The National Comprehensive Cancer Network® (NCCN®)--an alliance of leading cancer centers--has published new best practice recommendations for Management of COVID-19 Infection in Patients with Cancer. This new expert guidance cites more than 150 studies covering how best to manage and treat diagnosed or suspected COVID-19 in cancer patients to achieve the best possible outcomes for all conditions. The recommendations include topics such as:
- Who should be tested for SARS-CoV-2;
- Which SARS-CoV-2 tests to use;
- How to use/interpret PCR cycle threshold (Ct) value;
- Who should be isolated, how, and for how long;
- When to modify chemotherapy, immunotherapy, or transplantation schedules;
- And which COVID-19-directed treatment(s) to use under various circumstances.
These recommendations for the simultaneous treatment of both COVID-19 and cancer synthesize contemporary guidelines from other specialty societies and organizations, along with rapidly emerging data. Our mission to help people with cancer live better lives is more important than ever right now. This new guidance, along with other expanding resources at NCCN.org/covid-19, will help to answer many of the treatment questions that have come up over the course of the pandemic. While specific to COVID-19 in cancer patients, the recommendations also provide useful information for COVID-19 infection management in individuals without cancer."
Wui-Jin Koh, MD, Chief Medical Officer, NCCN
The organization has also updated the NCCN: Cancer and COVID-19 Vaccination guidance document that was originally published on January 22, 2021. The NCCN COVID-19 Vaccination Advisory Committee--which consists of leading oncologists with expertise in infectious diseases, vaccine development and delivery, and medical ethics--asserts that all people in active treatment for cancer should feel safe receiving any of the three vaccines currently approved under Emergency Use Authorization (EUA) from the Food & Drug Administration (FDA), with some additional recommendations around timing.
The committee continues to advocate for listing people with cancer among the high priority groups for the vaccine and highlights the importance of vaccination for household members and caregivers as well.
"The most important thing is that people get whichever vaccine is offered to them as soon as they can," said Steve Pergam, MD, MPH, Associate Professor, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center and Infection Prevention Director at Seattle Cancer Care Alliance, co-leader of the NCCN COVID-19 Vaccination Advisory Committee. "At this time, the available data does not indicate major differences in effectiveness relative to the most important clinical outcomes, and all three have been determined to be safe for adults. The exception is for people age 16 or 17 who should only receive a vaccine that has been approved for their age group."
The updated guidance document includes some new caveats around the timing of mammograms after vaccination to reduce the possibility of false positive results. The committee also added additional information on the importance of not letting clinical trial participation prevent anyone from getting vaccinated or vice versa. The members also cautioned against antibody testing post-vaccination outside of clinical trial research protocols.
Those updates add to previous recommendations pertaining to:
- how to recommend appropriate scheduling based around immunosuppressive therapy;
- how to prepare for possible medication interactions or adverse events;
- how to account for societal inequities and prioritize at-risk communities;
- how to communicate with patients and caregivers, particularly non-English speakers;
- and the balance of vaccination efforts between the cancer center and community settings.
"These resources, that address the multiple facets of COVID-19 and cancer, are intended to be living documents that evolve as circumstances change and new data emerge," said Robert W. Carlson, MD, Chief Executive Officer, NCCN. "I'm proud of NCCN's ability to rapidly and continually improve all of our evidence-based guidelines to meet many needs. We hope our efforts increase the safety and peace of mind for people with cancer everywhere."
The new treatment recommendations and updated guidance document can be found at NCCN.org/covid-19 along with other resources for optimal cancer management during the ongoing pandemic. Learn more about the importance of routine screening and treatment from the multi-organizational effort: Cancer Won't Wait and Neither Should You with the American Cancer Society (ACS).
NCCN is also hosting a keynote address on the Effects of the Pandemic on Cancer Care on Saturday, March 20, 2021 at 1:15PM ET. This expert roundtable discussion is part of the NCCN 2021 Virtual Annual Conference March 18 - 20, 2021. Visit NCCN.org/conference2021 to register.
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