Palliative cancer care during the COVID-19 outbreak
Palliation is an ethical obligation and we should strive for good symptom control and comfort care for cancer patients in a pandemic [11]. To support palliative and supportive care of people with cancer, these proposed four areas (4S) for palliating a pandemic [11] can be used to guide a response but need to be adapted and considered in the context of the availability of resources and expertise in the context of low-resource settings: “Stuff” (i.e. stockpile of medications, equipment to deliver medications)
“Staff” (identifying and consulting with clinicians with palliative care expertise, deliver focused education sessions to frontline staff for symptom management and supporting end-of-life care for patients with COVID-19)
“Space” (e.g. identify wards and nonclinical areas in all health care facilities that would be appropriate to accommodate large numbers of patients expected to die)
“Systems” (e.g. develop systems for direct consultation of palliative care expertise for staff in hospitals, create a triage system to identify patients with cancer in need of specialist palliative care management)
Bereavement needs to be considered in the context of COVID-19 too. Globally we are seeing increasing numbers of unexpected and premature deaths from COVID-19. Families will need support with bereavement where they may have been expecting a longer trajectory of illness for a loved one with cancer. Furthermore, traditional cultural rituals and ceremonies may be prohibited in line with social distancing. We need talk to spiritual leaders to understand what can occur and provide guidance to the families of those who die to discuss how and when they might be able to hold services for their loved ones.
A time like this is a true test of leadership and our values. As leaders we must make clinical and economical decisions in line with the ethical rationing of resources and the global call to flatten the curve of the infection.