New report: maintaining a cancer service in the midst of the COVID-19 pandemic

NICE has published Maintaining a cancer service in the midst of the COVID-19 pandemic: a single centre experience, which charts the experiences of the Bristol Haematology and Oncology Centre during the pandemic.

Like many oncology hospitals, the Bristol Haematology and Oncology Centre was faced with difficult decisions around maintaining a service and continuing patients’ cancer management without increasing patients’ risk of mortality or morbidity from COVID-19. The report describes the escalation strategies used successfully by the centre with the aim of sharing learnings and prompting discussion ahead of a potential second wave of COVID-19 over the winter period.

The authors state: ‘For each patient, the risk from COVID-19 exposure had to be weighed against the risk of not receiving cancer treatments. We aimed to limit visits to secondary care. Where visits were unavoidable, we aimed to create the safest possible environment for both patients and staff in our inpatient and outpatient environments… We accepted that some patients would have treatments, imaging and follow up delayed but success would be gauged if the vast majority of patients received standard of care management on schedule without seeing large numbers of patients diagnosed with serious COVID-19 infections.’

Consequently, the delivery of cancer services at the Bristol Haematology and Oncology Centre changed significantly over the course pandemic: the centre switched from face-to-face outpatient clinic appointments to an almost entirely telephone-based outpatient service; where possible, patients were switched to oral medications and prescription length was extended to obviate the need for hospital visits; intravenous anti-cancer treatments were moved off site and entry to the hospital was strictly controlled to create COVID hot and cold zones; and regular meetings were set up between registrars, consultants, senior nursing staff, and management to discuss patient management, service provision, and training.