Continuing cancer care through acoordinated disease outbreak response system
Authors: L. S. Thye
Journal: Clinical Cancer Research (2020)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in COVID-19, imposes unprecedentedchallenges to health care systems globally  Delivering cancer care during COVID 19 is particularly challenging forseveral 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, increasesthe risk of virus transmission  Cancer patients on active treatment who developed COVID-19 infection are also atrisk of increased morbidity and mortality  Currently, health care facilities are facing significant resource constraintsboth 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 workupevaluation, treatment, surveillance, psychosocial support, palliative care, and research  Cancer centers around theworld are struggling to develop a dynamic response with a strong focus on protecting patients with cancers andhealth care workers while simultaneously contributing efforts to combat COVID-19 in the community  Approachesadopted include appropriate triaging of patients with suspected symptoms, reconfiguring of outpatient journey andinfrastructure leveraging on technology, introducing “segregated team models,” developing inpatient policies on staffand patient movement, ethically adapting treatment decisions in accordance to best available consensus guidelinesdeveloped by professional bodies such ASCO and ESMO, and proactive efforts to address the physical andemotional well-being of employees, among many others  Leadership is crucial and “command structures comprisingmultiple stakeholders” are instituted to provide early coordination of institution-wide efforts as well as to consolidateand centralize all information disseminated to staff, patients, and the public  Of paramount importance, successfulrestoration 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 theentire health care sector, effective communication, and building trust are key for health care institutions to operateeffectively in this pandemic  Singapore, a densely populated city-state of 5 7 million and a global travel hub, isparticularly vulnerable to the importation of communicable disease and was one of the earliest countries to detectCOVID-19 in January 2020  Having experienced severe acute respiratory syndrome (SARS) in 2003, Singaporeenhanced its pandemic preparedness response and these measures are now being put to the test  Thispresentation describes the coordinated approach adopted by the National Cancer Centre Singapore within theframework of a National Disease Outbreak Response System to combat COVID-19  We were able to avoidnosocomial SARS-2 COV-2 transmissions among patients and staffs without compromising on cancer care  ThisCOVID-19 pandemic also presented unique learning opportunities and an impetus to radically transform cancer caredelivery going forward