The NCCN Releases Updated Protocol for Management of COVID-19 in Patients with Cancer

This week, the National Comprehensive Cancer Network (NCCN) released an updated set of guidelines for how to best manage and treat COVID-19 in patients with cancer. Using data from more than 150 studies covering various topics, these recommendations cover a range of topics including who should be tested, when to modify treatment, and more.

As noted in the guidelines, individuals with cancer are at in increased risk (29.4%) for severe disease and mortality from COVID-19 compared to those without (10.2%). Notably, these percentages vary depending on cancer type, treatment type, and stages of therapy. But given that the information about how the virus impacts patients with cancer is mostly based on observational data and has been gathered from larger population studies not focused solely on those with cancer, the NCCN gathered the latest data from a number of sources including the American Society of Hematology, the American Society of Clinical Oncology, the Society of Surgical Oncology and more.

“Our mission to help people with cancer live better lives is more important than ever right now,” said Dr. Wui-Jin Koh, chief medical officer of the NCCN, in a news release. “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.”

The guidelines provide information and recommendations on several topics, including:

Testing – In addition to what tests are available, the guidelines also cover what tests should be used and when depending on what point a patient is at in their cancer treatment. Of note, the authors found that the test for antibodies against SARS-CoV-2 or nucleocapsid antigens is not recommended as the only test when it comes to clinical decisions in those with cancer, due to the fact that these patients may not develop robust antibody responses after infection or vaccination.

Isolation – Given the differing opinions on the appropriate isolation period lengths for individuals at different points of the cancer spectrum, the guidelines now recommend that patients who are severely immunocompromised should isolate for up to 20 days after symptom onset. If the patient was asymptomatic, isolation can end 10 days after the date of their first positive test for SARS-CoV-2 RNA.

Treatment Delays – The immune-system-compromising effects of cytotoxic chemotherapy create several questions for patients that contract COVID-19, all of which the guidelines aim to answer. Ideally, mild or moderately symptomatic patients with non-hematologic cancer should delay chemotherapy until the resolution of all symptoms, as well as a minimum of 10 days after symptoms started. Severely symptomatic and/or patients with hematologic malignancies should have chemotherapy delayed until symptoms stop, with a minimum of 20 days after they began. Asymptomatic patients should delay chemotherapy for a minimum of 10 days after the date of their first positive test and should then be monitored for 14 days.

Additionally, guidance is offered for patients receiving hematopoietic cell transplantation (HCT) or CAR-T cell therapy.

The NCCN does note that if chemotherapy or another treatment is urgent due to an uncontrolled cancer, then it should be administered at the judgement of the physician.

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