to the covid-19 response may also be affected.

In its advice, the group says it accepts that clinicians may need to prioritise treatment to those who need it most, with all decisions made by the whole multidisciplinary clinical team and explained clearly to patients and their families.

The guidance sets out how patients should be categorised by the priority of their surgery or radiation treatment, the treatment’s chances of success, the number of different staff who might be involved in delivering the treatment and, at the same time, the patient’s risk of infection from coming into hospital.

The response group warns that one of the most important diagnostic tools for cancer teams, CT scanning, will be under additional pressure as it is the investigation of choice for patients suspected of having coronavirus-related inflammation of their lung tissue.

Non-surgical options such as extending chemotherapy are to be considered, with teams asked to look at alternative ways of running consultations and delivering medicines to reduce the number of times a patient has to attend hospital.

Chief Executive of the research and care charity Breast Cancer Now, Baroness Delyth Morgan, says covid-19 is adding extra worries for people undergoing treatment for cancer:

“These vital guidelines set out key steps for the delivery of NHS cancer care in Scotland during this totally unprecedented situation, including identifying alternative treatment options or methods of delivery to help limit the risk of infection for cancer patients.

“We know that people undergoing certain breast cancer treatments such as chemotherapy may be at greater risk of becoming seriously ill if they do contract coronavirus, and so the risks and benefits of going to hospital for treatment need to be carefully considered for each individual.

“Any changes to treatment in these circumstances will represent an incredibly tough decision at an already difficult time, and we need to do all we can to support patients, their doctors and multidisciplinary teams to make the right choice for each person.

“Any changes to treatment plans over the coming months could naturally cause significant concern and anxiety for patients and their families, and it’s now absolutely vital that everyone gets the support they need, as well as clear information to fully participate in decisions about their treatment.”

A Scottish Government spokesperson says the guidance is being reviewed constantly:

“The impact of covid-19 on cancer patients is a top priority in all of our planning. Our national covid-19 cancer treatment response group is meeting weekly and is providing ongoing advice and support around cancer treatments. Patient safety remains an absolute priority and covid-19 is a very significant new risk in relation to cancer treatment. For that reason, many patients - in discussion with them - will be offered alternative or delayed treatment plans.

“We understand how distressing that can be for those individuals, but these new approaches are to minimise very concerning risks to them. Any cancer patient worried about symptoms should call their existing cancer treatment helpline or the national cancer treatment helpline. Patient information leaflets have been disseminated through the NHS and are regularly updated with latest advice for people with cancer.”

A new role of ‘lead consultant’ is being created across all cancer teams to work full-time overseeing services and decisions. The national cancer treatment response group recognises the pressures that will come with that job, saying that it should not be done by one person but rotated amongst senior leaders, and the person doing it shouldn’t be expected to do anything else.

Advice for patients

The Scottish government advises any cancer patient who has a temperature or shivering or flu-like symptoms while on systemic anti-cancer therapy, or for has any side effects of drug treatment, to call their local cancer treatment helpline or the national Cancer Treatment Helpline on 0800 917 7711.

Breast Cancer Now has a helpline where anyone who is concerned about coronavirus and breast cancer treatment can call and speak to a specialist nurse, on 0808 800 6000.

 

The National Cancer Treatment Response Group is chaired by a Senior Medical Officer. Other members include representatives from Public Health England’s Systematic Anti-Cancer Therapy (SACT); the Scottish Government; National Services Division; the West of Scotland Cancer Network Regional SACT Group and the National SACT Governance Group; Scottish Cancer Lead Nurse Consultants and Network Clinical Leads.

 

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