The American Society of Clinical Oncology April 9 published a set of recommendations to support the oncology community as health care institutions across the United States face potentially difficult decisions around the allocation of scarce health care resources during the COVID-19 pandemic.
In some geographic areas, the crisis is expected to demand more resources—including ventilators, critical and intensive care beds, and medications—than the U.S. or local health care systems can supply, and institutions will need to develop allocation decision policies as they provide care for a growing number of patients.
ASCO’s recommendations assert:
Institutions should develop a fair and consistent prioritization and allocation policy before allocation becomes necessary. Decisions should be made at an institution-level, rather than at the bedside, so that oncologists can continue to maintain their duty to their patient.
Allocation of resources in a pandemic should be based on maximizing health benefits. Rationing for lifesaving critical care resources should not use assessments about the perceived quality of a patient’s life or perceptions about a patient’s social worth.
Oncologists should work with their institutions on how best to utilize scarce resources for care and support of cancer patients.
Oncologists should communicate allocation plans and decisions to their patients with compassion and honesty, and health care institutions should offer support to oncologists in these communications.
Oncologists should engage in advance care planning discussions with their patients and carefully document patient preferences for goals of care, particularly end of life care.
ASCO released the recommendations both in response to member reports that cancer care is being affected by the pandemic and to anticipate and inform the growing number of conversations happening at many institutions about resource allocation. The most critical aim is to ensure that the perspectives of patients with cancer and oncologists are included in all such discussions and decisions. The recommendations were developed by the ASCO Ethics Committee, approved by the board of directors, and accepted after peer review for future publication in the Journal of Clinical Oncology.
“As health care institutions make difficult decisions about where and how to deploy their resources during the COVID-19 crisis, they must ensure that allocation approaches don’t unconditionally deny patients with cancer access to resources,” ASCO President Howard A. “Skip” Burris III, said in a statement. “Every person with cancer has inherent worth and dignity. A cancer diagnosis alone should not keep a patient from a fair chance to access potentially life-saving resources, even in a public health crisis.”
ASCO’s recommendations aim to encourage the development of fair and equitable policies at the health system level for allocation of resources, especially critical care sources, and are not intended to guide individual treatment decisions. The recommendations also strive to promote the involvement of oncologists in the development and implementation of these policies to ensure that the needs of patients with cancer and their care teams are factored into the development of institutional policies. Individual oncologists will find guidance in ASCO’s recommendations about their critical role in caring for and advocating for patients who could potentially benefit from resources that are in scarcity during this time of crisis.
“Oncologists have great skill and expertise in treating the individual patient in front of them, but in a public health emergency like this one, we need to expand our view to also protect the health of the larger patient population,” Jonathan M. Marron, chair-elect of ASCO’s Ethics Committee and lead author of the recommendations, said in a statement. “Oncologists have an important role to play to promote resource allocation plans that fairly, objectively, and consistently consider patients with cancer, and to work with their institutions to communicate those decisions clearly to patients, families, and surrogates.”
