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. 2023 Jan 17;35(4):e289–e300. doi: 10.1016/j.clon.2023.01.004

Table 2.

Adaptive strategies targeting cancer care implemented in 2020 and 2021

Adaptive policies 2020 2021
Healthcare delivery – any adaptive strategies implemented to reduce the exposure to COVID-19 and maintain the capacity/services for cancer patients with limited resource constraint
1. Telemedicine
  • -

    Eight health systems except for Singapore and Hong Kong introduced telemedicine to maintain cancer care.

  • -

    China and Sri Lanka introduced telemedicine at a minimal level.

  • -

    England and India introduced telemedicine at a moderate level.

  • -

    Colombia, Indonesia, the UK and Zambia introduced telemedicine at a substantial level.
  • -

    Singapore and Sri Lanka started to provide cancer care via telemedicine.

  • -

    China, Egypt, India, Indonesia and Zambia increased their telemedicine services.

  • -

    Colombia decreased the level of implementation.
2. Restructure the cancer care provider system
  • -

    Three health systems, i.e. the UK, Zambia and Singapore, restructured the cancer care provider system at a minimal level.

  • -

    Colombia restructured the cancer care provider system at a moderate level.
  • -

    Colombia and Zambia maintained their implementation.

  • -

    The UK increased the scale of implementation.

  • -

    Singapore stopped its implementation.
3. Reduction of supportive treatments
  • -

    Four health systems, i.e. Colombia, Egypt, India and Zambia, reduced supportive treatment to a moderate level.
  • -

    Egypt increased the implementation.

  • -

    Zambia decreased the implementation.
4. Adaptation of treatment
  • -

    Except for China, Singapore and Hong Kong, all other health systems adapted cancer treatment, e.g. modification of surgery, altered fractionation of radiotherapy and dose-scheduling of chemotherapy.

  • -

    Zambia implemented treatment adaptation strategies at a minimal level.

  • -

    Egypt, India and Sri Lanka implemented treatment adaptation strategies at a moderate level.

  • -

    India, the UK and Colombia implemented treatment adaptation strategies at a substantial level.
  • -

    Singapore started to implement an adaptation strategy.

  • -

    India, Sri Lanka and Zambia increased their implementation.

  • -

    Egypt, Indonesia and Colombia reduced their implementation.
5. Prioritisation and triage
  • -

    Except for Singapore and Hong Kong, all other health systems prioritised critical treatment and postponed non-emergency or critical treatment.

  • -

    China and the UK implemented the prioritisation measures at a minimal level.

  • -

    Colombia, Egypt, Indonesia, Sri Lanka and Zambia implemented the prioritisation measures at a moderate level.

  • -

    India implemented the measures at a substantial level.
  • -

    The UK maintained its implementation of prioritisation measures.

  • -

    Sri Lanka started to implement prioritisation measures.

  • -

    India, Indonesia and Zambia increased their implementation.

  • -

    Egypt and Colombia decreased their implementation.

  • -

    China stopped prioritisation measures.
6. Reduction of palliative care
  • -

    Zambia and Colombia reduced palliative care at a minimal level.

  • -

    Egypt reduced palliative care at a moderate level.
  • -

    All three systems maintained their scales of implementation.
7. Reduction of patient involvement in clinical trials and research
  • -

    Except for China, Hong Kong and Sri Lanka, all other health systems reduced patient involvement in clinical trials and research.

  • -

    The UK and Zambia implemented the reduction at a minimal level.

  • -

    Singapore implemented the reduction at a moderate level.

  • -

    Colombia, Egypt, India and Indonesia reduced patient involvement at a substantial level.
  • -

    The UK increased the reduction of patient involvement in clinical trials and research.

  • -

    Egypt and Singapore decreased the level of reduction of patient involvement.
Healthcare workforce – any adaptive strategies implemented to maintain training of oncology professionals
1. Online seminars/classes
  • -

    Except for Egypt and Sri Lanka, all other health systems introduced online seminars/classes.

  • -

    India, Hong Kong, Sri Lanka and Singapore introduced the measure at a moderate level.

  • -

    China, Colombia, Indonesia, the UK and Zambia introduced the measure at a substantial level.
  • -

    China, Hong Kong and the UK maintained their implementation.

  • -

    Egypt and Sri Lanka started to implement online seminars/classes.

  • -

    India, Indonesia, China and Singapore increased online seminars/classes.

  • -

    Colombia reduced seminars/classes.
2. Restructure training and teaching into smaller groups
  • -

    Three health systems, i.e. Zambia, Indonesia and Colombia, restructured the training and teaching into smaller groups.

  • -

    Zambia restructured the training at a minimal level.

  • -

    Indonesia and Colombia restructured the training at a substantial level.
  • -

    Egypt and Sri Lanka started to implement the measure.

  • -

    Indonesia and Colombia increased the scale of implementation.
3. Restructure the training syllabus
  • -

    Four health systems restructured the training syllabus (e.g. consolidated training with other faculties).

  • -

    Colombia and Zambia implemented the measure at a minimal level.

