7.1 Think about how to modify usual care to reduce patient exposure to COVID-19 and make best use of resources (workforce, facilities, intensive care, equipment).
7.2 Try to deliver systemic anticancer treatment in different and less immunosuppressive regimens, different locations or via another route of administration where possible. Options include:
switching intravenous treatments to subcutaneous or oral alternatives where this would be beneficial (subject to agreement with commissioners)
using shorter treatment regimens
decreasing the frequency of immunotherapy regimens, for example moving to 4‑weekly or 6‑weekly
providing repeat prescriptions of oral medicines or other at-home treatments without patients needing to attend hospital
deferring treatments that prevent long-term complications such as bone disease
using home delivery of oral medicines where possible (but check the resilience of home care providers)
using treatment breaks for long-term treatments (possibly for longer than 6 weeks).
7.3 Make policy decisions about modifications to usual care at an organisational level.
7.4 Ensure each patient is considered on an individual basis by the multidisciplinary team. Record the reasoning behind each decision.
7.5 Discuss the risks and benefits of changing treatment regimens or having treatment breaks with patients, their families and carers.
7.6 Think about retraining nurses who have moved to other cancer nursing specialist roles to be systemic anticancer therapy (SACT) nurses (using the UK Oncology Nursing Society SACT Competency Passport) and provide supervision.
7.7 Retrain nurses who:
have administered SACT within the previous 2 years
have completed theoretical training (such as the passport or accredited course)
complete the relevant passport clinical competencies with a practice assessor.
7.8 It is proposed that the current treatment break policy, which applies to both Cancer Drugs Fund (CDF) and non-CDF treatments, will not be applied during the COVID‑19 outbreak.
7.9 Where a treatment break is needed, clinicians should complete the approval form to restart treatment, indicating that the patient had a break because of COVID‑19. The request will be approved even if their disease has progressed, providing the clinician indicates there is a reasonable chance that disease control can be regained on restarting treatment. It is expected that the response to treatment will be reviewed 2 or 3 cycles after restarting. If disease control has not been regained treatment should be stopped.