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Sequencing Treatments for Cancer During the COVID-19 Pandemic

DAILY RADIATION TREATMENTS AND THE RISK OF DYING FROM COVID-19 The pandemic caused by the coronavirus disease 2019 (COVID-19) has led to drastic measures to curtail the virus’s spread throughout the world. Countries have recommended social distancing— deliberately increasing the physical space between people to avoid transmission of the virus— sometimes with military enforcement. Yet, for patients with cancer receiving radiation therapy, social distancing is challenging given the daily need for in-person treatment over several weeks. Complicating the logistical difficulties of radiation therapy is that many patients with cancer are immunosuppressed, of advanced age, and have pre-existing comorbid conditions such as heart and lung disease. Coupled with these patient factors is the need for daily trips to the hospital, where patients ill with suspected or confirmed COVID-19 are concentrated, likely increasing the risk that a patient with cancer coming for treatment contracts and dies from COVID-19. In recent reports of patients with cancer in China, the rates of COVID-19 infection, serious illness, intensive care unit admissions and death for both hospitalized patients and those in the general community were significantly higher when compared with patients without a cancer diagnosis in the community.1–3