Changes in Cancer Treatment Practice During the COVID-19 Pandemic: An Egyptian Multi-Institution Study

Abstract

Background: In many countries, especially the lower-income ones, the COVID-19 pandemic had a significant negative impact on the services provided to cancer patients. This necessitated setting guidelines for the management of cancer during the pandemic and resulted in changes in its practice. Aim:To explore the change in practice of cancer treatment in cancer centers during the COVID-19 pandemic in Egypt, a lower-income country. Methods: Oncologists from six geographically-distributed Egyptian cancer centers were invited to complete a semi-structured questionnaire evaluating their cancer treatment practice changes. This included systemic anti-cancer treatment, radiotherapy, surgery and supportive and palliative care.  Results: Regarding systemic chemotherapy, there was a switch from weekly to 3-4 weekly schedules, from longer to shorter courses and from parenteral to oral administration whenever possible in the majority of centers. Single agents were encouraged and regimens more likely to cause neutropenia were avoided. Hormonal and palliative care treatments were prescribed for longer durations.  For many indications, especially the palliative, a switch to hypofractionated radiotherapy regimens was adopted. Excluding emergencies, surgeries were postponed in many centers. The number of elective hospital admissions was minimized and the time interval of follow up visits was prolonged. The majority used phone calls to follow up patients. Conclusion: The COVID-19 pandemic has been associated with many changes in cancer treatment practice in Egyptian cancer care facilities. These changes are likely to minimize the risk of exposure of patients and health care professionals and to utilize the limited resources in a better way.