And we will, in all likelihood, be keeping away from older people we love, to avoid passing on infection to them. We will be watching patients go through cancer with fewer visitors, less contact with friends and families, and very possibly inferior treatments. We will be watching patients, for whom perhaps this is their last summer, shut themselves off from the world, unable to do what they want to do with the time they have left. We will, no doubt, see some patients die sooner, not because of coronavirus but because we are not able to treat their cancers as we would normally. We will be counselling against treatments we would normally recommend. Nor can the emotional consequences on healthcare professionals working in oncology: we will be making difficult, life-changing treatment decisions without good evidence. The emotional consequences of all of this for people with cancer must not be underestimated. We are making judgments on risk without really understanding how high the risk might be. We are planning for the worst with no real idea how bad the worst might be. We are switching to phone consultations when possible minimising routine follow-ups adding prophylactic drugs to chemotherapy regimes to minimise risk of complications requiring hospital admissions trying to work out how on earth we best prioritise treatments when capacity is full. Our working patterns are already changing. We may start by making decisions based on risk and benefit, but at some point we may have no choice but to stratify treatments according to priority. Oncology capacity, in terms of workforce and delivery, will be reduced significantly. We will get infected and at some point, we will need to stay at home. We will be treating patients with, at best, simple face masks, gowns and gloves. If hospitals are inundated with sick patients with Covid-19, how many beds will be available for those needing cancer surgery? We just don’t know. Big cancer surgery often requires recovery in intensive care. People on treatment who are doing their best to self-isolate but become unwell may be scared to come into hospital for assessment for fear of infection.Īnd what about cancer surgery? We simply don’t know how bad this is going to get for hospitals. Yet people on chemotherapy will, inevitably, need to attend hospitals for treatment, which will increase their chance of infection. In advanced cancer, can we justify offering treatments to improve quality and quantity of life if we potentially expose patients to severe Covid-19 infection that may kill? People on chemotherapy have been advised by the government to stay at home if possible.
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