ESMO guidelines for treating lung cancer in COVID-19 era

by Cancer Consult India Cancer Consult India

2020 brought in a new decade and a brand new pandemic. Everybody is afraid and confused, especially people with pre-existing conditions, like cancer patients. Therefore, the European Society for Medical Oncology or ESMO is providing cancer patients with recommendations appropriate for the COVID-19 debacle. Now, for lung cancer patients, they have curated a specified recommendation chart. In this blog, we will discuss the same.

No systemic reports are suggesting that lung cancer patients or cancer patients as a whole are more susceptible to getting infected; i.e., cancer DOES NOT increase your vulnerability to getting infected with the novel coronavirus. But, many cancer patients are immunocompromised, and lung cancer patients already deal with scar tissues on their lungs; this is what makes them more susceptible to getting infected and more susceptible to suffering from severe symptoms, respectively, according to the best cancer doctors.

So, here are the recommendations/guidelines for you by ESMO if you’re a lung cancer patient or caring for a lung cancer patient.

Guidelines for treating lung cancer patients during COVID-19 pandemic by ESMO

Outpatient Visit-How to prioritize

Cancer survivors, patients with low/intermediate risk of relapse, and patients visiting facilities for psychological support fall under the low priority group. However, even the best oncologists in Delhi, India, and all over the world are assuring patients that whether they can come in or not, they will get support through telemedicine whenever possible.
Newly diagnosed patients, post-operative patients with zero complications, follow-up patients with a high risk of relapse, patients facing treatment-related symptoms, and patients suspected of localized lung cancer of clinical stage I fall under the medium priority group.
People with newly diagnosed invasive lung cancer, people under the suspicion of invasive lung cancer, and people receiving regular lung cancer treatment fall under the high priority group.

If you need any more information about the outpatient visit guidelines for lung cancer patients, you can consult a reputed cancer specialist in Delhi or anywhere in India, like Dr. Manish Singhal, the best lung cancer doctor in Delhi NCR.

Lung disease priorities-Imaging

Patients who need follow-up imaging for high/intermediate risk of relapse more than a year after finishing radical treatment, people after radical treatment with a low risk of relapse needing follow-up imaging, patients who need follow-up of nodules of incidental finding (special cases), and people who need lung cancer screening are categorized as low priority.
Patients who need follow-up imaging for high/intermediate risk of relapse within a year of finishing radical treatment, people who need standard staging work-up for early stage lung cancer, people who need biopsies of suspicious nodules or masses for suspected invasive cancer of unknown stages, lung cancer patients with new issues from treatment, stable patients who need active treatment response evaluation within 6 months, and patients who need follow-up of nodules of incidental finding (higher priority cases) are categorized as medium priority.
Patients who require staging work-up for lung cancer of suspected higher stages, patients with respiratory/cancer-related/cancer treatment related symptoms, patients needing biopsies for nodules at higher stages, patients who are suspected to be progressing in spite of treatment after 6 months, and patients with pre-planned image evaluation are categorized as high priority.

Surgical Oncology

Lung cancer patients needing discordant biopsies likely to be benign, patients needing diagnostic work-up (special cases), etc. are primarily low priority in this group.
Lung cancer patients needing discordant biopsies likely to be malignant, patients needing diagnostic work-up (special cases), and people with resectable NSCLC with T1AN0 are primarily medium priority in this group.
People who need drainage +/- pleurodesis of pleural effusion, pericardial effusion, tamponade risk, people who need evacuation of empyema-abscess, people with T2N0 or resectable T3/T4 tumors or resectable N-1/N2 disease naive from treatment/induction chemotherapy, and people in need of special diagnostic procedures are considered to be of high priority.

Medical Oncology

Early Stage

People needing adjuvant chemotherapy in stage T1A-T2bN0 with negative prognostic features or advanced age or comorbidities are low priority according to best cancer doctors providing lung cancer treatment in Delhi, India, and worldwide.
People needing adjuvant chemotherapy in T2b-T3N0 or N1 disease, and people needing medical follow-up or blood check between two cycles should be prioritized based on their condition and are categorized as medium priority.
People who need concomitant chemoradiotherapy for SCLC limited disease stage I/II, neoadjuvant chemotherapy (special case), delivery of adjuvant chemotherapy in T3/4, or N2 disease (special case), and G-CSF use (special case) should be given high priority.

As the stages progress, people need more and more care, and even during the pandemic, the need does not change. In the case of locally advanced lung cancer, people need a more controlled, regular treatment plan. So, ESMO does not consider any case to be of low priority. However, most cases lie in the medium priority or high priority category. For metastatic lung cancer patients, the approach is more aggressive and needs more in-house control, so they are considered to be high priority cases.

If you need more information or guidance, don’t forget to look up ESMO’s guidelines and always consult your oncologist for a better treatment plan during these difficult times. Also, if you need a second opinion or more insight, you can consult an experienced cancer specialist like Dr. Manish Singhal, lauded as one of the best oncologist in Delhi.

Radiation Oncology

People needing adjuvant PORT N2 R0 & non-life-threatening conditions should be given priority based on specific requirements, and PCI in extensive stage SCLC after chemotherapy may be replaced by MRI active surveillance.
People who need SABR-SBRT for stage I cancers, Adjuvant PORT for R1 resection (special cases), or PCI in limited stage SCLC after chemotherapy come under medium priority.
Cancer patients who need Radiotherapy for inoperable stage II-III cancers (special cases), Concomitant (preferred) or sequential chemoradiotherapy for inoperable NSCLC Stage II/III, and Concomitant (preferred) or sequential chemoradiotherapy for SCLC limited disease; along with people who experience life-threatening conditions are considered to be of high priority.

A few parting words

Yes, these are difficult, in fact, utterly chaotic times. But, you DO NOT need to worry. The best cancer doctors around the world have created guidelines for you. And you can get the best support, the best care from oncologists keeping themselves updated and innovating regularly to accommodate you, like Dr. Manish Singhal.

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