16 April 2020
New resources for tackling COVID-19 in Oncology
(Previous resources may be found here: https://ukons.org/news-events/resources-for-tacking-covid-19-in-oncology/)
- ESMO Guidance. These recommendations should be used as guidance for prioritising the various aspects of cancer care in order to mitigate the negative effects of the COVID-19 pandemic on the management of cancer patients. Available at: https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic
- Interim treatment change options during the COVID-19 pandemic, endorsed by NHS England. These interim treatment regimens are based on clinical opinion from members of the Chemotherapy Clinical Reference Group and cancer pharmacist and endorsed by NHS England and NHS Improvement. The responsibility for using these interim treatment regimens lies entirely with the prescribing clinician, who must discuss the risks and benefits of interim treatment regimens with individual patients, their families and carers. All patients who start on an interim treatment during the COVID-19 pandemic should be allowed to continue the treatment until they and their clinician jointly decide it is appropriate to stop or to switch to a different treatment. These treatment options can be viewed here https://www.nice.org.uk/guidance/ng161/resources/interim-treatment-change-options-during-the-covid19-pandemic-endorsed-by-nhs-england-pdf-8715724381
- Government Guidance about coronavirus (COVID-19) on personal protective equipment (PPE) (12.4.20) Latest PPE guidance from the UK government. Available at: https://www.gov.uk/government/collections/coronavirus-covid-19-personal-protective-equipment-ppe?utm_source=c42b0a02-e40c-497c-9683-9106e2e1b3ca&utm_medium=email&utm_campaign=govuk-notifications&utm_content=daily
- Government guidance on Coronavirus (COVID-19): hospital discharge service requirements (9.4.20). This sets out how health and care systems and providers should change their discharging arrangements and the provision of community support during the coronavirus situation. Available at: https://www.gov.uk/government/publications/coronavirus-covid-19-hospital-discharge-service-requirements?utm_source=25be7a58-e584-402e-947d-4cc7e5a0a45f&utm_medium=email&utm_campaign=govuk-notifications&utm_content=daily
- NICE COVID-19 rapid guideline: delivery of systemic anticancer treatments (9.4.20) latest update from NICE. Available at: https://www.nice.org.uk/guidance/ng161/chapter/7-Modifications-to-usual-service
- Scalp Cooling – many providers of chemotherapy/SACT have reviewed their provision of scalp cooling in light of the pandemic. Some have chosen not to offer scalp-cooling at all or reduce their offer. This is in order to reduce the length of time patients spend on chemotherapy units and also to address capacity issues. UKONS believe that these decisions should be discussed with patients, and where possible that there should be an element of patient choice. These are understandable decisions but there may be other resources and activities which can help with continuing to provide scalp-cooling. Paxman Scalp Coolers are offering to help with initial patient education, and this would lighten the load for scalp cooling, and minimize contact time as much as possible. There is a clear need for social distancing, which is challenging when assisting a patient with the cold cap, in addition to possible staffing limitations. Paxman can assist patients in preparing their own hair, fitting the cap and operating the system by accessing remote teaching. This would cover all areas from the initial cap sizing process, putting the cap on correctly, to support a patient through scalp cooling during chemo infusion. These calls can be facilitated through one to one FaceTime, WhatsApp video call or Zoom meetings with the Paxman team training team. If you would like to take up this service, please make contact with Paxman via firstname.lastname@example.org The Paxman Scalp Cooling private Facebook group is also open all hours to provide peer to peer support for patients where they can talk to others who are cold capping and access advice and support.
- NHS England Guidance on essential cancer surgery in the COVID-19 pandemic (7.4.20) available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0239-Specialty-guide-Essential-Cancer-surgery-and-coronavirus-v1-70420.pdf
- NICE COVID-19 rapid guideline: critical care in adults (9.4.20) Latest update available at: https://www.nice.org.uk/guidance/ng159
- NICE COVID-19 rapid evidence summary: acute use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19 (14.4.20) available at: https://www.nice.org.uk/advice/es23/chapter/Key-messages
- The Infection Prevention Society (IPS) and British Association of Critical Care Nurses (BACCN) issue joint statement on Facilitating compassionate care for patients dying with COVID-19. Available at: https://www.baccn.org/about/covid-19-nurse-educational-resource-centre/latest-news-and-updates/
- Masks for all? The science says yes. Written: 13 Apr 2020 by Professor Trisha Greenhalgh OBE and Jeremy Howard, available at: https://www.fast.ai/2020/04/13/masks-summary/
- Health and well being
Some psychological self-help apps are available to all NHS staff for free via NHS England. these include Unmind, Headspace, Sleepio and Daylight. NHS England and NHS Improvement announced the first in a series of psychological support mechanisms for all NHS staff during the COVID19 outbreak, recognising the importance of looking after your own health and wellbeing, whilst supporting patients and your family Additional self-help apps and support will be available over the next few weeks.
