Treating the SARS‐CoV‐2–positive patient with cancer: A proposal for a pragmatic and transparent ethical process

The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment priorit...

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Bibliographic Details
Published in:	Cancer Vol. 126; no. 17; pp. 3896 - 3899
Main Authors:	Perni, Subha, Milligan, Michael G., Saraf, Anurag, Vivenzio, Todd, Marques, Amy, Baker, Meghan A., Kosak, Tara, Bartlett, Sarah, Physic, Michelle A., Batchelder, Monica R., McBride, Sean, Bredfeldt, Jeremy, Cail, Daniel W., Kearney, Meghan C., Whitehouse, Colleen, Orio, Peter, Walsh, Gerard, Haas‐Kogan, Daphne A., Martin, Neil E.
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-09-2020 John Wiley and Sons Inc
Subjects:	Ambulatory Care - ethics Ambulatory Care - organization & administration Betacoronavirus bioethics Cancer Clinical Decision-Making Commentaries coronavirus disease 2019 (COVID‐19) Coronavirus Infections - complications Coronavirus Infections - virology Coronaviruses COVID-19 Decision making Delivery of Health Care - ethics Delivery of Health Care - organization & administration Ethics Health care Health Personnel - ethics Health Personnel - organization & administration Health services Humans Infectious diseases Medical personnel Neoplasms - complications Neoplasms - radiotherapy Oncology Pandemics - ethics Patient Safety Patients Physicians Pneumonia, Viral - complications Pneumonia, Viral - virology quality improvement Quality of Health Care - ethics Quality of Health Care - organization & administration radiation oncology Risk management SARS-CoV-2 Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Viral diseases radiation oncology patient safety bioethics quality improvement coronavirus disease 2019 (COVID-19)
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Summary:	The treatment of patients with cancer who test positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) poses unique challenges. In this commentary, the authors describe the ethical rationale and implementation details for the creation of a novel, multidisciplinary treatment prioritization committee, including physicians, frontline staff, an ethicist, and an infectious disease expert. Organizational obligations to health care workers also are discussed. The treatment prioritization committee sets a threshold of acceptable harm to patients from decreased cancer control that is justified to reduce risk to staff. The creation of an ethical, consistent, and transparent decision‐making process involving such frontline stakeholders is essential as departments across the country are faced with decisions regarding the treatment of SARS‐CoV‐2–positive patients with cancer. This commentary describes the ethical rationale and implementation details for a novel, multidisciplinary, treatment prioritization committee that makes treatment decisions regarding patients with cancer who are positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). This consistent, ethical, and transparent process could be adapted to any oncology department in which there is risk disparity between physician decision makers and the frontline staff who are implementing these decisions.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 The first 2 authors contributed equally to this article.
ISSN:	0008-543X 1097-0142
DOI:	10.1002/cncr.32962