Optimal cancer care in the context of COVID-19 in Australia

ABSTRACT

Background: Cancer Australia (CA), Australia’s national cancer control agency, aims to reduce the impact of cancer, address disparities and improve cancer outcomes. The approach to cancer care needs to be tailored to different phases of the pandemic and the multiple competing priorities driving healthcare. These include the likely increased risks to cancer patients of acquiring COVID-19 and of serious illness or mortality, the limitations of resources, the possibility of the healthcare system being overwhelmed and the risks of delaying cancer diagnosis and treatment. CA is in unique position to undertake this project. Methods: Australia’s Optimal Care Pathways (OCPs) for people with cancer guide the delivery of consistent, safe, high-quality and evidence-based care for people with cancer. Using published data, guidelines and recommendations, CA has developed a conceptual framework for system-wide approaches to cancer management in line with the OCPs mapped to different stages and potential severities of the COVID-19 pandemic. Results: A conceptual framework for optimal management of cancer during the COVID-19 pandemic has been developed, taking the journey from prevention and early detection through to survivorship and end-of-life care. Opportunities for evidence-based, risk-based and consensus-based decision-making about modifications to management which aim to both improve patient outcomes and minimise their exposure to, and risk of harm from, COVID-19 are mapped according to 3 acute phases (the beginning of the pandemic, approaching hospital capacity, and hospital capacity exceeded) and 2 recovery phases (early and late) of the pandemic. Second and subsequent waves of infection can also be accommodated. Some modifications to care will be of permanent value (and the pandemic has therefore driven improvement). Telemedicine is one example. Conclusions: This conceptual framework provides guidance on optimal management of cancer during the COVID-19 pandemic, is intended as a useful resource, and while designed with the Australian healthcare system and this COVID-19 pandemic in mind, is readily transferrable to any jurisdiction and for any pandemic. Lessons need to be learned for the future so that advances are not lost. Legal entity responsible for the study Cancer Australia. Funding: Has not received any funding. Disclosure All authors have declared no conflicts of interest.