Older Cancer Patients during the COVID-19 Epidemic: Practice Proposal of the International Geriatric Radiotherapy Group
Older Cancer Patients during the COVID-19 Epidemic: Practice Proposal of the International Geriatric Radiotherapy Group
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DOI：
10.3390/cancers12051287
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发表时间：
2020-05-01
期刊：
影响因子：
5.2
通讯作者：
Thariat, Juliette
中科院分区：
文献类型：
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作者：
Nguyen, Nam P.;Vinh-Hung, Vincent;Thariat, Juliette
冠状病毒病19(新冠肺炎)大流行是史无前例的，因为它在创纪录的短时间内传播到世界所有国家。尽管新冠肺炎感染在任何成年人中可能都很严重，但老年人(65岁或以上)可能会经历更高的死亡率。在那些受影响的人中，癌症患者的预后可能比普通人群更差，因为他们的免疫状态低迷。由于大多数国家的卫生资源有限，临床医生可能会面临痛苦的决定，如果需要人工呼吸机，应该拯救哪些患者。癌症患者，特别是老年患者，可能会因为预期寿命较短而得不到支持性护理。因此，应特别考虑预防老年癌症患者感染，并在癌症治疗期间为他们提供足够的社会支持。达成了以下建议：(1)对卫生保健提供者进行教育，使他们了解老年癌症患者的特殊需要及其感染风险。(2)应特别考虑，例如外科口罩和分开的时间安排，以保护他们免受感染。(3)提供患者导航员等社会服务，确保有足够的医疗供应、食物和日常交通至癌症中心。(4)通过电话、通讯等密切监测，确保患者家属的社会距离和心理支持，预防焦虑和抑郁。(5)尽可能缩短放射治疗疗程，减少日常运输和感染暴露。(6)如果确实发生感染，招募老年癌症患者参加潜在的抗病毒药物的临床试验。(7)对于新冠肺炎感染的老年癌症患者，当医疗资源变得有限时，家庭健康护理远程医疗可能是避免入院的有效策略。(8)对于选定的患者，免疫治疗和靶向治疗可能成为老年癌症患者的系统治疗选择，需要在临床试验中进行测试。
The coronavirus disease 19 (COVID-19) pandemic is unprecedented as it reached all countries in the world within a record short period of time. Even though COVID-19 infection may be just severe in any adults, older adults (65-year-old or older) may experience a higher mortality rate. Among those affected, cancer patients may have a worse outcome compared to the general population because of their depressed immune status. As the health resources of most countries are limited, clinicians may face painful decisions about which patients to save if they require artificial ventilation. Cancer patients, especially the older ones, may be denied supportive care because of their shorter life expectancy. Thus, special considerations should be taken to prevent infection of older cancer patients and to provide them with adequate social support during their cancer treatment. The following proposal was reached: (1) Education of health care providers about the special needs of older cancer patients and their risks of infection. (2) Special consideration such as surgical masks and separate scheduling should be made to protect them from being infected. (3) Social services such as patient navigators should be provided to ensure adequate medical supply, food, and daily transportation to cancer centers. (4) Close monitoring through phone calls, telecommunication to ensure social distancing and psychological support from patient family to prevent anxiety and depression. (5) Shorter course of radiotherapy by use of hypofractionation where possible to decrease the needs for daily transportation and exposure to infection. (6) Enrollment of older cancer patients in clinical trials for potential antiviral medications if infection does occur. (7) Home health care telemedicine may be an effective strategy for older cancer patients with COVID-19 infection to avoid hospital admission when health care resources become restricted. (8) For selected patients, immunotherapy and targeted therapy may become the systemic therapy of choice for older cancer patients and need to be tested in clinical trials.