We propose a conceptual framework for prioritizing cancer treatment during the pandemic (Fig. 1). The examples provided involve radiotherapy and systemic therapy, although the principles are also relevant to surgery. Interpretation of this framework will rely heavily on the capacity of locoregional health systems and the position of a given system on the epidemic curve. Our discussion will focus on three scenarios: (1) preparedness (with no confirmed cases); (2) moderate health-care resource limitation; and (3) severe health-care resource limitation.
Fig. 1 Conceptual framework for prioritizing the use of radiotherapy and systemic treatments during the COVID-19 pandemic.
The lowest and highest priority categories are unevenly spaced to illustrate the concept that prioritization between subgroups is variable. The spacing of categories in this diagram is conceptual rather than prescriptive. Priority of indications within each category is also variable and subject to the principles discussed in the commentary. These include the magnitude of treatment benefit, possible effects of treatment delays or interruptions on outcomes, patient-specific considerations and the availability of staff and resources to safely deliver treatment. This overlap implies that some items listed in a lower category could be prioritized over items listed in a higher category. Disease indications in each box are meant to serve as illustrative examples and are not intended to be an exhaustive list. NSCLC, non-small-cell lung cancer.