COVID-19
General Treatment
General Treatment Suggestions
Application of the suggestions herein are dependent on:
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Prevalence of COVID-19 in the patient’s community and associated risk of COVID-19 infection.
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Duration of COVID-19 endemically, since these guidelines are for temporary consideration during the local COVID-19 surge.
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Age of the patient being AYA, since more AYAs with cancer have died of COVID-19 than children (Figs. 1 & 2 ).
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Type of therapy (surgery, radiation, chemotherapy, immunotherapy, etc.) and whether or not on treatment.
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Clinical trial status of the patient (view clinical trial status information ).
General Care
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Enable as much indicated and planned primary therapy as possible
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Delay surgery and radiotherapy as feasible, e.g. with neoadjuvant chemotherapy
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Reduce/eliminate as many clinic and hospital visits as possible
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Rely on telehealth
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Use direct mail medication prescriptions
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Enable blood tests and chemotherapy at home, whenever feasible
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Use home health services, outside labs, and for essential routine clinic visits, provide facility separate from the clinic.
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Reduce the likelihood of fever and neutropenia (F&N) and need for rapid evaluation and institution of intravenous antibiotics
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Reduce the most immunosuppressive components of therapy (e.g., corticosteroid, type and duration of treatment)
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Extend intravenous port flush intervals to 8-12 weeks, and have home health services accomplish if feasible
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Administer GCSF if patient is severely neutropenic (ANC <0.5) and expected to be severely neutropenic for several days
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Avoid GMCSF, that may increase viral growth and/or worsen ARDS
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Use IVIG for documented hypogammaglobulinemia
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Help preserve blood products by adhering to conservative transfusion thresholds
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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
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Screen patient prior to any major procedure (surgery, radiation) or phase of chemotherapy
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If positive have the phase delayed until the patient recovers and/or repeat testing is negative
Fever and Neutropenia (F&N)
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Screen for active COVID-19 infection, whether or not symptomatic of infection
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Assume to have COVID-19 if any related symptoms
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Admit directly to the hospital, bypassing clinic and Emergency Department/Entrance
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Hospitalize in a room with negative pressure or laminar flow, if available
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If hospitalization delayed, arrange for initial IV antibiotic dose at home