A new expert panel consensus statement published simultaneously today in the journals Radiology: Imaging Cancer, Chest and the Journal of the American College of Radiology provides guidance to clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.
In many parts of the world, the COVID-19 public health crisis has stressed the health care system close to or even past its breaking point. Hospital resources are focused on the immediate needs of patients suffering from the disease, particularly those who are critically ill. The strain on health care systems and the need to control the virus using containment and mitigation has impacted the care of patients with other common medical disorders.
Clinicians have been forced to balance the risk of delaying potentially necessary exams against the risk of exposing patients to the virus in hospital settings or exposing health care workers to patients who may be asymptomatic carriers of the disease. This is further complicated by the re-allocation of resources, including hospital personnel, to evaluate and treat patients with COVID-19.
“The potential risk of exposure or transmission during routine care, as well as the diversion of resources to help combat the pandemic, has forced clinicians to make decisions about the timing of care,” says Peter J. Mazzone, MD, MPH, FCCP, director of the Lung Cancer Program and Lung Cancer Screening Program for the Cleveland Clinic Respiratory Institute. “This document provides guidance that we hope will help with these decisions. It outlines acceptable variances from standard practice during the pandemic and provides items to consider that could influence the decisions for a given patient.”
Performing a lung cancer screening exam or the evaluation of lung nodules both carry additional risk during the COVID-19 pandemic. There is added risk to the patient, other patients and healthcare providers from exposure to the healthcare environment and the contact that occurs during testing. Recovery from surgical resection may be influenced by asymptomatic carriage of the virus. These added risks may upset the balance of benefit and harm struck by current (pre-COVID) guideline recommendations. There is also a shift in healthcare resources, toward canceling elective procedures and imaging, in areas where COVID-19 is surging, or where systems are preparing for a surge, making it more difficult to adhere to available guidelines. These exposure risks and resource constraints have led the Centers for Disease Control and Prevention (CDC) to suggest that nonurgent care be deferred.
To date, clinicians and hospital systems have been independently determining how to modify their screening and lung nodule management programs during the pandemic. The consensus statement was developed to provide expert opinion to clinicians regarding the performance of lung cancer screening and the management of patients with lung nodules in a manner that is consistent with current CDC COVID-19 guidance.