This page was last updated on 04/02/2020. Please check back frequently for updates.
ASCO Webinar on COVID-19
On March 19, 2020, ASCO held an informational webinar for members to discuss the Society’s COVID-19 response and future plans. The webinar featured a current status update, advice on limiting transmission, a legislative and regulatory update, and a demonstration of the ASCO Coronavirus Oncology Resource Center. Please note that the webinar recording contains accurate information up to the date on which it was held but is not being regularly updated in the same manner as the rest of the Resource Center.
ASCO continues to invite its members to submit questions about issues and challenges they see emerging while caring for patients with cancer during the coronavirus pandemic. Currently, limited clinical cancer-specific data are available and information is evolving. The following information is based on evidence gathered through PubMed searches of the medical literature, a search of relevant websites with information on infectious diseases (CDC, WHO, IDSA, etc.), and input from clinical oncologists and infectious disease experts. ASCO will update this information as new questions emerge and evidence develops.
CLINIC/CENTER PREPAREDNESS: How should my practice prepare for a local outbreak of COVID-19?
The following guidance is for all cancer practices to consider, with or without reports of local transmission of COVID-19.
- Provide clinic staff with additional training on symptom recognition, screening procedures, and use of Standard Precautions and personal protective equipment (PPE).
- Additional PPE may need to be obtained/sourced, as staff that do not usually use it may be required to perform tasks where it is appropriate.
- Provide clinic staff with training on how to obtain SARS-COV2 testing for patients according to current testing guidelines.
- Identify telephone-based mental health services in your community if available and be prepared to refer patients and their families, and staff when appropriate.
- Limit access to the facility through one point of entry, if possible.
- Facility access should exclude vendors, minimal ancillary services, limitations on most or all visitors, and no one under 18 years of age. Consider remote or virtual support services.
- Establish triage stations outside the facility, clinic, or office with social distancing of six feet apart to screen patients and visitors for COVID-19 symptoms and fever before they enter.
- Install barriers or social distancing mechanisms at front desks if screening is not conducted outside of the facility.
- Convert waiting area to allow for distancing of at least six feet. This may require reduction in visits or an increased interval between visits to allow for a reduced or eliminated waiting area.
- Convert through a simple re-design, any current open infusion suite to semi-private space with at least six feet distance between patients and/or use available curtains as a barrier between patients.
- Suspend or move to a virtual platform, all on-site group and patient activities (yoga, education seminars, support groups, etc.).
- Postpone routine follow-up visits of patients not on active cancer treatment. This includes 6-month and 12-month survivorship visits.
- In place of routine follow-up visits, brief remote check-ins should be initiated to ensure that patients on maintenance therapies have sufficient drug supplies and provide instructions on when they should call their provider.
- For survivorship care, remote check-ins will become more important the longer the pandemic restrictions exist. A timeline over the next months should be identified to institute direct tele-communication for survivorship check-ins.
- Provide patient communication and education via direct tele-communication, websites, and patient portals regarding COVID-19 virus and rationale for changes in visit schedules will be essential.
- Home collection of routine lab samples may be considered instead of patient visits into the clinic. Evaluation of laboratory test results can be performed by the health care team and communicated via telecommunication.
- For areas not yet impacted by widespread, local transmission, the postponement of non-urgent visits should be used to enable more immediate scheduling of urgent visits.
The CDC has published guidance on steps you may take to prepare for and to respond to an outbreak of COVID-19 in your community:
TELEMEDICINE: Should our clinic move to telemedicine for routine follow-up?
Along with postponing certain non-urgent visits, we recommend adoption of telemedicine for patients not requiring a physical exam, treatment or in-office diagnostics. Specifically:
- Explore alternatives for face-to-face triage and visits.
- Conduct appointments via telemedicine.
- Identify staff to conduct telephonic and telehealth interactions with patients. Develop protocols for staff to triage and assess patients quickly.
- Instruct patients to use available telephone triage, patient portals, on-line assessment tools, or call and speak to an office/clinic staff member.
- Conduct remote check-ins for symptom monitoring of high-risk patients.
The American College of Physicians has created a tutorial for deploying telemedicine services:
Additional information regarding expanded access to telemedicine may be found on the COVID-19 Government, Reimbursement & Regulatory Updates page.
INFECTION PREVENTION AND CONTROL: What screening and infection prevention and control practices should my clinic undertake?
Cancer centers are recommended to limit access to the facility to one point of entry and screen all patients and visitors outside the facility, clinic, or office for COVID-19 symptoms and fever. Further recommendations include:
- When scheduling appointments, instruct the patient to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (e.g. cough, sore throat, fever) on the day they are scheduled to be seen.
- Contact the patient the day prior to appointment for screening of symptoms of cough, sore throat, fever, or other flu-like symptoms. Patient should be rescheduled if symptoms are present.
- Allow access to visitors only if essential to the visit. If visitors are required, limit to one visitor for all provider visits and deny entry of visitors in any communal treatment area – ask visitors to wait in vehicles or return after treatment. Deny entry to any visitor displaying symptoms of a respiratory or other infection.
- Upon access to the facility, screen all patients and visitors:
- Provide screening staff PPE (including masks), waste bins, access to cleaning/disinfecting agents.
- Question patients and visitors as to symptoms of cough, sore throat, fever, recently out of the country in the past 14 days, exposure to anyone with respiratory symptoms or known COVID-19. If available, use an infrared thermometer to take temperatures during screening.
