This guideline aims to maximise the safety of patients with cancer and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for cancer treatment to patient needs if services become limited because of the COVID-19 pandemic.
This Guidelines summary only covers key recommendations for primary care. For a complete set of recommendations, see the full guideline.
View this summary online at guidelines.co.uk/455238.article
Communicating with patients
- Communicate with patients and support their mental wellbeing, signposting to charities and support groups where available, to help alleviate any anxiety and fear they may have about COVID-19
- Minimise face-to-face contact by:
- offering telephone or video consultations (particularly for follow-up appointments and pretreatment consultations)
- cutting non-essential face-to-face follow up
- using home delivery services for medicines if capacity allows
- introducing drive-through pick-up points for medicines
- using local services for blood tests if possible
- Advise all patients to contact their local cancer chemotherapy helpline (rather than NHS 111) if they feel unwell to ensure their symptoms are appropriately assessed
- Tell patients who still need to attend services to follow relevant parts of government advice on social distancing (this differs across the UK), or UK government guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19
- Discuss with patients the individual factors that may affect their risk of becoming severely ill with COVID-19, including underlying conditions, older age, male sex, ethnicity, cancer symptoms, and vaccination status.
Patients without COVID-19
- Ask patients to attend appointments without family members or carers, if they can, to reduce the risk of contracting or spreading SARS-CoV-2
- Minimise time in the waiting area by:
- careful scheduling
- encouraging patients not to arrive early
- texting patients when you are ready to see them, so that they can wait in their car, for example.
Patients with known or suspected COVID-19
- When patients with known or suspected COVID-19 have been identified, follow appropriate UK government guidance on infection prevention and control. This includes recommendations on patient transfers, transport and options for outpatient settings
- All healthcare workers involved in receiving, assessing and caring for patients who have known or suspected COVID-19 should follow UK government guidance on infection prevention and control. This contains information on using personal protective equipment (PPE), including visual and quick guides for putting on and taking off PPE.
Patients with symptoms of COVID-19 at presentation
- If a patient not previously known or suspected to have COVID-19 shows symptoms on presentation, the general advice is to follow UK government guidance on investigation and initial clinical management of possible cases. This includes information on testing and isolating patients
- Be aware that patients having systemic anticancer treatments are immunocompromised and may have atypical presentations of COVID-19. Also, symptoms of COVID-19, neutropenic sepsis and pneumonitis may be difficult to differentiate at initial presentation
- Screen and triage all patients to assess whether they are known or suspected to have COVID-19, or have been in contact with someone with confirmed infection
- If patients have fever (with or without respiratory symptoms), suspect neutropenic sepsis because this can be rapid and life-threatening, and follow the NICE guideline on neutropenic sepsis, which recommends:
- referring patients with suspected neutropenic sepsis immediately for assessment in secondary or tertiary care
- treating suspected neutropenic sepsis as an acute medical emergency and offering empiric antibiotic therapy immediately
- If COVID‑19 is later diagnosed in someone not isolated from admission or presentation, follow UK government guidance on management of exposed staff and patients in health and social care settings.
Systemic anticancer treatments
Shared decision making with individual patients
- Discuss with all patients the risks and benefits of starting, continuing or deferring systemic anticancer treatment. Include in the discussion:
- factors that may affect their risk of becoming severely ill with COVID-19, including underlying conditions, male sex, ethnicity, cancer symptoms and vaccination status
- that there is uncertainty whether patients who have received systemic anticancer treatment are at increased risk of becoming severely ill with COVID-19
- the possible greater risk of poor outcomes for patients with haematological cancers from COVID-19
- the possible greater risk of poor outcomes from COVID-19 with increasingly immunosuppressive systemic anticancer treatments
- Reach a shared decision with the patient about their treatment
- If a patient has COVID-19, reach a shared decision about treatment but if possible defer systemic anticancer treatment:
- until at least 10 days after a positive test for SARS CoV 2, and
- until any significant symptoms have resolved.
For recommendations on prioritising systemic anticancer treatments, refer to the full guideline.
Modifications to usual service
- Think about how to modify usual care to reduce patient exposure to COVID-19 and make best use of resources (workforce, facilities, equipment)
- Make policy decisions about modifications to usual care at an organisational level.
Staff who are self-isolating
- If a healthcare professional needs to self-isolate, ensure that they can continue to help by:
- enabling telephone or video consultations and attendance at multidisciplinary team meetings
- identifying patients who are suitable for remote monitoring and follow up and those who are vulnerable and need support
- carrying out tasks that can be done remotely, such as entering data
- Support staff to keep in touch as much as possible, to support their mental wellbeing.
NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.
Published date: 20 March 2020.
Last updated: 12 February 2021.