Unmind is a mental health platform that empowers staff to proactively improve their mental wellbeing. Using scientifically-backed assessments, tools and training you can measure and manage your personal mental health needs, including digital programmes designed to help with stress, sleep, coping, connection, fulfilment and nutrition.
They are offering free access to NHS staff until the end of December 2020, active now.
How NHS staff can get access
Go to https://nhs.unmind.com/signup and sign up with your NHS email address or download the Unmind app from your appstore - your organisation name is NHS.
Headspace is a science-backed app in mindfulness and meditation, providing unique tools and resources to help reduce stress, build resilience, and aid better sleep. They are offering free access to all NHS staff with an NHS email address until 31 December, active now.
How NHS staff can get access
Go to https://www.headspace.com/nhs and select clinical or non-clinical staff to start enrolling
You will need to use your NHS email address to sign up
Sleepio and Daylight (developed by Big Health):
Sleepio is a clinically-evidenced sleep improvement programme that is fully automated and highly personalised, using cognitive behavioural techniques to help improve poor sleep. Free access to Sleepio for all NHS staff is active now until 31 December.
Daylight is a smartphone-based app that provides help to people experiencing symptoms of worry and anxiety, using evidence-based cognitive behavioural techniques, voice and animation.
Free access to Daylight is active now until 31 December.
How NHS staff can access Sleepio
Visit http://sleepio.com/redeem on your laptop or desktop computer and enter redeem code NHS2020 and sign up for an account using your name and email address. You can then complete the sleep test
How to access Daylight
Click on the following link http://trydaylight.com/nhs-staff and answer a few short questions to tailor the programme to you. Then sign up for an account using your name and email address. You can also download the Daylight smartphone app (search 'Daylight - Worry Less').
A yoga app is being made available to NHS staff for free until 1st July: https://www.downdogapp.com/healthcare
The FIIT home workout app gives NHS staff access to Pilates, Yoga, strength and cardio workouts. FIIT is offering Premium memberships to all NHS staff - for free. https://fiit-squad.typeform.com/to/UFEfqW?utm_campaign=unknown&utm_source=shortlink&utm_medium=referral
To access Fitness Studio, visit the NHS website https://www.nhs.uk/conditions/nhs-fitness-studio/
Yoga with Adrienne has multiple Youtube videos for all levels from 10 mins to 45 mins. This could be good for necks/backs while WFH. There are some practices for reducing stress, anxiety, anger etc too. https://www.youtube.com/user/yogawithadriene
The Body Coach lots of video for short intense workouts for all skill levels, including low impact ones. He has also started doing ‘P.E.’ at home lessons for children and adults to take part in, live and daily from 9am on Youtube https://www.thebodycoach.com/blog/pe-with-joe-1254.html
- The UK Coronovirus Cancer Monitoring Project (UKCCMP) this is a national project which allows oncologists to report the case details and outcomes of people with a cancer diagnosis who also contract COVID-19. Details of the project can be found here https://ukcoronaviruscancermonitoring.com/. A visual representation of data from the first cohort of oncology patients in the UK can be viewed on Twitter via @UKCORONACANCER.
- Macmillan Video Resources for Primary Care ‘Courageous Conversations’
We know that GPs and other health professionals will be entering into discussions around end of life care with patients and families which will have been made more complex and distressing by the current situation. As with Macmillans other ‘Courageous Conversations’ video resources, these recordings are vehicles for learning and should not be interpreted as examples of perfect consultations but rather to demonstrate some useful strategies, words and phrases.
