Treating the SARS-CoV-2-positive patient with cancer: A proposal for a pragmatic and transparent ethical process

Abstract

The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment prioritization committee, including physicians, frontline staff, an ethicist, and an infectious disease expert. Organizational obligations to health care workers also are discussed. The treatment prioritization committee sets a threshold of acceptable harm to patients from decreased cancer control that is justified to reduce risk to staff. The creation of an ethical, consistent, and transparent decision-making process involving such frontline stakeholders is essential as departments across the country are faced with decisions regarding the treatment of SARS-CoV-2-positive patients with cancer.

Keywords: bioethics; coronavirus disease 2019 (COVID-19); patient safety; quality improvement; radiation oncology.

Figure 1

Flowchart of the radiation oncology treatment prioritization committee process for patients who are positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and are undergoing active cancer treatment. EMR indicates electronic medical record; ID, infectious disease; RT, radiotherapy.