CORONAVIRUS (COVID-19) – PRIMARY CARE CANCER UPDATE
Friday 27th March 2020
What’s new with respect to 2-week-wait (2WW) referrals
- Continue to refer patients along a 2WW pathway if you suspect cancer
- Providers (hospitals & 2WW clinics) will conduct telephone triaging for all patients as the first step. (reduce face-to-face interaction, prioritise patients based on clinical need, and to stratify those for straight to test pathways).
- Providers cannot downgrade 2WW without GPs consent
- In some cases, where a 2WW referral is made that is not consistent with the guidelines/criteria the Provider may downgrade the referral. In these situations the Providers should be ensuring appropriate safety-netting for these patients.
Which cancer patients are at highest risk?
- Anyone receiving chemotherapy, radiotherapy, immunotherapy, antibody treatments, protein kinase inhibitors or PARP inhibitors
- Blood or bone marrow cancers e.g leukaemia/lymphoma/myeloma at any stage of treatment
- Anyone who has had a bone marrow or stem cell transplant in the last 6 months, or who are still taking immunosuppressive drugs
Management of high risk cancer patients
- Patients in high risk groups identified by NHSE were sent the following letter: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/at-risk-patient-letter-march-2020.pdf
- The list of patients identified will be provided by your clinical system supplier. Practices are asked to review the list and add and remove patients if necessary. Some patients identified may not be appropriate, e.g patient choice/end of life, please consider this with the patient.
Steps to mitigate risk:
- Online consultations via telephone or video wherever possible
- If face-to-face required encourage patients not to arrive early and consider measures such as texting when you are ready to see them, allowing them to wait in their cars
- Cut non-essential follow ups
- Online ordering for regular medication as soon as possible for those at high risk, with either home or nominated delivery.
- Repeat prescription – ensure that where appropriate that repeat prescriptions are valid for 1 year. E.g 28 day supply with repeat dispensing set up as 12 x 28 days’ supply.
- Patients who do not have family or friends to help can register for additional support with daily living (e.g. shopping and social care) at: www.gov.uk/coronavirus-extremely-vulnerable
- High risk patients can use the letter they receive from NHS England as evidence to show their employer that they cannot work outside the home
Disruption to cancer services
- Very likely cancer services will be impacted. Providers have been instructed to prioritise treatment for those most in need.
- Treatment such as surgery, chemotherapy or radiotherapy may be postponed. This decision will be taken on a case by case basis by the oncology team caring for the patient.
- Providers should be communicating directly with patients on the impact of covid-19 on their treatment and ongoing care.
- One Cancer Voice: Guidance for Cancer Patients on COVID-19. Guidance developed in Partnership with NHS England. Published: 24.03.2020.
This article was accurate as of the 27th March 2020.