Pancreatic Cancer
According to the consensus statements for patients with pancreatic cancer, each patient should be operated after completing neoadjuvant therapy (statement 1), as is also advised by the SSO.11 However, patients should be prioritized based on objective prognostic factors and comorbidities in case of limited resources. If surgery is postponed, patients should continue with neoadjuvant therapy (statement 3), but neoadjuvant therapy should not be used to select each patient with nonmetastatic pancreatic cancer for surgery (statement 2). Subsequently, patients with postponed surgery need to be evaluated as soon as possible for surgery when resources are available again (statement 7). Oba et al17 recently described the value of a new nomogram for pancreatic cancer, estimating patients’ predicted survival based on preoperative factors and confirmed the prognostic power of known predictive factors. These models could be used for prioritization of surgery for pancreatic cancer in case of limited resources. However, no consensus was reached on statement 4 and 5 to prioritize each pancreatic cancer patient on comorbidity and objective pancreas cancer-related prognostic factors, considering the life threatening nature of pancreatic cancer. Nevertheless, statement 18—prioritization of COVID-19 patients with a better prognosis over pancreatic cancer patients adhering to the process of triage for hospital resources and ICU beds—did not reach 60% agreement. However, the difficulty to prioritize between patients with severe COVID-19 or resectable pancreatic cancer is conceivable. See the section “Triage” for further explanation and recommendations.
Italy has demonstrated the feasibility of continuing crucial cancer care during the COVID-19 pandemic, among others by appropriate resource allocation and separate health care pathways between COVID-19 patients and noninfected cancer patients, structured by performance criteria (eg, hospital volume).3,18