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Applying Lessons Learned From Low-Resource Settings to Prioritize Cancer Care in a Pandemic.
DeBoer, Rebecca J; Fadelu, Temidayo A; Shulman, Lawrence N; Van Loon, Katherine.
  • DeBoer RJ; Division of Hematology/Oncology, University of California, San Francisco.
  • Fadelu TA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
  • Shulman LN; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
  • Van Loon K; Abramson Cancer Center, University of Pennsylvania, Philadelphia.
JAMA Oncol ; 6(9): 1429-1433, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-807051
ABSTRACT
Importance The coronavirus disease 2019 (COVID-19) pandemic has forced oncology clinicians and administrators in the United States to set priorities for cancer care owing to resource constraints. As oncology practices adapt to a contracted health care system, expertise gained from partnerships in low-resource settings can be used for guidance. This article provides a primer on priority setting in oncology and ethical guidance based on lessons learned from experience with cancer care priority setting in low-resource settings. Observations Lessons learned from real-world experiences are myriad. First, in the setting of limited resources, a utilitarian approach to maximizing survival benefit should guide decision-making. Second, conflicting principles will often arise among stakeholders and decision makers. Third, fair decision-making procedures should be established to ensure moral legitimacy and accountability. Fourth, proactive safeguards must be implemented to protect vulnerable individuals, or disparities in cancer treatment and outcomes will only widen further. Fifth, communication with patients and families about priority setting decisions should be intentional and standardized. Sixth, moral distress among clinicians must be addressed to avoid burnout during a time when resilience is critical. Conclusions and Relevance Although the need to triage cancer care may be new to those who underwent training and now practice oncology in high-resource settings, it is familiar for those who practice in low- and middle-income countries. Oncologists in the United States facing unprecedented decisions about prioritization can draw on ethical frameworks and lessons learned from real-world cancer care priority setting in resource-constrained environments.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Oncology Service, Hospital / Coronavirus Infections / Pandemics / Neoplasms Type of study: Observational study / Prognostic study / Qualitative research Topics: Long Covid Limits: Humans Country/Region as subject: North America Language: English Journal: JAMA Oncol Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Oncology Service, Hospital / Coronavirus Infections / Pandemics / Neoplasms Type of study: Observational study / Prognostic study / Qualitative research Topics: Long Covid Limits: Humans Country/Region as subject: North America Language: English Journal: JAMA Oncol Year: 2020 Document Type: Article