Abstract IA15: Continuing cancer care through a coordinated disease outbreak response system
Authors: Thye Lim Soon 
Published: December 2020

Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in COVID-19, imposes unprecedented challenges to health care systems globally. Delivering cancer care during COVID 19 is particularly challenging for several reasons. Cancer therapy is complex, and success is intricately linked to timely access to appropriate care. The cancer patient’s journey, which invariably involves multiple touchpoints and multiple set of specialists, increases the risk of virus transmission. Cancer patients on active treatment who developed COVID-19 infection are also at risk of increased morbidity and mortality. Currently, health care facilities are facing significant resource constraints both in terms of infrastructure and manpower as these resources are increasingly redeployed to COVID-19 facilities. The need for appropriate social distancing to reduce risk of infection puts further pressure on limited resources. These challenges disrupt cancer care and significantly impact the delivery holistic care from diagnosis to workup evaluation, treatment, surveillance, psychosocial support, palliative care, and research. Cancer centers around the world are struggling to develop a dynamic response with a strong focus on protecting patients with cancers and health care workers while simultaneously contributing efforts to combat COVID-19 in the community. Approaches adopted include appropriate triaging of patients with suspected symptoms, reconfiguring of outpatient journey and infrastructure leveraging on technology, introducing “segregated team models,” developing inpatient policies on staff and patient movement, ethically adapting treatment decisions in accordance to best available consensus guidelines developed by professional bodies such ASCO and ESMO, and proactive efforts to address the physical and emotional well-being of employees, among many others. Leadership is crucial and “command structures comprising multiple stakeholders” are instituted to provide early coordination of institution-wide efforts as well as to consolidate and centralize all information disseminated to staff, patients, and the public. Of paramount importance, successful restoration and continuation of care requires a “whole-of-government, whole-of-society” approach to combat COVID-19 beyond its impact on health. Best government practices in containment strategies, leadership in coordinating the entire health care sector, effective communication, and building trust are key for health care institutions to operate effectively in this pandemic. Singapore, a densely populated city-state of 5.7 million and a global travel hub, is particularly vulnerable to the importation of communicable disease and was one of the earliest countries to detect COVID-19 in January 2020. Having experienced severe acute respiratory syndrome (SARS) in 2003, Singapore enhanced its pandemic preparedness response and these measures are now being put to the test. This presentation describes the coordinated approach adopted by the National Cancer Centre Singapore within the framework of a National Disease Outbreak Response System to combat COVID-19. We were able to avoid nosocomial SARS-2 COV-2 transmissions among patients and staffs without compromising on cancer care. This COVID-19 pandemic also presented unique learning opportunities and an impetus to radically transform cancer care delivery going forward.
Citation Format: Lim Soon Thye. Continuing cancer care through a coordinated disease outbreak response system [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr IA15.