These new resources consist of recordings designed to replicate telephone and Skype calls and illustrate the following scenarios:
Scenario 1: Older patient with co-morbidities but currently well, GP calls phones to discuss advance care planning. Available here https://vimeo.com/405774487
Scenario 2: Patient at home with multiple co-morbidities, elderly and COVID symptoms, in Skype conversation with GP. Available here https://vimeo.com/405875369
Scenario 3: Daughter of a patient in a care home phones her mother's GP on learning that her mother has COVID-19. Available here https://vimeo.com/405775809
Scenario 4: Follow up phone call from GP to patient with advanced bowel cancer and liver metastases. Available here https://vimeo.com/405776765
- Latest articles relating to cancer and COVID-19
- COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting? https://ecancer.org/en/journal/article/1023-covid-19-and-treatment-with-nsaids-and-corticosteroids-should-we-be-limiting-their-use-in-the-clinical-setting/abstract
- Upheaval in cancer care during the COVID-19 outbreak https://ecancer.org/en/journal/editorial/97-upheaval-in-cancer-care-during-the-covid-19-outbreak
- Anosmia and ageusia are emerging as symptoms in patients with COVID-19: What does the current evidence say? https://ecancer.org/en/journal/editorial/98-anosmia-and-ageusia-are-emerging-as-symptoms-in-patients-with-covid-19-what-does-the-current-evidence-say
- How should health systems prepare for the evolving COVID-19 pandemic? Reflections from the perspective of a Tertiary Cancer Center, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134548/pdf/cln-75-1864.pdf
- Caring for Patients With Cancer During the COVID-19 Outbreak in Italy, available at: https://jamanetwork.com/journals/jamaoncology/article-abstract/2764435
- Challenges in lung cancer therapy during the COVID-19 pandemic, available at: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30170-3/fulltext
- The role of growth factor receptors in viral infections: An opportunity for drug repurposing against emerging viral diseases such as COVID‐19? https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fba.2020-00015
9th April 2020
As the COVID-19 pandemic reaches a crucial stage in the UK with increasing numbers of patients admitted to most hospitals, many have moved oncology wards away from the main sites and redeployed oncology nurses to care for patients with COVID-19. This is an unprecedented time of challenge and upheaval for oncology nursing and UKONS and Macmillan will continue to try and provide you with the information you need to care for our patients.
- Macmillan Resources for Health Care Professionals
Some of the content relating to cancer and the pandemic may be of a sensitive nature to people living with cancer and the general public, so Macmillan created a safe area COIVD-19 related for Cancer professionals on the Macmillan ‘Learnzone’ site. There is an enrolment key that will be needed to access the site and the link is as follows: https://learnzone.org.uk/coronavirus/ . To access the resources you will need a Learnzone account. If you do not already have a ‘Learnzone’ account, it’s easy to create one on the site but here is the link to register https://learnzone.macmillan.org.uk/login/signup.php?_ga=2.118657033.1631791940.1586166299-1936566431.1569233690
Your first access of each set of resources will require an enrolment key. For every set of resources, the key is ‘covid19’. If you do run into any issues with the site, you can contact the Macmillan information team by clicking the Support button in the top right-hand corner.
Macmillan hope that the resources will be of help, and some benefit to our professionals, but they seek to gain feedback on what else can be added, so regular updates will be added to the learn Zone site.
Macmillan has resources for professionals relating to
• Emotional health and Wellbeing
• Cancer and Covid19: including treatment info for nurses and AHP’s
• End of Life and bereavement
• Communication skills and difficult conversations
• Resources you can use to support your patients
• General and other resources
- NHS England have issued guidance on maintaining Cancer Services during the pandemic, and this has been passed to all NHS Trusts via a letter which is available here
The letter outlines how Trusts are expected to continue to deliver cancer services with particular emphasis on continuing essential and urgent cancer treatments. Cancer specialists should discuss with their patients whether it is riskier for them to undergo or to delay treatment at this time and where referrals or treatment plans depart from normal practice, safety-netting must be in place so that patients can be followed up. The letter also suggests that urgent consideration should be given to consolidating cancer surgery in a COVID-free hub, with centralised triage to prioritise patients based on clinical need.
