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Piñeiro et al. J Cancer Metastasis Treat 2021;7:10 I http://dx.doi.org/10.20517/2394-4722.2020.115 Page 9 of 13
[84]
As suggested by Sterpetti , based on the difficult situations in Italy during the first months of 2020, it is
of great importance to predict the need for resources (ICU, beds, specialized facilities and staff), and to
organize them efficiently in order to face the most critical moments of the pandemic.

Clinical judgment is essential to determine whether cancer therapy should be continued or discontinued
in patients with COVID-19. Health care providers caring for oncology patients are encouraged to review
the latest literature related to cancer and COVID-19 to provide evidence-based and individualized care.
There is an urgent need for well-designed studies to identify the long-term clinical consequences of either
continuing or terminating specific treatments in oncology and haematology settings.

ONCOLOGICAL CLINICAL TRIALS DURING THE PANDEMIC
Clinical trials with new therapies constitute the basic pillar of clinical research. Like all aspects of clinical
practice, clinical trials have been influenced by the COVID-19 pandemic. The new situation raises new and
difficult questions, since it is unknown in what way the administration of these experimental treatments
will influence the participants of clinical trials under the COVID-19 pandemic situation. In addition, trial
protocols require frequent visits by patients to health care settings, which increases the chances of exposure
[85]
to COVID-19. Doherty et al. , analyzed the aspects related to the adaptation of clinical trials to the new
epidemiological situation, pointing out that many governments have made the legislation more flexible so
that the more relaxed protocols can allow trials to continue. They also point out the need to prioritize the
primary objectives of the trials and give less importance to the secondary ones, thus reducing the need for
controls and subsequent contact with the hospital or health setting environment.

Another aspect to take into account in this regard is to avoid the abandonment of patients who adhere to
clinical trial protocols and to facilitate the contact and availability of professionals, as indicated by Shuman
[86]
and Pentz . For such patients, it is essential that we adapt and make use of resources such as telemedicine
or home care.

Despite the current situation, we must try to keep clinical research ongoing, since the prognosis and
evolution of many patients will depend on it, and as professionals, it is in our hands to take on the challenge
of adapting to the new situation.

PSYCHOLOGICAL CARE FOR HEALTH CARE PROVIDERS
The situation experienced during the COVID-19 pandemic has subjected health care professionals to
[87]
stressful situations that have been shown to increase their anxiety levels. In a survey conducted in China
medical health workers showed higher anxiety and psychosocial problems than non-medical health
[88]
workers. Most of the studies carried out in this line have reached similar conclusions . This situation may
be even more worrisome among professionals affected by the burnout syndrome, which is increasingly
frequent among physicians [89,90] .

In the case of cancer patients, professionals must face the greater challenges and ethical dilemmas that
we have previously mentioned. For all this, the need to provide psychological support for professionals
is evident, thus also preventing clinical errors derived from mental fatigue and stress. There are several
published initiatives in the literature that have been implemented to improve the mental health of health
care workers in the context of COVID-19 [91-93] .

CONCLUSIONS
The COVID-19 pandemic has had a great impact on the health care systems of most countries. Cancer
patients, and especially those who suffer from lung cancer, when infected with SARS COV2, have a worse