Oncologists are being given the option of changing chemotherapy treatment regimes, and using medicines normally deemed too expensive, during the covid-19 epidemic under new Scottish Government guidance.

In an update to advice published last month, the expert National Cancer Treatment Response Group of advisers says the outbreak has shifted the “balance of benefit to risk” for patients receiving chemotherapy and says there is an “urgent” need to review drugs being used for chemotherapy.

Organisations representing cancer patients say they accept that treatment plans will often have to change to reduce the risks for patients and deal with potentially fewer oncology staff being available to run services.

Breast Cancer Now says it’s vital patients are involved in the “incredibly tough decision” to change an existing treatment plan.

Breast Cancer Now chief executive Baroness Delyth Morgan said: “We’re hearing from many breast cancer patients calling our helpline that changes to treatment plans due to the coronavirus outbreak are causing significant concern.

“This important guidance will help ensure that patients in Scotland receive the clear information they need and a discussion with their clinician about any proposed alterations."

A new national cancer medicines advisory group is being set up to consider requests to switch to alternative medicines to ensure patients are safe, and deal with the fallout from staff being off sick and potentially supply shortages.

Some treatment options that were previously ruled out due to their high cost may need to be used.

Cancer doctors have been told previously to delay surgery where possible, because catching covid-19 when recovering from surgery drastically reduces the chance of a successful recovery.

Other treatments that suppress the immune system make patients especially vulnerable to the virus.

The new rules follow a call from a leading surgeon to set up more covid-free zones in separate hospitals or sections of hospitals, where the most urgent cancer surgeries can go ahead.

The goal is for any changes to chemotherapy to take place across the country, but the document says this could happen at a board or regional level if there is an “urgent” local need.

Clinicians are being asked to give patients “realistic messaging” around outcomes that could be affected and patient consent for any changes to chemotherapy is mandatory.

Marion O’Neill, Cancer Research UK’s head of external affairs in Scotland, said: “These treatment guidelines for Scotland are crucial to ensure there is a coordinated national approach.

“We know a number of treatments have been amended or suspended due to the impact of cancer and cancer treatments on the immune system, which means patients are at an even higher risk of developing complications should they contract coronavirus.

“It’s important that these difficult treatment decisions are made in collaboration with patients and on a case by case basis.

“It’s welcome these updated guidelines set out a clear process for patients and clinicians to get flexible access to appropriate alternative treatments where this could benefit patients.

Breast Cancer Now CEO Baroness Morgan added: “Crucially, the guidance sets out the need for local systems to record patients whose treatment is delayed to ensure they receive treatment as soon as is possible moving forwards.

“Any changes to treatment in these circumstances will represent an incredibly tough decision at an already difficult time, and we need to do all we can to support patients, their doctors and multidisciplinary teams to make the right choice for each person.

“It’s absolutely vital that everyone gets the support they need. Anyone who is concerned about coronavirus and breast cancer treatment can call our free Helpline on 0808 800 6000 to speak to our expert nurses.”

A Scottish Government spokesperson said: “Patient safety remains an absolute priority and covid-19 is a very significant new risk in relation to cancer treatment.

“For that reason, patients may also be offered different types of appointments, including telephone and video consultations and many patients - in discussion with their clinical teams - will be offered alternative or delayed treatment plans.

“We understand how distressing that can be for those individuals, but these new approaches are to minimise very concerning risks to them. Any cancer patient worried about symptoms should call their existing cancer treatment helpline or the national cancer treatment helpline on 0800 917 7711.”

 

 

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