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Other tools to reduce overcrowding and potential exposure to COVID-19 in outpatient clinics are virtual
health services such as teleconsultation or telemonitoring, especially for routine checks or refilling
prescriptions. In this sense, the latest ASCO recommendations advise the use of telemedicine systems
[39]
[60]
when possible for the follow-up of cancer patients . Lonergan et al. , published their experience with an
initiative related to telemedicine and oncology in an oncology center at the University of California (United
States) in which telematic consultations increased from 2,284 to 12,946 in a period of 11 weeks, immediately
before the start of the pandemic. This initiative made it possible to continue maintaining access to health
care for these patients at all times. However, telemedicine involves a series of inconveniences such as
communication barriers (deafness, language), legal problems related to confidentiality and data protection,
and difficulties in handling computer or electronic equipment due to cognitive problems, advanced age, or
lack of internet access, among others [61,62] .

Home health care systems have shown benefits in the treatment of cancer patients, especially in the case of
[64]
[63]
palliative care, showing an increase in the quality of life of patients and more cost-effectiveness of care .
The epidemiological situation derived from COVID-19 has further increased interest in home care, since
the management of SARS-CoV-2 infection at home has been a useful tool in many countries. In Spain,
home care in mild cases of COVID-19 is seen as a fundamental pillar of care by the Ministry of Health,
Social Affairs and Equality . This type of care is of particular interest, for example, in the case of cancer
[65]
patients under palliative care, in which intensive therapeutic measures have been ruled out and the patient’s
greater comfort is sought in their family environment, reducing anxiety and other factors associated with
[66]
hospitalization .

In some countries and health systems, the administration of chemotherapy by home hospitalization units
[67]
has previously been carried out with good results . Candidate patients are, in addition to those who
receive oral chemotherapy, patients who receive intravenous chemotherapy with low intensity regimens.
Other factors to consider are clinical stability, need for storage and processing of drugs, family support, and
capacity of caregivers to be educated in different measures including follow-ups, risks for adverse reactions
[68]
and anaphylaxis . In a project carried out in 2019 in the United Kingdom in which the administration of
[69]
home chemotherapy was implemented in patients with myelodysplastic syndrome , satisfaction surveys
showed that 100% of the patients had noticed a positive change in their experience treatment. Nevertheless,
the position of some oncology societies such as ASCO does not advise these modalities of treatment in
[39]
general, except for selected patients .
In general, cancer treatment is recommended in oncology patients who do not present with an active SARS-
CoV-2 infection. Delaying the treatment of metastatic disease causes a worsening of one’s functional status,
increases the number of admissions for palliative support, and causes disease progression [70-72] . Kutikov
[73]
et al. , have proposed specific recommendations that can be used to guide the decision-making process
when delaying or continuing cancer treatment during the COVID-19 pandemic. These recommendations
are mainly based on categorizing patients at low, medium or high risk of disease progression depending on
the type and extension of the disease.

Some authors have pointed out that the greatest danger for cancer patients in the current pandemic
situation is the difficult access to the health care system and resources, which sometimes implies greater
complications and diagnostic delays . This situation is also being detected in other areas of medicine.
[74]
For example, in Spain there has been a marked decrease in the number of acute coronary syndromes that
receive hospital care coinciding with the times of highest incidence of COVID-19. This finding has been
[75]
related with the population’s fear of coming into contact with the hospital environment .