3 Systemic anticancer treatments

Shared decision making with individual patients

3.1 Discuss with all patients the risks and benefits of starting, continuing or deferring systemic anticancer treatment. Include in the discussion:

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

  • that there is uncertainty whether patients who have received systemic anticancer treatment are at increased risk of becoming severely ill with COVID-19

  • the possible greater risk of poor outcomes for patients with haematological cancers from COVID-19

  • the possible greater risk of poor outcomes from COVID-19 with increasingly immunosuppressive systemic anticancer treatments.

    Reach a shared decision with the patient about their treatment. [12 February 2021]

3.2 If a patient has COVID-19, reach a shared decision about treatment but if possible defer systemic anticancer treatment:

  • until at least 10 days after a positive test for SARS CoV 2, and

  • until any significant symptoms have resolved. [12 February 2021]

Prioritising systemic anticancer treatments

3.3 If systemic anticancer treatments need to be prioritised, use table 1 to help make these decisions. Take into account:

  • the level of immunosuppression associated with individual treatments and cancer types, and any other patient-specific risk factors (including vaccination status) [amended 12 February 2021]

  • capacity issues, such as limited resources (workforce, facilities, intensive care, equipment)

  • balancing the risk of cancer not being treated optimally with the risk of the patient being immunosuppressed and becoming seriously ill from COVID‑19.

Table 1 Prioritising systemic anticancer treatments [amended 3 April 2020]

Priority level

Treatment

1

Curative treatment with a high (more than 50%) chance of success

Adjuvant or neoadjuvant treatment which adds at least 50% chance of cure to surgery or radiotherapy alone or treatment given at relapse

2

Curative treatment with an intermediate (20% to 50%) chance of success

Adjuvant or neoadjuvant treatment which adds 20% to 50% chance of cure to surgery or radiotherapy alone or treatment given at relapse

3

Curative treatment with a low (10% to 20%) chance of success

Adjuvant or neoadjuvant treatment which adds 10% to 20% chance of cure to surgery or radiotherapy alone or treatment given at relapse

Non-curative treatment with a high (more than 50%) chance of more than 1 year extension to life

4

Curative treatment with a very low (0% to 10%) chance of success

Adjuvant or neoadjuvant treatment which adds less than 10% chance of cure to surgery or radiotherapy alone or treatment given at relapse

Non-curative treatment with an intermediate (15% to 50%) chance of more than 1 year extension to life

5

Non-curative treatment with a high (more than 50%) chance of palliation or temporary tumour control and less than 1 year expected extension to life

6

Non-curative treatment with an intermediate (15% to 50%) chance of palliation or temporary tumour control and less than 1 year expected extension to life

Table adapted from NHS England's clinical guide for the management of non-coronavirus patients requiring acute treatment: cancer.

3.4 Make prioritisation decisions as part of a multidisciplinary team and ensure each patient is considered on an individual basis. Ensure the reasoning behind each decision is recorded.

3.5 Clearly communicate, with written documentation if possible, what prioritisation is and the reason for the decision to patients, their families and carers.