Clinical Oncology Guidance for Doctors in context to COVID-1
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ASCO encourages clinicians and oncology practices to follow this guidance where possible in the context of the coronavirus pandemic.The practice points may be considered to guide clinic preparation and planning:

Basic Treatment planning:

-For patients with fever or other symptoms of infection, a comprehensive evaluation should be
performed as per usual medical practice.
-For patients with diagnosed COVID-19 on active anti-cancer treatment, follow standard clinical
management plans for delay or modification of cancer treatment in a patient with active infection.
- Current information suggests that cancer patients have higher risk of infection and serious
complications from COVID-19 than other patients. For patients without known COVID-19 infection, in most circumstances it is likely more important to initiate or continue systemic cancer treatment than to delay or interrupt treatment due to concerns about potential COVID-19 infection. However, decisions should be individualized after considering the overall goals of treatment, the patient’s current oncologic status and treatment tolerance as well as their general medical condition.
- Consider whether home infusion of chemotherapy drugs is medically and logistically feasible for the patient, medical team and caregivers.
-Tamiflu is not known to be effective in treatment of COVID-19

Below are few practice points with given considerations to follow.

1. For patients with hematological malignancies

Delaying allogeneic stem cell transplantation In some cases of patients at high-risk for COVID-19, delaying a planned allogeneic SCT may be reasonable, particularly if the patient’s malignancy is controlled with conventional treatment.

Until further data are available, clinicians are encouraged to follow the recommendations provided by the ASTCT (https://www.astct.org/connect/astct-response-to-covid-19) and EBMT with respect to stem cell transplantation (https://www.ebmt.org/ebmt/news/coronavirus-disease-covid-19-updated-ebmtrecommendations-8th-march-2020).

Key practice points may be considered:
- It may be prudent to test potential donors for COVID-19 even in an absence of evidence on transmission by blood transfusion.
- As a general precaution, visitation post-transplant may need to be limited and visitors may need to be screened for symptoms and potential exposure.

2. Holding chemo for patients currently on treatment so that their immune systems can reconstitute as they get infected from likely community spread of COVID-19

Key practice points may be considered:
- For patients in deep remission who are receiving maintenance therapy, stopping chemotherapy may be an option.
- Some patients may be able to switch chemotherapy from IV to oral therapies, which would decrease the frequency of clinic visits.
- Decisions on modifying or withholding chemotherapy should include consideration of the indication for chemotherapy and the goals of care as well as where the patient is in the treatment course and their tolerance of treatment. For example, the risk: benefit assessment for proceeding with chemotherapy in patients with untreated extensive small cell lung cancer is different from that for patients on maintenance pemetrexed for metastatic NSCLC.
- Patients should be informed regarding the symptoms of COVID-19, and trained in proper
handwashing, hygiene, and minimizing exposure to sick contacts and large crowds.
- If a local transmission affects a particular cancer center, giving a chemotherapy break for two weeks, arranging infusion at an unaffected satellite unit or arranging treatment with another facility that is not affected, may be reasonable options.

3. Chemo in Risk of neutropenia may be a factor in patients becoming very unwell with COVID-19.

Key practice points to be followed:
- In some settings delays or modifying adjuvant treatment may pose a higher risk of compromised disease control and long-term survival than in others.
- Prophylactic growth factors would be used in high-risk chemotherapy regimens as well as Prophylactic antibiotics may be of potential value in maintaining the overall health of the patient and make them less vulnerable to potential COVID-19 complications.
- In cases where the absolute benefit of adjuvant chemotherapy may be quite small, and where non immunosuppressive options are available (e.g. hormonal therapy in ER+ early-stage breast cancer),potential exposure to COVID-19 may be considered as an additional factor in weighing the different options available to the patient.

About ASCO
Founded in 1964, the American Society of Clinical Oncology is the world's leading professional organization for physicians and oncology professionals caring for people with cancer.

Note: This list is a brief compilation of some of the key practice points included in the Guideline and is not exhaustive and does not constitute medical advice.

Kindly refer to the original publication in the document attached.
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