- Include signage with COVID-19 screening questions and visualization of symptoms for all patient/visitors, as well as patient education materials and illustrations of proper hygiene for infection prevention and symptoms to report.
- Provide a facemask to and rapidly isolate patients with suspected infection until more thorough screening or testing can be conducted. Isolation should take place in an exam room or other private area with the door closed.
- All staff entering the room of a patient with known or suspected COVID-19 should adhere to Standard Precautions and use a N95 respirator or facemask, gown, gloves, and eye protection.
- Establish a plan of action for patients that present with respiratory symptoms (e.g. resource for testing, schedule patient with primary care or local/health department).
The CDC has published guidance for infection control and prevention in health care settings in the context of COVID-19 (Accessed March 18, 2020).
How can we protect our health care professionals who are immunocompromised, older, or otherwise at higher risk?
- Protect all healthcare professionals by limited opportunities for exposure through the following strategies:
- Use Standard Precautions and other infection prevention and control strategies to limit exposure.
- Reduce the number of staff in your clinic by allowing work-from-home for scheduling, billing, and other phone-based staff.
- Move cancer conferences and other meetings to a virtual format.
- Use telemedicine and other remote patient management strategies.
- Some health care professionals have additional risk factors that may necessitate modified duties or other accommodations. Such professionals should consult their personal health care provider to evaluate the risk for infection and notify their human resources department to evaluate applicable laws and policies.
- The CDC’s Guideline for infection control in health care personnel, 1998 includes, “At the request of the immunocompromised health care personnel, employers should offer but not compel a work setting in which health care personnel would have the lowest possible risk for occupational exposure to infectious agents.”
Should staff be quarantined if they have treated a patient with COVID-19?
The CDC has provided guidance for risk assessment and public health management of health care personnel with potential exposure. Risk assessment is based on length of contact, use of personal protective equipment, and whether the patient was wearing a facemask. View CDC’s risk factors, recommended monitoring, and work restrictions here.
If a staff member has recovered from confirmed or suspected COVID-19, when may they return to work?
Please refer to the Centers for Disease Control and Prevention’s Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (interim guidance).
CLINICAL TRIALS: How should clinical trial investigators respond to the COVID-19 pandemic?
ASCO acknowledges that conducting clinical trials will be particularly challenging during this time.
- The FDA has issued guidance on management of clinical trial patients during the coronavirus pandemic.
- The National Cancer Institute has issued guidance on the NCI Central Institutional Review Board (CIRB) website including advisories and FAQ’s.
DRUG SHORTAGES: How can we help ensure that chemotherapy/biotherapy drugs remain readily available for all of our patients?
ASCO encourages its members to work together to ensure judicious use of any scarce resources. It is quite possible that we will experience drug shortages as this pandemic progresses, but there are resources available with reliable information. The FDA maintains a list of drugs in shortage, which includes information on expected duration of shortage and alternative suppliers, when available.
The FDA has requested that providers report any critical drug or biological products that may be in shortage or being closely monitored or rationed in your facility. Please include in your submission why the drug is considered critical in your practice. To report a shortage, visit How to Report a Product Shortage or Supply Issue to FDA.
Mental Health Resources for Oncologists
Clinicians and members of the cancer care team are likely feeling increased stress due to the COVID-19 pandemic. The following page includes information on stress, tips to support physical and mental well-being, and links to additional resources. ASCO will continue to update this content as new resources become available.
Health Professional Well-Being
Clinicians are at risk of increased stress during crisis due to a number of factors, including:
- Isolation: Need to employ strict biosecurity measures; physical isolation from friends and family.
- Risk: Risk of disease transmission; worry about own health and health of family, peers, and colleagues.
- Competing demands: Multiple medical and personal demands; competing demands of typical daily workload and COVID-19 response; changes in family care responsibilities.
- Clinical challenges: Difficult choices and challenges in patient care, worry about patients; supporting patients and families during reduced visitation.
Sources: US Department of Veterans Affairs, Managing Healthcare Workers’ Stress Associated with the COVID-19 Virus Outbreak ; National Academies, Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2
Tips to Enhance Coping
- Maintain social support
- Avoid information overload
- Trust reputable sources
- Take a break from news/social media about COVID
Tips to Enhance Physical and Mental Health
- Use deep breathing, stretching, meditation
- Try to maintain healthy eating, exercise, and sleep routines
- Take time to unwind
- Practice social distancing yet maintain social connections virtually (phone/FaceTime, Skype, Twitter, text, etc.).
- Engage in mindful practice: pay attention purposefully, nonjudgmentally, in the moment during clinical interactions; focus on the present patient experience. Mindfulness includes attentive observation of ourselves, our patients, and the issues at hand. Journaling may also help to explore challenging patient cases.
- Exercise: Mindful hand washing (or use of hand gel): Simply focus and pay purposeful attention to the water/gel: its weight, temperature, sound, its flow. Look at the water/gel. Your thoughts may wander, simply acknowledge them and return your focus to the water.
- Seek Mental Health support to address COVID-19 stress and additional support if overwhelmed or feel like harming self/others
- PTSD Coach:an app created by the VA and DoD to help those who are or may be experiencing effects of trauma.
- Doctor On Demand: a telemedicine service focused on behavioral health.
- Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)
- TalkSpace: offering free online therapy to health care workers fighting COVID
- American Medical Association, Caring for our Caregivers During COVID-19
- American Psychological Association, Resources for Pandemic
- Cates, Gomes, and Krasilovsky. Bioemergency Planning, Behavioral Health Support for Patients, Families, and Healthcare Workers