COVID-19 is prompting major reorganisation of NHS cancer services.
Cancer services have changed beyond recognition recently following new guidance from NHS England, published in March, outlining how oncology patients should be managed during the coronavirus pandemic.
The Clinical guide for the management of non-coronavirus patients requiring acute treatment: Cancer attempts to shape the priorities for cancer services over the coming months.
Under the new arrangements, each cancer unit will be headed by a ‘lead consultant’ who will be accountable for making rapid decisions in areas such as surgery and systemic anti-cancer treatment (SACT).
Surgery falls into strict priority categories. The first priority level is for emergencies where an operation is needed within 24 hours to save life, followed by urgent cases where an operation is needed within 72 hours.
The second priority level covers elective surgery, with the expectation of cure, required within the next four weeks. However, most patients will fall into the third category where treatment can be delayed for up to 12 weeks without causing harm.
The guide states that decisions on SACT, which covers chemotherapy and other drugs, will be made on a case by case basis with input from multi-disciplinary teams and patients themselves.
Nevertheless, there are strict priority levels, which put curative therapy with a greater than 50% chance of success at the top and indicate that there will be treatment rationing for people with less than a year to live.
However, in addition to these priorities, when determining treatment, clinicians will also have to weigh up a patient’s immune response, stage and progression, and balance them against their risk of contracting COVID-19.
So, for example, some patients on chemotherapy and other drugs that compromise the immune system, may have their treatment paused during the COVID-19 pandemic, regardless of their position on the priority list.
Other changes to drug treatment that should be considered under the guidance include swapping intravenous drugs, that must be administered in hospital, for subcutaneous or oral ones that can be taken at home.
Local service delivery
It is likely that there will be an increased demand for homecare support from chemotherapy nurses and allied healthcare professionals (HCPs) and also a need for consultant services to be delivered in the patient’s home, to reduce the risk of infection posed by attending hospital appointments. This could include telephone or virtual appointments.
Consultant oncologists, cancer surgeons and radiotherapists may be organised into regional hubs to support local service delivery and help the NHS to address key priorities in cancer care.
It is not clear how long this new guidance will be in place, but as the Royal College of Surgeons has warned, the impact of COVID-19 and the ‘mountainous backlog’ that is developing is likely to create issues that will take many years to resolve.
Oli Hudson is Content Director at Wilmington Healthcare. Go to www.wilmingtonhealthcare.com