The tiered approach of ESMO in delivering a guidance for cancer patients during the COVID-19 pandemic is designed across three levels of priorities, namely: tier 1 (high priority intervention), 2 (medium priority) and 3 (low priority) – defined according to the criteria of the Cancer Care Ontario, Huntsman Cancer Institute and ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS), incorporating the information on the value-based prioritisation and clinical cogency of the interventions
- High priority: Patient's condition is immediately life threatening, clinically unstable, and/or the magnitude of benefit qualifies the intervention as high priority (e.g. significant overall survival [OS] gain and/or substantial improvement in quality of life [QoL]);
- Medium priority: Patient's situation is non-critical but delay beyond 6 weeks could potentially impact overall outcome and/or the magnitude of benefit qualifies for intermediate priority;
- Low priority: Patient's condition is stable enough that services can be delayed for the duration of the COVID-19 pandemic and/or the intervention is non-priority based on the magnitude of benefit (e.g. no survival gain with no change nor reduced QoL).
Priorities for cervical cancer
Documented multidisciplinary tumour team (MDT) decision making, taking into account patient condition (vulnerable patients)* and available resources [Intensive Care Unit (ICU) support for surgery]. If not adequate, refer to or discuss with an Oncological Hub for gynaecological cancers.
Patients and family should be adequately informed about the risk/benefit ratio of each intervention with clinicians taking into account of national therapeutic or interventional guidelines or national specialty recommendations in relation to COVID-19.
*vulnerable patients: >65 years, pre-existing cardiovascular disease, pre-existing respiratory disease
Outpatient visit priorities
High Priority |
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Medium Priority |
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Low Priority |
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Priorities for cervical cancer: Imaging (CT scan/US)
High Priority |
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Medium Priority |
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Low Priority |
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For patients on clinical trials, seek information about changes in management for individual studies from the co-ordinating trials unit – treatment frequency, blood investigations and imaging
Priorities for cervical cancer: Surgical oncology
High Priority |
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Medium Priority |
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Low Priority |
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Priorities for cervical cancer: Medical oncology
High Priority |
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Medium Priority |
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Low Priority |
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*2018 FIGO classification.
Immune checkpoint inhibitors only within clinical studies.
Priorities for cervical cancer: Radiation oncology
High Priority |
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Medium Priority |
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Low Priority |
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List of abbreviations: BSO, bilateral salpingo-oophorectomy; CRT, chemoradiotherapy; CT, computed tomography; DVT, deep vein thrombosis; EBRT, external beam radiotherapy; SLN, sentinel lymph node; US, ultrasound.
References
NHS Clinical guide for the management of non-coronavirus patients requiring acute treatment: Cancer 23 March 2020, Version 2. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/specialty-guide-acute-treatment-cancer-23-march-2020.pdf (31 March 2020, date last accessed)
BGCS framework for care of patients with gynaecological cancer during the COVID-19 Pandemic (Final. 22/03/2020). https://www.bgcs.org.uk/wp-content/uploads/2020/03/BGCS-covid-guidance-v1.-22.03.2020.pdf (31 March 2020, date last accessed)
SGO surgical considerations for gynecologic oncologists during the COVID-19 pandemic (March 27, 2020). https://www.sgo.org/clinical-practice/management/covid-19-resources-for-health-care-practitioners/surgical-considerations-for-gynecologic-oncologists-during-the-covid-19-pandemic/ (31 March 2020, date last accessed)
Ramirez et al: COVID-19 Global pandemic: options for managements of gynaecologic cancers. Int J Gynecol Cancer 2020; 1-3.
Marth C., Landoni F., Mahner S., McCormack M., Gonzalez-Martin A. and Colombo N: Cervical Cancer: ESMO clinical practice guidelines. Ann Oncol 2017, 28 (suppl 4): iv72-iv83.
ESGO-ESTRO-ESP Guidelines for the Management of Patients with Cervical Cancer, 2017. https://guidelines.esgo.org/media/2018/04/Cervical-cancer-Guidelines-Complete-report.pdf (9 April 2020, date last accessed)