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General Treatment 

General Treatment Suggestions

Application of the suggestions herein are dependent on:

  • Prevalence of COVID-19 in the patient’s community and associated risk of COVID-19 infection.

  • Duration of COVID-19 endemically, since these guidelines are for temporary consideration during the local COVID-19 surge.

  • Age of the patient being AYA, since more AYAs with cancer have died of COVID-19 than children (Figs. 1 & 2     ).

  • Type of therapy (surgery, radiation, chemotherapy, immunotherapy, etc.) and whether or not on treatment.

  • Clinical trial status of the patient (view clinical trial status information     ).

General Care

  • Enable as much indicated and planned primary therapy as possible

  • Delay surgery and radiotherapy as feasible, e.g. with neoadjuvant chemotherapy

  • Reduce/eliminate as many clinic and hospital visits as possible

  • Rely on telehealth

  • Use direct mail medication prescriptions

  • Enable blood tests and chemotherapy at home, whenever feasible

  • Use home health services, outside labs, and for essential routine clinic visits, provide facility separate from the clinic.

  • Reduce the likelihood of fever and neutropenia (F&N) and need for rapid evaluation and institution of intravenous antibiotics

  • Reduce the most immunosuppressive components of therapy (e.g., corticosteroid, type and duration of treatment)

  • Extend intravenous port flush intervals to 8-12 weeks, and have home health services accomplish if feasible

  • Administer GCSF if patient is severely neutropenic (ANC <0.5) and expected to be severely neutropenic for several days

  • Avoid GMCSF, that may increase viral growth and/or worsen ARDS

  • Use IVIG for documented hypogammaglobulinemia

  • Help preserve blood products by adhering to conservative transfusion thresholds

  • Encourage family and friends to continue to donate to the general blood bank pool regularly during the COVID-19 crisis

Newly-Diagnosed or Relapsing Patients

Recognize that patients with a new diagnosis or in remission may present at more advanced stages

given reluctance to present for medical attention or travel challenges

COVID-19 Screening

  • Screen patient prior to any major procedure (surgery, radiation) or phase of chemotherapy

  • If positive have the phase delayed until the patient recovers and/or repeat testing is negative

Fever and Neutropenia (F&N)

  • Screen for active COVID-19 infection, whether or not symptomatic of infection

  • Assume to have COVID-19 if any related symptoms

  • Admit directly to the hospital, bypassing clinic and Emergency Department/Entrance

  • Hospitalize in a room with negative pressure or laminar flow, if available

  • If hospitalization delayed, arrange for initial IV antibiotic dose at home

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