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COVID-19 and older patients with cancer

COVID-19 is affecting the whole world, but older persons with cancer are among the highest risk groups for suffering more than others. Both older persons and patients with cancer are at increased risk of obtaining COVID-19 and dying from it, and the 2 risk factors add on. Moreover, older persons with cancer are at highest risk of being excluded from intensive care support for COVID-19 infection and/or adequate cancer treatment if resources are limited.

SIOG therefore wants to make some concrete statements and practical recommendations for all health care workers dealing with older persons with cancer. It should be clearly acknowledged that these are empirical considerations, not based on solid science, which doesn’t exist yet unfortunately.

  • More than ever, for every individual patient, physicians should search strategies to avoid undertreatment of the cancer while also avoiding overtreatment and useless hospital visits where patients potentially come in contact with the COVID-19. We need to protect older persons with cancer both from COVID-19 and from their cancer.
  • Chronological age is NOT a good parameter to omit visits or oncological treatments that provide true benefits for older patients. Some kind of geriatric or frailty evaluation can help to evaluate the global health status and propose individualized treatment plans.
  • Minimize face-to-face appointments by using tele-consultations, cutting of non-essential follow-up visits, reduce dwell time in services, home delivery of oral systemic therapy.
    - Many options are available to optimally support and treat older persons with cancer;
    - Timing and indications of surgery should be discussed multidisciplinary and with patient and caregivers, and in some situation, alternative bridging strategies may be useful;
    - Radiotherapy indications and timing need to be balanced well and put in context with the risks of frequent hospital visits;
    - Concerning systemic therapies, many different strategies can be considered such as subcutaneous home administrations instead of intravenous in hospital administrations, dispensing longer periods for oral medications, having oral drugs delivered at home by courier, increasing intervals between treatments or treatment breaks, separate rooms in the hospital for vulnerable patients in order to avoid contact with other patients;
  • Don’t forget that the patients’ opinion is also crucial in any decision. Treatment goals should be clearly defined and communicated, and it is ultimately the patient who decides after being well informed.

Position papers, research letters, hospital guidelines concerning older patients with cancer have been produced rapidly since the COVID-19 crisis appeared in the month of March. It is SIOG’s mission to diffuse all this important work through its website and network in order to increase visibility as much as possible. If you are aware of new papers, letters, guidelines on COVID-19 and older persons with cancer coming out in the next weeks/months, please send them to the SIOG office (info@siog.org), so the information can be added to this website. We aim to mention only information specifically directed to older persons with cancer, since many cancer organizations have already provided guidelines on cancer patients in general.

Concrete recent manuscripts are shown here:

In the meantime, we receive messages that research projects (retrospective and prospective) are starting to learn about what has happened or is happening with COVID-19 and older persons with cancer. SIOG also aims to collect information on starting or ongoing projects in order to facilitate collaboration. SIOG has already started a COVID-19 working group to deal with this issue. Please send information to the SIOG office (info@siog.org), so this information can be added to this website.

Hans Wildiers,
SIOG President,
On behalf of the SIOG Board of Directors and the SIOG COVID-19 working group.