  • -

    China and Indonesia implemented the measure at a substantial level.
  • -

    Indonesia increased the restructuring of the training syllabus.
Healthcare workforce – any adaptive strategies implemented to maintain the cancer service workforce
1. Rapid COVID-19 testing
  • -

    Six health systems, i.e. Colombia, India, Indonesia, Singapore, the UK and Zambia, introduced rapid COVID-19 testing.

  • -

    Colombia introduced rapid testing at a moderate level.

  • -

    India, Indonesia, Singapore, the UK and Zambia introduced the rapid testing at a substantial level.
  • -

    Egypt, Sri Lanka and China started rapid testing.

  • -

    Colombia, India, Indonesia, Singapore and Zambia increased the scale of rapid testing.
2. Relocation of healthcare workforce to one or selected institutions
  • -

    Three health systems, China, Singapore and Zambia, relocated their healthcare workforce to one or selected institutions.

  • -

    China and Singapore implemented the measure at a minimal level.

  • -

    Zambia implemented the measure at a moderate level.
  • -

    The UK started to relocate its healthcare workforce.

  • -

    China decreased the relocation of its healthcare workforce.

  • -

    Singapore stopped the relocation of its healthcare workforce.
3. Work-from-home arrangement for supporting staffs
  • -

    Except for Egypt and Sri Lanka, all other health systems adopted remote work practice for supportive staff.

  • -

    Hong Kong, China and Singapore adopted remote work at a minimal level.

  • -

    India and Colombia adopted remote work at a moderate level.

  • -

    Indonesia, the UK and Zambia adopted remote work at a substantial level.
  • -

    Egypt and Sri Lanka started remote work practice for supportive staff.

  • -

    Zambia and Singapore increased the scale of implementation.

  • -

    Indonesia and Colombia decreased the scale of implementation.

  • -

    India stopped the implementation.
4. Psychological support interventions
  • -

    Five health systems provided psychological support to healthcare professionals.

  • -

    China and Zambia provided the support at a minimal level.

  • -

    Colombia and India provided the support at a moderate level.

  • -

    Indonesia provided the support at a substantial level.
  • -

    Sri Lanka started providing psychological support.

  • -

    Colombia, India and Zambia increased their provision of psychological support.

  • -

    Indonesia reduced the psychological support.
5. Sympathetic working scheduling
  • -

    Five health systems implemented sympathetic work scheduling.

  • -

    China and Zambia implemented the measure at a minimal level.

  • -

    Sri Lanka and Colombia implemented the measure at a moderate level.

  • -

    Indonesia implemented the measure at a substantial level.
  • -

    Egypt started sympathetic work scheduling.

  • -

    Colombia, India and Zambia increased the scale of implementation.

  • -

    Indonesia decreased the scale of implementation.
6. Outsourcing of treatment services
  • -

    Five health systems arranged some services to other providers.

  • -

    China and Singapore implemented the measure at a minimal level.

  • -

    Hong Kong, Indonesia and the UK implemented the measure at a moderate level.
  • -

    China increased its scale of service outsourcing.
Information – any adaptive strategies implemented to provide related information about cancer services
1. Tailored public health messaging for patients about the risk of COVID-19
  • -

    Except for India, Sri Lanka and Zambia, all other health systems provided tailored information to patients.

  • -

    Hong Kong implemented the measure at a minimal level.

  • -

    Egypt implemented the measure at a moderate level.

  • -

    China, Colombia, Indonesia, Singapore and the UK introduced the measure at a substantial level.
  • -

    Sri Lanka started providing tailored information to patients.

  • -

    China, Egypt, Hong Kong and Indonesia increased the provision of information.

  • -

    Colombia and Singapore decreased the provision of information.
2. Evidence-based information for healthcare workers to manage cancer patients at risk of COVID-19
  • -

    Six health systems, i.e. China, Colombia, Indonesia, Singapore, the UK and Zambia, provided evidence-based information to healthcare workers at a substantial level.
  • -

    Sri Lanka started providing information to healthcare workers.

  • -

    All six health systems increased information provision to healthcare workers.
3. Evidence-based guidance for the healthcare workers to ration healthcare resources
  • -

    Five health systems provided evidence-based guidance for healthcare workers to ration healthcare resources.

  • -

    Egypt and Zambia implemented the measure at a moderate level.

  • -

    China, Colombia and Indonesia implemented the measure at a substantial level.
  • -

    Sri Lanka started providing guidance.

  • -

    Colombia, Egypt, Indonesia and Zambia increased the scale of implementation.

  • -

    China stopped providing guidance.
Health financing – any adaptive strategies implemented to enhance financial affordability of cancer patients
1. Government cancer funding/financial assistance
  • -

    No health system initiated government financial assistance for cancer patients.
  • -

    Indonesia started providing some financial assistance for cancer patients.
2. NGO-related initiatives and financial assistance
  • -

    Sri Lanka had some NGOs providing financial assistance for cancer patients.
  • -

    Indonesia started having NGOs provide financial assistance.

  • -

    The level of NGO-related financial assistance in Sri Lanka increased.

NGO, non-government organisation.