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. 2020 Apr 21;11(5):753–760. doi: 10.1016/j.jgo.2020.04.010

Table 2.

Practice Considerations for the Older Patient with Cancer in the Context of COVID-19.

During this pandemic, specific considerations for the older adult patient include:
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    COVID-related risks to our older patients when traveling for treatment

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    Consider how COVID risk competes with cancer progression risk (e.g., which is the greater risk for the patient at a particular time)

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    Consider how risks related to cancer treatment and other comorbidities that are more common in older adults enhance COVID risk


When considering above, potential ways to mitigate risk may include:
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    Consider oral therapy treatment options when possible, to minimize the need for infusion visits; continue to conduct toxicity checks via tele-visits or home visit (if possible) to reduce in-person office visits

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    Address miscellaneous aspects of care, such as lab monitoring, etc. Are there ways to minimize/modify approach to counteract this?
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      Examples: Might patients be eligible for home draw labs to minimize need to go out to lab draw station? Can lab draws intervals be adjusted? Can laboratories arrange for scheduled times (rather than walk-in) to reduce exposures? Can interval between port flush be extended?
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    Re-consider data on cancer treatment benefit in the context of risks of COVID-19 exposure for older adults
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      Example: In adjuvant her-2 positive breast cancer, historically one year of her-2 directed therapy has been given. Recent studies have suggested 6 months of treatment may be non-inferior, although the field has not yet transitioned to 6 months as standard. However, risks of COVID-19 exposure may alter interpretation of risks/benefits of >6 months of therapy depending on the individual clinical scenario.
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    For patients on single agent, particularly antibody therapies, consider increasing interval between treatments if feasible

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    For older, frail patients with low-volume and stable metastatic disease, consider treatment breaks and monitoring symptoms closely.


With our shift in care delivery to tele-visits and societal social distancing, some important thoughts for our older adult population include:
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    Social distancing may be especially isolating for older adults living alone; important to emphasize social connectedness for these patients.
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      Example: Social support system may be physically separated to minimize COVID risk but still very involved; offer to three-way call to include children/friends/other supports during tele-health visits. Inquire during visits about access to food, medications, socialization, and mental health.
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    Consider comorbidities when conducting tele-health visits:
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      Example: For older adults with hearing impairment, check in more regularly on ability to hear and comprehension during the tele-health call and provide written information by email or patient portals after the tele-health visit For patients with cognitive impairment, three-way call to include children/friends/other supports during tele-health visits.