Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic

Abstract

During the COVID-19 global pandemic, the cancer community faces many difficult questions. We will first discuss safety considerations for patients with cancer requiring treatment in SARS-CoV-2 endemic areas. We will then discuss a general framework for prioritizing cancer care, emphasizing the precautionary principle in decision making.

Fig. 1. Conceptual framework for prioritizing the use of radiotherapy and systemic treatments during the COVID-19 pandemic.

The lowest and highest priority categories are unevenly spaced to illustrate the concept that prioritization between subgroups is variable. The spacing of categories in this diagram is conceptual rather than prescriptive. Priority of indications within each category is also variable and subject to the principles discussed in the commentary. These include the magnitude of treatment benefit, possible effects of treatment delays or interruptions on outcomes, patient-specific considerations and the availability of staff and resources to safely deliver treatment. This overlap implies that some items listed in a lower category could be prioritized over items listed in a higher category. Disease indications in each box are meant to serve as illustrative examples and are not intended to be an exhaustive list. NSCLC, non-small-cell lung cancer.