Allocating Scarce Healthcare Resources during Pandemics: Making the Case for Patients with Advanced and Metastatic Cancer

Langston, Amelia A.; Quest, Tammie E.; Abernethy, Eli Rowe; Campbell, Gavin Paul; Owonikoko, Taofeek K.; Pentz, Rebecca D.

The oncology community is concerned that cancer patients will be unfairly classified in pandemic allocation guidances. Past guidances either excluded metastatic cancer patients from consideration or categorized them as having a survival of less than one year. Given recent improvements in treatments, we recommend that (1)the prognosis of an individual cancer patient be determined with input from a cancer specialist, or (2) if this is impractical, (a) The presence of active metastatic solid cancer or relapsed hematologic malignancy is graded as a major comorbidity, with a likelihood that survival will be less than 5 years; (b) Severe limitation in physical functioning (3 or 4 on the Eastern Cooperative Oncology Group performance status (ECOG‐PS) would define an advanced cancer patient as having a severe comorbidity, with a likelihood of less than 1 year survival. Cancer may be the “Emperor of all Maladies,” but it is no longer a certain death sentence.