Management changes for patients with endocrine-related cancers in the COVID-19 pandemic.

Raghavan, Derek; Tan, Antoinette R; Story, E Shannon; Burgess, Earle F; Musselwhite, Laura; Kim, Edward S; Clark, Peter E

Substantial management changes in endocrine-related malignancies have been required as a response to the COVID-19 pandemic, including a draconian reduction in the screening of asymptomatic subjects, delay in planned surgery and radiotherapy for primary tumors deemed to be indolent, and dose reductions and/or delays in initiation of some systemic therapies. An added key factor has been a patient-initiated delay in the presentation because of the fear of viral infection. Patterns of clinical consultation have changed, including a greater level of virtual visits, physical spacing, masking, staffing changes to ensure a COVID-free population and significant changes in patterns of family involvement. While this has occurred to improve safety from COVID-19 infection, the implications for cancer outcomes have not yet been defined. Based on prior epidemics and financial recessions, it is likely that delayed presentation and treatment of high-grade malignancy will be associated with worse cancer outcomes. Cancer patients are also at increased risk from COVID-19 infection compared to the general population. Pandemic management strategies for patients with tumors of breast, prostate, thyroid, parathyroid and adrenal gland are reviewed.