key: cord-0839490-hd0yj34k
authors: Huillard, Olivier; Goldwasser, Francois
title: Cancer treatment during COVID-19 pandemic: do not postpone but decide wisely
date: 2020-06-04
journal: Eur J Cancer
DOI: 10.1016/j.ejca.2020.05.024
sha: a3846afc0874f95d639e23f64e2e1ee80701a0f2
doc_id: 839490
cord_uid: hd0yj34k

nan

Department of Medical Oncology, Hopital Cochin, APHP.Centre -Université de Paris, Paris, France.

We thank Omarini et al. for sharing the practical health recommendations adopted in their center and their experience with COVID-19 [1] . They conclude that cancer care cannot be postponed only on the basis of the risk of COVID-19 infection. Even if we agree on the general principle that cancer treatment cannot be definitively postponed in the context of a pandemic which end is uncertain, we believe that decisions may differ from those made in the pre COVID-19 context.

As described by the authors, the rate of infection with SARS-CoV-2 does not appear to be higher in cancer patient but the mortality rate (22 to 28%) is higher than in patient without cancer [1, 2] . This high mortality rate is most probably explained by the toxic effect of antitumoral treatments or the frailty induced by cancer itself [3] . Omarini et al. advise, by considering the high rate of mortality and/or severe complications, that an intensive attention should be paid to patients with cancer and COVID-19 symptoms/infections. But in the current context of an absence of treatment with significant effect for COVID-19, this intensive attention will not result in better outcome for our infected patients. Oncologists must adapt to this new context and understand the implication for the benefit/risk ratio of antitumor drug prescription. Though the benefit of our treatments is unchanged, their risks have risen with the possibility of resulting in death by COVID-19. This shift in the balance between benefit and risk may be particularly true for treatments with uncertain benefit compared to palliative care in advanced stages and treatments with uncertain necessity as neoadjuvant and adjuvant treatments.

In the troubled times that we are experiencing, we must understand the persistent implication for decision making in oncology. Eventually we will have a score to predict the risk of severe COVID-19 [3] , a treatment for COVID-19 patients or even a vaccine. In the meantime, cancer treatment should not be unnecessarily postponed since it can be lifesaving, but we should be even wiser in the decision-making process and be careful to first not harm.

Declaration of Competing Interest : All authors have nothing to disclose in relation to this manuscript.

Cancer treatment during COVID-19 pandemic: do not postpone, do it!

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