7 Modifications to usual service

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).

  • providing interim treatment regimens. [amended 9 April 2020]

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.

Interim NHS England treatment regimens

7.8 Be aware that to allow for flexibility in the management of cancer during the COVID-19 pandemic, NHS England has endorsed interim treatment regimens for some cancer medicines. This is to reduce the need for direct patient contact for administration of drugs and to minimise potential side effects that make people more susceptible to viral infections and other ill-health effects that may add pressure to the health system. These interim treatment regimens are based on clinical opinion from members of the NHS England Chemotherapy Clinical Reference Group and cancer pharmacists (see the interim treatment regimens for details). [9 April 2020]

7.9 Be aware that treatment regimens will revert to the standard commissioned position once the emergency measures put in place to address the COVID-19 pandemic are no longer necessary. [9 April 2020]

7.10 Discuss the risks and benefits of interim treatment regimens with patients, their families and carers. [9 April 2020]

7.11 All patients who start on an interim treatment regimen during the COVID 19 pandemic should be allowed to continue the treatment until they and their clinician jointly decide it is appropriate to stop or to switch to a different treatment. [9 April 2020]

Treatment breaks

7.12 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.

7.13 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.