3 Systemic anticancer treatments

3 Systemic anticancer treatments

Shared decision making with individual patients

3.1 Do not routinely delay starting systemic anticancer treatment (SACT), or pause SACT that is already underway, because of the risk of contracting COVID-19. [2022]

3.2 Discuss the risks and benefits of SACT with people with cancer and their family members and carers, taking into account current dominant COVID-19 variants and COVID-19 prevalence. Topics to cover include:

  • that most people who have SACT do not go on to have worse outcomes from COVID-19 infection, should they develop it

  • that the risks of deferring SACT are likely to be greater than the risks of increased COVID-19 severity

  • that people with myeloma or other types of haematological cancer who have immunomodulatory SACT may have worse outcomes from COVID-19

  • factors that may affect their risk of becoming severely ill with COVID-19, including vaccination status, underlying conditions, increasing age, male sex, ethnicity and cancer symptoms

  • how to reduce the risk of catching COVID-19 while having SACT

  • local access to current treatment options for COVID-19

    Reach a shared decision with the person about their treatment. Follow relevant national guidance on communication, providing information (including in different formats and languages) and shared decision making, for example, NICE's guideline on shared decision making. [2021, amended 2022]

3.3 For people with myeloma or other types of haematological cancer, discuss treatment strategies with a specialist team (such as, haematology and/or subspecialised myeloma teams) before giving immunomodulatory SACT. [2022]

3.4 If a person who is going to have (or has started) SACT has tested positive for COVID-19:

  • if possible, delay the start of SACT (or pause the treatment if already underway) until any significant COVID-19 symptoms have resolved

  • if delayed or paused, reach a shared decision with the person about when to start or resume SACT (discussions should include the factors described in recommendation 3.2, and take into account any local guidance on testing for SARS-CoV-2)

  • ensure the risk to other patients and healthcare staff is minimised when the person attends hospital for SACT, in line with local policies. [2021, amended 2022]