Table 1.

General considerations for cancer directed therapy.

Prior to start of therapy	-Consider goals of therapy: Frontline curative intent should be prioritized, maintenance therapy should be evaluated in terms of incremental survival benefit, and palliative treatment should be utilized to mitigate uncontrolled cancer symptoms that may lead to inpatient hospitalization -Transfer patients to infusion centers not at main hospital campuses where patients with COVID-19 are being evaluated and treated. -Consider local administration of chemotherapy if a patient lives far from the current infusion site or it requires traveling to a COVID-19 “hotspot”. -Test for COVID-19 prior to cancer directed therapy if testing capabilities allow -Try to limit frequency of infusions; avoid weekly infusions -Consider single agent therapy or holding cancer-directed therapy for patients >65 years old, patients at any age with significant co-morbidity (DM, chronic lung disease and cardiovascular disease) or ECOG status ≥2 [74]. Patients with these co-morbid conditions appear to be at higher risk for severe COVID-19 disease than those without. Fatality was highest in persons ≥85 years old, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55–64 years, <1% among persons aged 20–54 years, and no fatalities among persons aged ≤19 years [75]. More recent reports note very few fatalities in ≤19 years age group. -Consider oral therapies over infusion-based treatments when appropriate; be mindful that some oral regimens may have more toxicities than infusion-based therapies. -With select exceptions (i.e. high risk GTD), avoid inpatient administration of chemotherapy, when possible. -Screen all patients for symptoms of COVID-19 and ensure temperature <99.5 prior to treatment and consider testing if possible, prior to chemotherapy
During therapy	-Utilize telemedicine to reduce the frequency of in person evaluation and allow for patients to proceed directly to infusion center for treatment. -Obtain local collection of labs whenever possible. -Consider liberal use of granulocyte colony stimulating factor. Prioritize home administration or use of pegfilgrastim on-body injector in lieu of return for pegfilgrastim on day 2. -Consider outpatient management of neutropenic fever when clinically stable with moxifloxacin 400 mg po daily or ciprofloxacin po 500–750 mg BID and Augmentin 875 mg BID po. Maintain close follow-up with daily phone contact for at least 3 days to ensure no clinical deterioration [76,77].
Post-therapy	-Delay imaging during or after completion of treatment to a post-COVID surge timeframe unless critical to patients' immediate care. -Ensure that goals of care discussions with patients (including DNR/DNI status) are prioritized prior to or shortly after admission, even if via telephone or telemedicine. -Increase interval for routine port flushes to 8–12 weeks.