Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group

Nicolò Matteo Luca Battisti¹, Anna Rachelle Mislang², Lisa Cooper³, Anita O'Donovan⁴, Riccardo A Audisio⁵, Kwok-Leung Cheung⁶, Regina Gironés Sarrió⁷, Reinhard Stauder⁸, Enrique Soto-Perez-de-Celis⁹, Michael Jaklitsch¹⁰, Grant R Williams¹¹, Shane O'Hanlon¹², Mahmood Alam¹³, Clarito Cairo¹⁴, Giuseppe Colloca¹⁵, Luiz Antonio Gil Jr¹⁶, Schroder Sattar¹⁷, Kumud Kantilal¹⁸, Chiara Russo¹⁹, Stuart M Lichtman²⁰, Etienne Brain²¹, Ravindran Kanesvaran²², Hans Wildiers²³

Affiliations

¹ Breast Unit, Department of Medicine Department, The Royal Marsden NHS Foundation Trust, Breast Cancer Research Division, The Institute of Cancer Research, London, UK. Electronic address: nicolo.battisti@rmh.nhs.uk.
² Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Bedford Park, SA, Australia. Electronic address: Anna.Mislang@sa.gov.au.
³ Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: lcooper5@bwh.harvard.edu.
⁴ Discipline of Radiation Therapy, Trinity College, Dublin, Ireland. Electronic address: Anita.ODonovan@tcd.ie.
⁵ Department of surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: raudisio@doctors.org.uk.
⁶ School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK. Electronic address: kl.cheung@nottingham.ac.uk.
⁷ Department of Medical Oncology, Hospital Universitari i Politècnic La FE, Valencia, Spain.
⁸ Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria. Electronic address: reinhard.stauder@i-med.ac.at.
⁹ Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Electronic address: enrique.sotop@incmnsz.mx.
¹⁰ Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. Electronic address: mjaklitsch@bwh.harvard.edu.
¹¹ Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. Electronic address: grwilliams@uabmc.edu.
¹² University College Dublin, St Vincent's University Hospital, Dublin, Ireland. Electronic address: shaneohanlon@svhg.ie.
¹³ Pfizer Oncology, Asia Pacific Region, Australia. Electronic address: Mahmood.Alam2@pfizer.com.
¹⁴ National Integrated Cancer Control Program, Department of Health, Manila, Philippines.
¹⁵ Policlinico A. Gemelli, Rome, Italy.
¹⁶ Geriatric Division, São Paulo University, São Paulo, Brazil.
¹⁷ College of Nursing, University of Saskatchewan, Regina, Canada. Electronic address: schroder.sattar@usask.ca.
¹⁸ School of Pharmacy, University of East Anglia, Norwich, UK. Electronic address: k.kantilal@uea.ac.uk.
¹⁹ Department of Medical Oncology, Centre Léon Bérard, Regional Comprehensive Cancer Centre, Claude-Bernard Lyon-1 University, Lyon, France. Electronic address: Chiara.RUSSO@lyon.unicancer.fr.
²⁰ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: LichtmaS@mskcc.org.
²¹ Department of Medical Oncology, Institut Curie/Saint-Cloud, Paris, France. Electronic address: Etienne.brain@curie.fr.
²² Department of Medical Oncology, National Cancer Centre Singapore, Singapore. Electronic address: ravindran.kanesvaran@singhealth.com.sg.
²³ Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium. Electronic address: hans.wildiers@uzleuven.be.

PMID: 32709495
PMCID: PMC7365054
DOI: 10.1016/j.jgo.2020.07.008

Practice Guideline

Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group

Nicolò Matteo Luca Battisti et al. J Geriatr Oncol. 2020 Nov.

. 2020 Nov;11(8):1190-1198.

doi: 10.1016/j.jgo.2020.07.008. Epub 2020 Jul 16.

