Cancer in the time of COVID-19: expert opinion on how to adapt current practice

Our plain-English summary of Cancer in the time of COVID-19: expert opinion on how to adapt current practice, by J. Raskin, M. Lebeer, C. De Bondt, et al (The European Respiratory Journal, 2020).

The study

• Authors: J. Raskin, M. Lebeer, C. De Bondt, R. Wener, A. Janssens, J.P. van Meerbeeck
• Journal: The European Respiratory Journal
• Published: 2020;55(5)
• Type of article: Letter
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Our current thoracic oncology practice could/should be adapted to the COVID-19 pandemic by reducing time in hospital and patient contacts with healthcare workers, whilst maintaining quality of care. This letter offers expert advice on how to do so. https://bit.ly/2JR2IoT

In plain English

This was a letter to the editor, not a study, giving the expert opinion of six authors at Antwerp University Hospital, Belgium, in April 2020; it reported no new data. Drawing on recommendations from the British Thoracic Society and the French Haut Conseil de la Santé Publique, the authors offered practical advice on adapting care for lung cancer, malignant pleural mesothelioma and thymic epithelial tumours during the COVID-19 pandemic. Their aims were to limit time in hospital and contact with healthcare workers, maintain quality of care and reduce severe neutropenia. They suggested using video consultation as much as possible. For malignant pleural mesothelioma, they advised evaluating fit patients with early-stage disease for multimodality treatment including surgery. They recommended four cycles of palliative platinum/pemetrexed in all other patients with ECOG performance status 0 to 1. They urged extra care before palliative chemotherapy in elderly patients, those with significant comorbidity and those with poorer performance status. They also advised considering delay in patients without symptoms, no pemetrexed maintenance, reluctance about second-line chemotherapy, and a home-managed indwelling pleural catheter. They noted some suggestions may not be feasible because of reimbursement issues. Asbestos exposure was not discussed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor (correspondence) giving expert opinion and practical treatment advice; no original data were collected
• Who was studied: No patients were studied. The advice concerned the care of patients with small-cell and nonsmall-cell lung cancer, malignant pleural mesothelioma and thymic epithelial tumours. The authors were from the Dept of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Belgium.
• Exposure: No asbestos or fiber exposure was discussed. The letter concerned adapting thoracic cancer care to the COVID-19 pandemic.
• Main results:
  • For all patients, the authors suggested using video consultation as much as possible instead of face-to-face consultation.
  • Malignant pleural mesothelioma, early-stage disease in fit patients: the authors advised evaluating for multimodality treatment including surgery (preferably extended pleurectomy/decortication) and chemotherapy.
  • Malignant pleural mesothelioma, all other patients with ECOG performance status 0 to 1: the authors recommended palliative chemotherapy with four cycles of platinum/pemetrexed.
  • Malignant pleural mesothelioma: the authors advised evaluating the indication for palliative chemotherapy with extra care in elderly patients, patients with significant comorbidity and patients with poorer performance (ECOG performance status 2 or higher).
  • Malignant pleural mesothelioma, patients without symptoms: the authors advised considering delaying chemotherapy.
  • Malignant pleural mesothelioma: the authors did not recommend pemetrexed maintenance therapy and advised reluctance about second-line chemotherapy with vinorelbine, gemcitabine or doxorubicin.
  • Malignant pleural mesothelioma: the authors preferred a home-managed indwelling pleural catheter over procedures that require a clinic visit.
• The authors' conclusion: The authors proposed that thoracic oncology practice be adapted to the COVID-19 pandemic. They proposed limiting time in hospital, promoting telemedicine, avoiding unnecessary contact with medical personnel and reducing severe neutropenia, while maintaining quality of care.
• Limitations the authors state:
  • The authors noted that some of their suggestions may not be feasible because of reimbursement issues.

Related studies

• COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study — M.C. Garassino, J.G. Whisenant, et al. (2020)
• Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups — O. Glehen, V. Kepenekian, et al. (2020)
• County-level longitudinal clustering of COVID-19 mortality to incidence ratio in the United States — N. Vahabi, M. Salehi, et al. (2021)
• The impact of COVID-19 on new mesothelioma diagnoses in Italy — L. Mangone, P. Mancuso, et al. (2022)
• Pleural mesothelioma incidence and use of systemic treatment decreased during the COVID-19 pandemic in The Netherlands — I. Smesseim, L.H. Douma, et al. (2025)
• Mortality rates from asbestos-related diseases in Italy during the first year of the COVID-19 pandemic — L. Fazzo, E. Grande, et al. (2023)

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