Table 5.

Table of Recommendations.

Testing and Tracking	Pre-admission screening and testing outside hospital entrances Mandatory health questionnaires for patients and visitors regarding symptoms Testing for all patients before undergoing any medical procedures Frequent staff testing Strict and thorough contact tracing (e.g. documentation of contact and travel histories) Dedicated tracer team to monitor patients progress, investigations, outcomes and staff exposure and quarantine
Outreach and Communication	Use of videoconferencing meetings for MDT and staff to coordinate care Patient education on cross-contamination risks and safe practice Use of telehealth to communicate with patients (treat, track and monitor) Consider the ethical and financial challenges of transitioning to telehealth and the psychological impact on tele-oncology on patients Consider and address the impact of tele-oncology on the doctor-patient relationship Provision of cancer-related education materials online or through leaflets Development of mobile phone apps for monitoring treatment and/or identifying those at risk of COVID-19 Education about and open discussion on the impact of COVID-19 or additional risks of COVID-19 infection with patients
Protection	Provide training on PPE and provide PPE to all staff Perform weekly PPE stock checks to mitigate potential shortages Implement a tiered PPE protocol based on patient type and status Staff change into clean surgical scrubs when entering hospital Provide visitors and patients with masks upon entering facility Use of video laryngoscopes and plastic sheaths can be used as a barrier to reduce aerosol spread during intubation to protect anesthetists Hand sanitization should be made compulsory Disinfect surrounding environments and frequently contacted areas Consider using UV light radiation and vaporized hydrogen peroxide to extend the use of N95 respirators Maintain PPE supply through engaging with external stakeholders (e.g manufacturers and charities)
Social Distancing	Patients and Visitors Visitors/caregivers should be given limited access to health facility If accompanying visitors are allowed, health checks should be put in place Limit number of patients on-site (prioritization of admission can be done through triaging) Instate measures to reduce waiting room congregation and waiting time (e.g. online booking systems to reduce waiting time, ask patients to wait in car) Use of videoconferencing for discussions with patient and family Requiring patients to quarantining and test negative for COVID-19 before surgery Immediate patient isolation in a single room upon arrival Staff Ensure personnel and staff onsite are kept to a minimum (especially for surgical procedures) Staff segregation systems put into place to reduce intermixing Set up oncological teams focusing solely on COVID-19 patients with cancer, including a respiratory specialist Movement restrictions should be put in place to contain staff/patients to one area to reduce interdepartmental/facility viral spread Workspaces should be reconfigured to ensure adequate spacing Plans to combat staff shortages if staff isolation is required (e.g. split teams into sub-teams) Use of videoconferencing for multidisciplinary teams and healthcare workers Perform aerosol generating procedures with the minimum number of members of the anesthetic team in the operating theater General Segregation by area (allocate areas for COVID-19 and COVID-19 free rooms/zones) Treatment rooms should utilize cameras to reduce healthcare worker-patient contact Provide training on social distancing to staff and patients
Treatment Managements	Carry out careful risk-benefit assessment before treatment initiation /continuation Consider de-escalation of treatment regimens/frequency: Consider oral/subcutaneous treatments over intravenous treatments (as well as prolonged treatment intervals for intravenous treatment) Consider defer radiotherapy for less aggressive tumors; Hypofractionating radiation for those who are on radiotherapy to shorten treatment schedules Consider changing to less invasive/immunosuppressive treatments Consider postponing/canceling elective operations Employ surgical techniques with lower risks of aerosolization Minimize length of hospital stay using less invasive (e.g. robotic) surgery or enhanced recovery protocols after surgery Document treatment variation and regularly audit clinical activity to maintain standard of care Consider non-surgical interventions when possible
Service Restructuring	Consider outsourcing selected clinical investigations (e.g. blood tests) to non-academic centers or the private sector Delegate and refer care provision to family doctors/local centers Streamline drug delivery: set up dug-refill clinics, home delivery, and prescription of medication through telehealth. Limit case load and space-out patient appointments Instate out-of-hour operations to reduce accumulation of delayed appointments Form leadership teams or committees to help advise and streamline care Form shadow rotas to help cover sick or quarantining staff Leadership roles should be given to senior staff members to delegate tasks effectively Select experienced surgeons to perform airway operations to minimize contact time with patient. Redeploy staff from hospital departments that are not in service to oncological wards