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For all these reasons, it is essential that, despite the current situation, we should give out best efforts to
provide excellent care to our patients from a multidisciplinary approach.

GUIDELINES AND CLINICAL RESOURCES FOR THE MANAGEMENT OF ONCOLOGIC
PATIENTS DURING THE COVID-19 PANDEMIC
In the current epidemiological context, different clinical resources published by different institutions have
emerged in order to guide patients, professionals and health institutions to take appropriate measures for
the continuity and excellence of care. Many of these resources are in the form of web pages of different
medical societies and patient associations in different countries.

[76]
The British Columbia Cancer Center has posted on its website a dossier that includes many frequently
asked questions from cancer patients and provides appropriate instructions on necessary precautions
regarding the detection of signs and symptoms of COVID-19; social distancing; personal protective
equipment; and hospital visits. Additionally, the Cancer Council of Australia has published a multilingual
[77]
cancer patient briefing that includes up-to-date information on COVID-19 .

Recently, the National Institute for Excellence in Health and Care (NICE) published a clinical guideline
regarding recommendations for oncologic treatments in the present epidemiological context , which can
[78]
help health providers with the latest evidence regarding this topic.

The European Society for Medical Oncology has developed an updated online clinical resource page to help
collect all cancer-related COVID-19 clinical issues and the latest available evidence to provide the best care
[79]
possible to cancer patients .
The Royal College of Radiologists has also recently established a clinical resource that includes guidelines
on the management of many cancers, including lung neoplasm. during the COVID-19 pandemic. These
guidelines give detailed recommendations on radiation therapy treatment, including radiation therapy,
[80]
administered doses, and when to continue, delay, or interrupt treatment .

ETHICAL ASPECTS AND DECISION MAKING IN PATIENTS WITH CANCER AND COVID-19
During the COVID-19 pandemic, many health systems have faced the challenge of an avalanche of patients
in emergency medical services, hospitals, and intensive care units in the context of high demand for
pharmaceuticals, shortage of personal protective equipment, and limitation on medical supplies. Physicians
have had to make very tough and difficult decisions to optimize the use of advanced therapeutic options,
such as invasive mechanical ventilation, based on many factors, including age, co-existing conditions, or
prognosis. Unfortunately, this situation is not new, and has its historical precedents as reflected in a recently
published editorial , wherein Mannelli reflects on the scarcity of resources and the difficult decisions that
[81]
many health care professionals had to deal with in the initial stages of the pandemic.

Patients with advanced-stage lung cancer have a poor prognosis per se, so oncologists and multidisciplinary
care teams should discuss with patients the measures to take if their clinical situation worsens. Generally,
we try to respect the wishes of patients when deciding whether they want to receive invasive mechanical
ventilation and advanced life support treatments if necessary, providing them with information and
resources about palliative care to help them decide. It is important to discuss these issues in advance, to
be able to take the appropriate clinical action when the patient is not able to decide, thereby respecting
[82]
their previous decisions . The Ethics Committee of the American College of Surgeons has developed
a guideline to assist health care professionals in the decision-making process regarding the allocation of
[83]
resources in the present epidemiological context .