Nathan I Cherny (Israel) Anna KL Reyners and Elisabeth DeVries (The Netherlands) unveil the latest guidelines from The European Society for Medical Oncology (ESMO) in respect of the pandemic.
The COVID pandemic has now caused almost 200,000 deaths, and sadly many more are still anticipated. This pandemic has generated enormous global healthcare challenges that in some places have proven overwhelming. To assist the global medical community, The European Society for Medical Oncology (ESMO) has harnessed the expertise and experience of its faculty to develope two important resources: ESMO Prioritised Practice Guidelines in cancer care and Emergency palliative care protocols for non-ventilated COVID-19 patients.
ESMO Prioritised practice guidelines in cancer care
To mitigate the negative effects of COVID-19 on care delivery, the oncology practice guidelines prioritise the various aspects of cancer care into three levels of priorities, namely: tier 1 (high priority intervention), 2 (medium priority) and 3 (low priority). Guidance is provided for individual disease settings and also for supportive and palliative care.
The Emergency palliative care protocols for non-ventilated COVID-19 patients are presented in two versions: for inpatients and home care. They emphasise six underlying principles:
- Patients have a right to relief of suffering at the end of life;
- Application of simple protocols can provide relief in most situations;
- COVID-19 can be a rapidly progressive disease and some patients will need very intensive symptom control urgently;
- Expert consultative back up by palliative care service will be available 24/7;
- Aim to optimise relief and minimise staff exposure and;
- Sensitive and effective communication is a core element of care.
Each pathway lists essential medicines (and other important alternatives), and presents stepwise approaches to palliation of breathlessness, palliation of agitated delirium and palliative sedation for patients near death. Additionally, the inpatient guide provides pragmatic tips for communication with the patient and their family members.
These can be used either as freestanding documents, or they can be edited for local use with adjusted medication formulary to fit local resources and to add the names and contact details of local clinicians with palliative care expertise. Indeed, formulary customisation to emphasise locally available medicines and formulations will be epically important when using these pathways in countries with more limited access to medications.
A truly global effort
The Prioritised supportive and palliative guidelines and the Emergency palliative care protocols have been a multinational project involving the input of palliative care experts from more than 20 countries, many of whom have been seriously impacted by COVID-19, and most of whom are also members of the European Association for Palliative Care.
These resources are part of ESMO’s contribution to the major global mobilisation of resources and knowledge that is needed to confront this pandemic and the palliative care challenges it has generated. (1)
- Radbruch L, Knaul FM, de Lima L et al. The key role of palliative care in response to the COVID-19 tsunami of suffering. The Lancet April 22 2020 DOI:https://doi.org/10.1016/S0140-6736(20)30964-8.
Links to ESMO resources
- Oncology practice guidelines for supportive and palliative care.
- Emergency palliative care protocols for non-ventilated COVID 19 patients.
More resources relating to Covid-19 and palliative care in humanitarian emergencies
- Coronavirus and the palliative care response: EAPC web page to source and share information, with links to publications and resources including the ESMO pathways and WHO resources, national guidelines, videos, scientific journal collections. Please email us if you have new or updated resources to share.
- Palliative care in humanitarian emergencies – see ‘Integrating palliative care into responses to humanitarian emergencies and crises – a WHO guide’.
- PalCHASE – Palliative Care in Humanitarian Aid Situations and Emergencies network.
Read more posts about Coronavirus and the Palliative Care Response and Palliative Care in Humanitarian Crises on the EAPC blog. More are coming soon, including a post from the team at Cicely Saunders Institute, King’s College London.