- Health Education England resources To support healthcare professionals during the current crisis, HEE have made available the Coronavirus e-Learning Programme free of charge. This programme brings together quality-assured content from Health Education England e-Learning for Healthcare, NHS England and NHS Improvement, and the World Health Organization (WHO). The programme is suitable for doctors, nurses, consultants, healthcare assistants, midwives and other allied healthcare professionals, including those who are returning to the workforce to help during the current crisis. You can access the content online – enabling you to refresh and extend your knowledge on critical themes and this is available here https://www.eintegrity.org/e-learning-healthcare-course/coronavirus.html
- Consensus Advice on Managing Haematological and Oncological patients from Health Journal Of Australia. This is a good summary of the general principles guiding the delivery of oncological and haemato-oncological services during the pandemic. It is available here https://www.mja.com.au/journal/2020/212/10/managing-haematology-and-oncology-patients-during-covid-19-pandemic-interim
- PPE Guidance this is the latest guidance from NHSE on the use of PPE. This follows a recent update https://www.gov.uk/government/news/new-personal-protective-equipment-ppe-guidance-for-nhs-teams
6) London Cancer template letters This document contains cancer and COVID-19 letter and script templates to support Trust written and verbal communications with patients and healthcare professionals regarding cancer and COVID-19. Please note that this repository of documents is advisory only and intended as a useful resource for trusts to review and tailor locally during the coronavirus outbreak. It is available on the UKONS website here. https://ukons.org/site/assets/files/1134/trust_cancer_covid19_letter_script_templates_final.pdf
- Acute Oncology Consensus Document Acute Oncology Services play a key role in the assessment and management of those cancer patients who have been identified as most vulnerable and are more at risk of becoming seriously ill if they contract the coronavirus (COVID-19) infection. An expert group, including some UKONS members, have provided input into producing this document as a consensus of the development and review groups’ views on best acute oncology practice. The guidance aims to clarify and support the continued provision of acute oncology services in light of the current COVID-19 pandemic and the extreme pressures being experienced within the NHS. This guidance should be used in conjunction with any local policies/procedures/guidelines and should be approved for use according to Trust’s own clinical governance process. Care has been taken in the preparation of the information contained in the guidance. Nevertheless, any person seeking to consult the guidance, apply its recommendations or use its content is expected to use independent, personal medical and/or clinical judgment in the context of the individual clinical circumstances, or to seek out the supervision of a qualified clinician. The document is available here https://ukons.org/site/assets/files/1134/aosguidance_with_review_group_final310320-3.pdf
8) Managing Mental Health issues in staff The NHS mental health hotline for NHS staff delivered by Hospice UK and Samaritans has been announced today. It is open 07.00 to 23.00 seven days a week Phone 0300 131 7000 or Text FRONTLINE 85258. There is also a video developed by UCL https://youtu.be/WFWvkjJ755Y
9) ONS Recommendations for Oncology Staff Assignments During the COVID-19 Pandemic In the US the Oncology Nursing Society has produced guidance on how oncology nurses should be deployed. Hospitals and cancer centres are facing unique challenges in staffing and are redeploying staff to other units. Factors contributing to decisions about temporary reassignment of oncology staff outside of the oncology unit or ambulatory department or discussed in the document which is available here https://www.ons.org/oncology-staff-assignments-covid-19
- Compassionate Leadership During a Crisis The Covid-19 situation is full of uncertainties. Leaders are struggling to find the right solutions as the context changes almost hour by hour. Now more than ever, leaders need to draw upon all available resources, most particularly their people, utilising the collective intelligence of experience and knowledge while adapting and revising solutions as the situation unfolds. The Kings Fund have produced a blog around why compassion is important when leading teams during the pandemic. This is available here https://www.kingsfund.org.uk/blog/2020/03/covid-19-crisis-compassionate-leadership
11) Public Health England (PHE) (2.4.20) Public Health England (PHE) has worked with NHS England and NHS Improvement, and the Devolved Administrations to review the UK’s infection prevention and control recommendations for COVID-19. Latest advice available at: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/updates-to-the-infection-prevention-and-control-guidance-for-covid-19
- NICE SACT updated guidance (3.4.20) On 3 April 2020, they added 2 recommendations on when to offer and continue systemic anticancer treatment for patients with COVID-19. They also amended the table on prioritising treatments in line with new advice from NHS England. Available at https://www.nice.org.uk/guidance/ng161
- NICE guidance on HSCT (1.4.20) the purpose of this guideline is to maximise the safety of patients who need haemopoietic stem cell transplantation and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for transplantation to patient needs if services become limited because of the COVID 19 pandemic. Available at: https://www.nice.org.uk/guidance/ng164
- NICE COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community. The purpose of this guideline is to provide recommendations for managing COVID 19 symptoms for patients in the community, including at the end of life. It also includes recommendations about managing medicines for these patients, and protecting staff from infection. Available at: https://www.nice.org.uk/guidance/ng163/chapter/8-Managing-medicines-for-patients-with-COVID-19
- The Lancet Cancer guidelines during the COVID-19 pandemic (2.4.20) Published Online, https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30217-5/fulltext
- American Society of Clinical Oncology Coronavirus Resources current information and resources to its members and the larger oncology community to help ensure that individuals with cancer receive high-quality care. ASCO has compiled a wide range of resources to support clinicians, the cancer care delivery team, and patients with cancer. Available at: https://www.asco.org/asco-coronavirus-information
UKONS and Macmillan Cancer Support would like to thank Oncology Nurses for continuing to work selflessly to protect our patients during this unprecedented time. Many of the UKONS Board continue to work clinically or in patient -support roles but we will continue to support our members as far as we can via our website and our MIG groups.