Authors

Affiliations

¹ Breast Unit, Department of Medicine Department, The Royal Marsden NHS Foundation Trust, Breast Cancer Research Division, The Institute of Cancer Research, London, UK. Electronic address: nicolo.battisti@rmh.nhs.uk.
² Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Bedford Park, SA, Australia. Electronic address: Anna.Mislang@sa.gov.au.
³ Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: lcooper5@bwh.harvard.edu.
⁴ Discipline of Radiation Therapy, Trinity College, Dublin, Ireland. Electronic address: Anita.ODonovan@tcd.ie.
⁵ Department of surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: raudisio@doctors.org.uk.
⁶ School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK. Electronic address: kl.cheung@nottingham.ac.uk.
⁷ Department of Medical Oncology, Hospital Universitari i Politècnic La FE, Valencia, Spain.
⁸ Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria. Electronic address: reinhard.stauder@i-med.ac.at.
⁹ Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Electronic address: enrique.sotop@incmnsz.mx.
¹⁰ Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. Electronic address: mjaklitsch@bwh.harvard.edu.
¹¹ Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. Electronic address: grwilliams@uabmc.edu.
¹² University College Dublin, St Vincent's University Hospital, Dublin, Ireland. Electronic address: shaneohanlon@svhg.ie.
¹³ Pfizer Oncology, Asia Pacific Region, Australia. Electronic address: Mahmood.Alam2@pfizer.com.
¹⁴ National Integrated Cancer Control Program, Department of Health, Manila, Philippines.
¹⁵ Policlinico A. Gemelli, Rome, Italy.
¹⁶ Geriatric Division, São Paulo University, São Paulo, Brazil.
¹⁷ College of Nursing, University of Saskatchewan, Regina, Canada. Electronic address: schroder.sattar@usask.ca.
¹⁸ School of Pharmacy, University of East Anglia, Norwich, UK. Electronic address: k.kantilal@uea.ac.uk.
¹⁹ Department of Medical Oncology, Centre Léon Bérard, Regional Comprehensive Cancer Centre, Claude-Bernard Lyon-1 University, Lyon, France. Electronic address: Chiara.RUSSO@lyon.unicancer.fr.
²⁰ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: LichtmaS@mskcc.org.
²¹ Department of Medical Oncology, Institut Curie/Saint-Cloud, Paris, France. Electronic address: Etienne.brain@curie.fr.
²² Department of Medical Oncology, National Cancer Centre Singapore, Singapore. Electronic address: ravindran.kanesvaran@singhealth.com.sg.
²³ Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium. Electronic address: hans.wildiers@uzleuven.be.

PMID: 32709495
PMCID: PMC7365054
DOI: 10.1016/j.jgo.2020.07.008

Abstract

The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.

Keywords: COVID-19; Competing risks; Geriatric oncology; Older patients; Recommendations; SARS-CoV-2.

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Figures

**Fig. 1**
Factors to consider in treatment decision-making for older patients with cancer during the COVID-19 pandemic.

See this image and copyright information in PMC

Comment in

The SIOG COVID-19 working group recommendations on the rollout of COVID-19 vaccines among older adults with cancer.
Mislang AR, Soto-Perez-de-Celis E, Russo C, Colloca G, Williams GR, O'Hanlon S, Cooper L, O'Donovan A, Audisio RA, Cheung KL, Sarrió RG, Stauder R, Jaklitsch M, Cairo C, Gil LA Jr, Sattar S, Kantilal K, Loh KP, Lichtman SM, Brain E, Wildiers H, Kanesvaran R, Battisti NML. Mislang AR, et al. J Geriatr Oncol. 2021 Jun;12(5):848-850. doi: 10.1016/j.jgo.2021.03.003. Epub 2021 Mar 5. J Geriatr Oncol. 2021. PMID: 33715995 Free PMC article. No abstract available.

References

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1. Kuderer N.M., et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. The Lancet. 2020;395(10241):1907–1918. doi: 10.1016/S0140-6736(20)31187-9. Epub 2020 May 28. - DOI - PMC - PubMed
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1. Liang W., et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335–337. - PMC - PubMed

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Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group

Affiliations

Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group

Authors

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