Institutional restrictions due to the coronavirus disease 2019 (COVID-19) pandemic are taking a large toll on patients with hematologic cancers. Some medical centers have canceled treatments and all centers have altered their policies and procedures. Starting in March, elective and semielective surgical procedures at most hospitals throughout the United States were put on hold, and uncertainty remains regarding when these procedures will start up again.

Currently, the American College of Surgeons (ACS) is suggesting that all physicians and their staff consider every patient individually in order to strike a balance between the risks of delaying surgery and the risks to both patients and hospital staff performing the operation. “Our ability to offer some surgical procedures in this immediate pandemic period is being impacted. The impacts vary significantly by region of the country and the impact of the pandemic,” said Elizabeth A David, MD, who is an associate professor of clinical surgery in the Division of Thoracic Surgery Department of Surgery at the Keck School of Medicine of the University of Southern California, Los Angeles, in an interview with Hematology Advisor.

ACS now is providing guidelines for determining who needs to have surgery sooner and who can wait until normal surgical schedules have resumed. In making these decisions, clinicians must weigh the current condition of each patient, and the potential for natural progression of each patient’s surgical disorder or disease while waiting. They also must factor in the current capabilities of their surgical facility. During this time, it is crucial to reserve hospital resources, such as ventilators and intensive care unit beds, for critically ill patients with COVID-19.

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“The important message for providers and patients at this time is that treatment decisions need to be made on an individual patient basis. There will be some patients for whom it will be appropriate to defer surgical treatment for a few months, others will need to have operations done as is possible during the COVID pandemic depending on supply availability and staff,” explained Dr David.

She said there will be other patients for whom alternate strategies for radiation and chemotherapy may be considered. Clinicians need to be particularly mindful of those patients who are already at high risk to experience health care disparities, and to ensure that they are appropriately guided through the health care system during this challenging time. 

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Because there is no way to estimate the duration of the current disruption, clinicians currently are in a difficult position. The situation is a very fluid one and literally is changing on an hourly basis. “In many parts of the country, as part of the attempt to free up [operating rooms], recovery rooms, and [intensive care units], elective surgery is being deferred,” said Henry I. Miller, MD, who is a senior fellow at the Pacific Research Institute in San Francisco, California, in an interview with Heamtology Advisor. “I don’t know how widespread that interpretation is or to what extent other non-emergency cancer surgery is being delayed. It’s a very hard risk-risk calculation. Cancers do metastasize, after all. These delays are very hard on patients.”