Table 1.
Summary problems and possible solutions of palliative care for non-COVID lung cancer patients during the COVID-19 pandemic.
| Domain of palliative care | Problems during COVID-19 pandemic | Possible solution |
|---|---|---|
| Psychological | - Anxiety for COVID-19 but also for cancer treatment changes - Depression due to social isolation |
- Self-care and distress management tools. Links with examples of self-care tools for patients or clinicians are found below. • https://www.nccn.org/covid-19/pdf/NCCN_Patient_Self_Care_COVID-19.pdf (17) • https://helixcentre.com/project-end-of-life-toolkit (18) • https://www.nccn.org/covid-19/pdf/Distress-Management-Clinician-COVID-19.pdf (19) - Telemedicine |
| Social | - Social distancing and therefore lack of social support | - Technical applications for video calling |
| Physical | - Shortage of drugs - Shortage of materials such as pump drivers - Shortage of caregivers - Minimized face-to-face contact between treating physician and patient |
- Adapting guidelines with alternative drugs and pump systems. If a shortage is impending it is recommended to look at the local (changed) guidelines, because the local availability of products can be different in every region. Links to currently adapted guidelines are found below. • https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/alternatives-to-regular-medication-normally-given-via-a-syringe-pump-when-this-is-not-available.aspx (20) • https://www.esmo.org/content/download/286441/5690599/1 (21) • https://www.esmo.org/content/download/286432/5690545/1 (22) - Telemedicine - Adapting palliative care for specific complaints • Painful bone metastases: avoid RTx when pain controlled by level 1–3 oral analgesics. If RTx necessary, mono-fractionated (8 Gy in 1 fr) (23) • Thoracic RTx: palliative RTx for symptomatic mediastinal/hilar mass → not postpone treatment but change to a more hypofractionated regimen (24) • Malignant pleural effusions: pleural indwelling catheter when in need of frequent pleural fluid drainage (25) |
| Spiritual | - Loss of sense of meaning of life - Loss of faith |
- Seek partnership with local spiritual counselors |
COVID-19, corona virus disease 2019; RTx, radiotherapy; Gy, Gray; fr, fraction.