COVID-19 NICE Guidance - Delivery of systemic anti-cancer treatments

The purpose of this guideline is to maximise the safety of patients with cancer and make the best use of NHS resources while protecting staff from infection.

Communicating with patients

• Communicate with patients and support their mental wellbeing, signpost to charities and support groups, where available, to help alleviate any anxiety and fear they may have about COVID-19
• Minimise face-to-face content
• Inform patients who still need to attend services to follow relevant parts of the UK government guidance on social distancing/protecting older people and vulnerable adults

Patients not known to have COVID-19

• Ask patients to attend appointments without family members or carers if they can
• Minimise time in the waiting area

Patients known or suspected to have COVID-19 at presentation

• When patients with known or suspected COVID-19 have been identified follow appropriate UK government guidance on infection prevention and control
• All healthcare workers involved in receiving, assessing and caring for patients who have known or suspected COVID-19 should follow UK government guidance on infection prevention and control
• Be aware that patients with COVID-19 are at risk of severe disease following systemic anticancer treatment
• If a patient has COVID-19:
  • Only continue systemic anticancer treatment if it is needed for urgent control of the cancer
  • If possible, defer systemic anticancer treatment until the patient has at least 1 negative test for COVID-19

Patients with symptoms of COVID-19 at presentation

• If a patient not previously known or suspected to have COVID-19 shows symptoms on presentation, the general advice is to follow the UK government guidance on investigation and initial clinical management of possible cases
• Be aware that patients having systemic anticancer treatment are immunocompromised and may have an atypical presentation. Symptoms can include neutropenic sepsis and pneumonitis and may be difficult to differentiate at initial presentation
• Advise all patients to contact their local cancer chemotherapy helpline rather than NHS111 if they feel unwell to ensure their symptoms are appropriately assessed
• Screen and triage all patients to assess whether they are known or suspected to have COVID-19, or have been in contact with someone with confirmed infection
• If patients have a fever (with or without respiratory symptoms) suspect neutropenic sepsis because this can be rapid and life-threatening, and follow NICE guidance on neutropenic sepsis
• If COVID-19 is later diagnosed in someone not isolated from admission or presentation follow UK government guidance for health professionals

Staff who are self-isolating

• If healthcare professionals need to self-isolate ensure that they can continue to help by telephone/video consultations, remote monitoring of patients etc
• Support staff to keep in touch as much as possible, to support their mental wellbeing

Prioritising systemic anticancer treatments

• If systemic anticancer treatments need to be prioritised – NICE has provided a table in this guide to follow.
• Make prioritisation decisions as part of a multidisciplinary team and ensure each patient is considered on an individual basis – ensure the reasoning behind each decision is recorded.
• Clearly communicate with written documentation if possible, what prioritisation is and the reason for the decision to patients, their families and carers.