All patients

1.1.

Communicate with patients and support their mental wellbeing, signposting to charities and support groups where available, to help alleviate any anxiety and fear they may have about COVID-19.

1.2.

Minimise face-to-face contact by:

• offering telephone or video consultations (particularly for follow-up appointments and pre-treatment consultations)
• cutting non-essential face-to-face follow-up
• using home delivery services for medicines if capacity allows
• introducing drive-through pick-up points for medicines
• using local services for blood tests if possible.

1.3.

Advise all patients to contact their local cancer chemotherapy helpline (rather than NHS 111) if they feel unwell to ensure their symptoms are appropriately assessed.

1.4.

Tell patients who still need to attend services to follow relevant parts of government advice on social distancing (this may differ across the UK), or UK government guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19. [amended 26 May 2020]

1.5.

Discuss with patients the individual factors that may affect their risk of becoming severely ill with COVID-19, including underlying conditions, older age, male sex, ethnicity, cancer symptoms and vaccination status.

See the UK Chemotherapy Board’s clinician frequently asked questions and guidance on COVID-19 vaccine for patients receiving systemic anti-cancer therapy (SACT). [12 February 2021]

Patients without COVID-19

1.6.

Ask patients to attend appointments without family members or carers, if they can, to reduce the risk of contracting or spreading SARS-CoV-2.

1.7.

Minimise time in the waiting area by:

• careful scheduling
• encouraging patients not to arrive early
• texting patients when you are ready to see them, so that they can wait in their car, for example.

Patients with known or suspected COVID-19

1.8.

When patients with known or suspected COVID-19 have been identified, follow appropriate UK government guidance on infection prevention and control. This includes recommendations on patient transfers, transport and options for outpatient settings.

1.9.

All healthcare workers involved in receiving, assessing and caring for patients with known or suspected COVID-19 should follow UK government guidance on infection prevention and control. This contains information on using personal protective equipment (PPE), including visual and quick guides for putting on and taking off PPE.

Shared decision making with individual patients

3.1.

Discuss with all patients the risks and benefits of starting, continuing or deferring systemic anticancer treatment. Include in the discussion:

• factors that may affect their risk of becoming severely ill with COVID-19, including underlying conditions, male sex, ethnicity, cancer symptoms and vaccination status
• that there is uncertainty whether patients who have received systemic anticancer treatment are at increased risk of becoming severely ill with COVID-19
• the possible greater risk of poor outcomes for patients with haematological cancers from COVID-19
• the possible greater risk of poor outcomes from COVID-19 with increasingly immunosuppressive systemic anticancer treatments.

Reach a shared decision with the patient about their treatment. [12 February 2021]

3.2.

If a patient has COVID-19, reach a shared decision about treatment but if possible defer systemic anticancer treatment:

• until at least 10 days after a positive test for SARS CoV 2, and
• until any significant symptoms have resolved. [12 February 2021]

Prioritising systemic anticancer treatments

3.3.

If systemic anticancer treatments need to be prioritised, use table 1 to help make these decisions. Take into account:

• the level of immunosuppression associated with individual treatments and cancer types, and any other patient-specific risk factors (including vaccination status) [amended 12 February 2021]
• capacity issues, such as limited resources (workforce, facilities, intensive care, equipment)
• balancing the risk of cancer not being treated optimally with the risk of the patient being immunosuppressed and becoming seriously ill from COVID-19.

Table 1

Prioritising systemic anticancer treatments [amended 3 April 2020].

Table adapted from NHS England’s clinical guide for the management of non-coronavirus patients requiring acute treatment: cancer.

3.4.

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.

3.5.

Clearly communicate, with written documentation if possible, what prioritisation is and the reason for the decision to patients, their families and carers.

Interim NHS England treatment options

4.8.

Be aware that to allow for flexibility in the management of cancer during the COVID-19 pandemic, NHS England has endorsed interim treatment options for some cancer medicines. This is to reduce the need for direct patient contact for administration of drugs and to minimise potential side effects that make people more susceptible to viral infections and other ill-health effects that may add pressure to the health system. These interim treatment options are based on clinical opinion from members of the NHS England Chemotherapy Clinical Reference Group and cancer pharmacists (see the interim treatment regimens for details). [9 April 2020]

4.9.

Be aware that treatment regimens will revert to the standard commissioned position once the emergency measures put in place to address the COVID-19 pandemic are no longer necessary. [9 April 2020]

4.10.

Discuss the risks and benefits of interim treatment regimens with patients, their families and carers. [9 April 2020]

4.11.

All patients who start on an interim treatment regimen during the COVID 19 pandemic should be allowed to continue the treatment until they and their clinician jointly decide it is appropriate to stop or to switch to a different treatment. [9 April 2020]

Treatment breaks

4.12.

It is proposed that the current treatment break policy, which applies to both Cancer Drugs Fund (CDF) and non-CDF treatments, will not be applied during the COVID-19 outbreak.

4.13.

Where a treatment break is needed, clinicians should complete the approval form to restart treatment, indicating that the patient had a break because of COVID-19. The request will be approved even if their disease has progressed, providing the clinician indicates there is a reasonable chance that disease control can be regained on restarting treatment. It is expected that the response to treatment will be reviewed 2 or 3 cycles after restarting. If disease control has not been regained treatment should be stopped.

1. Risk of systemic anticancer treatment in people with cancer and COVID-19

Are patients with cancer and COVID-19 who are receiving/have recently received systemic anticancer treatment (SACT) (that is, within the 4 weeks preceding a diagnosis of COVID-19) at increased risk of severe COVID-19 illness or death? [12 February 2021]

It is recommended that this research should also consider:

• if there are specific types of SACT carrying increased risk of poor outcomes from COVID-19
• if there are specific types of cancer for which SACT may carry increased risk of poor outcomes from COVID-19
• if there is a difference in any risk of poor outcomes from COVID-19 between people who have received SACT alone, radiotherapy alone, or both SACT and radiotherapy
• if there is a difference in any risk of poor outcomes from COVID-19 between children and young people who have received SACT and adults who have received SACT.

2. Duration of risk of systemic anticancer treatment in people with cancer and COVID-19

Are people who have had SACT recently (that is, within the 4 weeks preceding a diagnosis of COVID-19) at increased risk of poor outcomes from COVID-19 compared with those who had SACT less recently? [12 February 2021]

Minor changes since publication

26 May 2020: We aligned recommendation 1.4 with current government advice on social distancing and recommendation 2.5 with current government advice on managing exposed staff and patients in health and social care settings.