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NHS guidance for healthcare professionals

NHS guidance for managing cancer patients during the coronavirus pandemic – what does this mean for me and my cancer treatment?

NHS England have produced guidance for healthcare professionals to help them manage treatment for cancer patients during the coronavirus pandemic. This advice is being used by NHS organisations in all UK nations. We’ve produced a summary of this guidance below to help you understand what this may mean for you. We advise you to speak to your GP or treatment team to get tailored information for your individual circumstances. 

Why are cancer services being affected?

Although cancer services aren’t at the forefront of the pandemic, there is a lot of pressure on the NHS as a whole. Healthcare professionals and those planning services are working hard to make sure essential cancer services continue, but some non-urgent treatments may be reduced. Some healthcare professionals may also need to work outside of their specific areas of expertise to deliver treatment and care.

What will happen to my cancer treatment?

Clinicians will always make decisions to prioritise treatment for those most in need and in consultation with patients.

Many hospitals have started to use more telephone consultations as a way of helping people to avoid long waits in clinics and for treatment. You may be called to arrange your treatments in this way, and planned treatments may need to be moved to help with running a smooth service.

Your clinical team are best placed to talk with you about the effect on your treatment and appointments.  They will work with you to determine the best course of action in each individual situation. If you have any concerns or questions about your treatment, please speak to your clinical team.

Am I more at risk?

Some people with cancer are more at risk of becoming seriously ill from coronavirus. If you are currently having cancer treatment you may be at greater risk of becoming more unwell if you get coronavirus. This risk could be higher if you are also over 60 or have other health conditions such as diseases affecting your heart or lungs. Your medical team will think about whether the risks of beginning or continuing cancer treatment outweigh the benefits when making treatment decisions.

Will my surgery be delayed?

At the moment, the coronavirus pandemic doesn’t mean that everyone will experience delays to their surgery. If any surgery does need to be delayed, clinicians will look at how urgently each patient needs to have surgery.  This will help them decide which operations will go ahead as planned and which ones might need to be delayed. They will use the following groups to help them make these decisions if required (priority level 1 is seen as the most urgent and level 3 is the least urgent):

Priority level 1a: an emergency operation is needed within 24 hours to save life

Priority level 1b: an urgent operation is needed within 72 hours

Surgery falling into groups 1a and 1b include things like:

  • an obstruction (or blockage)
  • bleeding
  • infection
  • if your disease has progressed and is causing you injury or harm (for example if there is a lot of pressure on your spinal cord, known as spinal cord compression)

Priority level 2:  a non-urgent operation is needed to try and cure your cancer or stop the disease progressing within four weeks.

  • How quickly you have surgery will depend on the severity of any symptoms or complications you’re having and how quickly your cancer is likely to grow.
  • If your operation falls under this category, you might be able to have other types of treatment whilst you’re waiting for surgery (for example, you may be able to have a colonic stent)  

Priority level 3 – a non-urgent operation that can be delayed for 10-12 weeks 

Can I still have chemotherapy, targeted or immunotherapy?

At the moment the coronavirus pandemic doesn’t mean that everyone will experience delays to their treatment. If any treatment needs to be delayed, clinicians will look at how urgently each patient needs to have treatment. They will use the following groups to help them make these decisions if required (priority level 1 is seen as the most urgent and level 6 is the least urgent):

Priority level 1:

    • Treatment aims to cure the cancer, and is likely to have a high chance of success.
    • Treatment which is likely to significantly increase the chance of success when given alongside other treatment, such as surgery.

Priority level 2:

    • Treatment aims to cure the cancer and is likely have a moderate chance of success.
    • Treatment which is likely tooffer a moderate chance of curing the cancer when given alongside other treatment, such as surgery.

Priority level 3:

    • Treatment aims to cure the cancer but has a low chance of success.
    • Treatment which is likely to offer a low chance of curing the cancer when given alongside other treatment, such as surgery.
    • Treatment aims to prolong life, rather than cure the cancer. There is a high chance that the treatment could extend life by more than one year

Priority level 4:

    • Treatment aims to cure the cancer but has a very low chance of success. This includes additional treatment offered alongside, such as surgery.
    • Treatment aims to prolong life, rather than cure the cancer. There is a moderate chance that the treatment could extend life by more than one year

Priority level 5:

  • There’s a high chance that the treatment could help control symptoms and improve quality of life, but is not likely to extend life by more than one year

Priority level 6:

  • There’s a moderate chance that the treatment could help control symptoms and improve quality of life, but is not likely to extend life by more than one year 

Could I have a different type of treatment or over a different length of time?

  • Depending on what drug you are having, you might be able to take your treatment in a different way. For example, if you usually have a drip or infusion, it might be possible to have a tablet version of your medicine if this is available.
  • You might be able to have your treatment over a shorter length of time or the time between your treatment cycles might change. For example, if you usually have treatment every two weeks, this might change to every four or six weeks.
  • If you usually have your treatment in a tablet form, you might be given a larger supply of your medicine to keep you going for a longer period.
  • If you’re having other treatments to help keep your bones strong (such as denosumab) this might be temporarily stopped.
  • You might be able to have your treatment at home if it’s available in a tablet form.
  • You might be given additional treatment alongside your normal treatment to help promote your blood cells to grow and boost your immune system. This extra treatment is known as GSCF (granulocyte-colony stimulating factor).
  • Your clinical team might suggest you take a treatment break when risk of coronavirus is high.
  • Some of your usual appointments and check-ups might change. For example, you might have blood tests locally or have more appointments over the phone or via video. 

Will my radiotherapy treatment be delayed?

At the moment the coronavirus pandemic doesn’t mean that everyone will experience delays to their radiotherapy treatment. If any treatment needs to be delayed, clinicians will look at how urgently each patient needs to have treatment. They will use the following groups to help them make these decisions if required (priority level 1 is seen as the most urgent and level 5 is the least urgent):

Priority level 1:

  • high doses of radiotherapy (or a combination of chemotherapy and radiotherapy) is already being used to try and cure a fast growing cancer and there is no allowance for gaps between treatment
  • radiotherapy is already being delivered from outside the body (external beam radiotherapy) and radiotherapy from inside the body (brachytherapy) is planned afterwards to treat a fast growing cancer
  • If radiotherapy hasn’t started yet, it may still go ahead if there is an urgent need to start it in line with current cancer waiting times

Priority level 2:

  • Radiotherapy is being used to treat patients whose cancer is putting pressure on their spinal cord (spinal cord compression)

Priority level 3:

  • high doses of radiotherapy are being used as a first treatment to try and cure a less aggressive cancer
  • radiotherapy is being given after surgery to try and destroy any cancer that still remains

Priority level 4:

  • Radiotherapy is being used to try and treat symptoms, improve quality of life or slow down growth of the cancer.

Priority level 5:

  • Radiotherapy is being given after surgery and there is a low risk that the cancer will come back within 10 years.

Will I still have face to face appointments?

You are likely to have more consultations via telephone or video where possible. Some appointments such as follow up visits might be delayed or cancelled.

You may be asked not to arrive for your appointment early. Some hospitals may ask you to wait in your car and they will let you know when they’re ready for you to see them.

We’ve worked with the One Cancer Voice group of 19 cancer charities to produce advice on coronavirus for people with cancer. Read the FAQs here

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