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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 348-349

Approach to geriatric oncology patients during the coronavirus disease 2019 pandemic: A changing treatment paradigm


Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha Cancer Institute, Mumbai, Maharashtra, India

Date of Submission07-May-2020
Date of Decision08-May-2020
Date of Acceptance14-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Anbarasan Sekar
Department of Medical Oncology, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_176_20

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How to cite this article:
Sekar A. Approach to geriatric oncology patients during the coronavirus disease 2019 pandemic: A changing treatment paradigm. Cancer Res Stat Treat 2020;3:348-9

How to cite this URL:
Sekar A. Approach to geriatric oncology patients during the coronavirus disease 2019 pandemic: A changing treatment paradigm. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 9];3:348-9. Available from: http://www.crstonline.com/text.asp?2020/3/2/348/287224



Our world has witnessed a period of upheaval during this coronavirus disease 2019 (COVID-19) pandemic. As seen globally, the older people (>60 years of age) are a vulnerable age group, with a high risk of mortality. The reasons postulated for this are many, but there is some evidence to support the hypothesis.[1],[2] The physical disabilities and low immunity of the older people make them susceptible to an increased risk of infection, and the presence of comorbidities makes the management more complicated.[3] Dr. Pinninti's article is helpful in the current situation, when there are limited data available for the management of this privileged population.[4] The author has highlighted the important issues faced by the older patients with cancer. Certain suggestions made by the author were to begin screening of the older population, maintain social distancing, avoid travel, and propagate the use of telemedicine for aiding this group of older patients with cancer. Moreover, the article suggests categorizing the patients and prioritizing cancer treatment based on the category. Management of the toxicity associated with chemotherapy and the use of growth factors at an appropriate time were also appropriately highlighted.

As the peak of the pandemic appears imminent, with no promising drug or vaccines in sight, the treatment options listed are very limited. One drug that got special attention from all over the world is hydroxychloroquine,[5] but it has not proven to be of any significant benefit; its toxicity profile (increased QTc interval) along with its risks and benefits have been clearly explained in this article. In addition, the article also clearly explains the role of polypharmacy.

However, the author should have addressed the importance of administering the pneumococcal and influenza vaccines in geriatric oncology patients. The decision on end-of-life care versus active oncological management and resuscitation of critically ill patients needs to be better emphasized. The various issues to be considered when deciding on whether to resuscitate geriatric oncology patients during this pandemic warrant further discussion.

In patients receiving immunotherapy like nivolumab, should the treatment interval be prolonged, is a question worth contemplating (2-weekly vs. 4-weekly dosing).[3],[6] The role of other investigational therapies such as the antiviral drug remdesivir, which has received the Food and Drug Administration approval and appears to be a promising therapy for patients with COVID-19, needs to be studied in geriatric oncology patients.[7] Moreover, would other therapies, such as plasma exchange therapy, be beneficial for older patients who already have a contracted blood volume is yet another challenging question that needs to be answered. With regard to palliative care in this subgroup of patients, the role of oral metronomic chemotherapy and whether it would be helpful in such patients is worth exploring. The ethical issues that arise when dealing with older patients receiving palliative care also need consideration.[8]

Other aspects, such as the psychological impact of the viral pandemic, its projection as a risk factor mainly in the older people, prolonged stay at home, and distance from loved ones, highlight the need for special counseling for the older patients during therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Garnier-Crussard A, Forestier E, Gilbert T, Krolak-Salmon P. Novel coronavirus (COVID-19) epidemic: What are the risks for older patients? J Am Geriatr Soc 2020;68:939-40.  Back to cited text no. 1
    
2.
Bansal N, Ghafur A. COVID-19 in oncology settings. Cancer Res Stat Treat 2020;3 Suppl S1:13-4.  Back to cited text no. 2
    
3.
Falandry C, Filteau C, Ravot C, Le Saux O. Challenges with the management of older patients with cancer during the COVID-19 pandemic. J Geriatr Oncol 2020. pii: S1879-4068(20)30153-3.  Back to cited text no. 3
    
4.
Pinninti R. Management of geriatric cancer patients during the COVID-19 pandemic. Cancer Res Statist Treat 2020;3:71-5.  Back to cited text no. 4
    
5.
Batra U, Sharma M, Redhu P. Chloroquine and hydroxychloroquine: Clutching at straws in the time of COVID-19? Cancer Res Stat Treat 2020;3 Suppl S1:3-6.  Back to cited text no. 5
    
6.
Klimek L, Jutel M, Akdis C, Bousquet J, Akdis M, Bachert C, et al. Handling of allergen immunotherapy in the COVID-19 pandemic: An ARIA-EAACI statement. Allergy 2020 Apr 24;10.1111/all.14336. doi: 10.1111/all.14336. Online ahead of print.  Back to cited text no. 6
    
7.
Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y, et al. Remdesivir in adults with severe COVID-19: A randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2020;395:1569-78.  Back to cited text no. 7
    
8.
Singhai P, Rao KS, Rao SR, Salins N. Palliative care for advanced cancer patients in the COVID-19 pandemic: Challenges and adaptations. Cancer Res Stat Treat 2020;3 Suppl S1:127-32.  Back to cited text no. 8
    




 

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