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I have been very much impressed by the clarity, pragmatism and good medical judgement of the article by Camilo Porta,1 a respected and dedicated ESMO faculty member and friend, giving his personal perspective on real issues many oncologists working in a public system are eventually facing during the SARS-CoV-2 pandemic. I understand Professor Porta is voicing what many oncologists from countries deeply affected by the pandemic, such as Italy or Spain, may think. Although I concur with most of his approaches and comments, I would like to complement some of these statements with some additional thoughts.
Medicine was created more than 2500 years ago as a profession aiming at alleviating suffering in human beings. Despite the complexity of current developments and technologies, those of us who practise medicine have to remember the basis of our profession—staying closer to patients, respecting and understanding their wishes, and providing the best possible clinical care. Even the old aphorism by Hippocrates “Cure sometimes, relieve often and comfort always” may still sound contemporary to us. However, these relatively simple principles may become extremely complex to implement, particularly under situations of extreme stress such the one we are experiencing now.
These difficulties have also been an issue to us, when the preference of all public health structures has been to settle priorities by focusing on the care of patients infected with covid-19 and putting aside other serious common conditions such as cancer. We have been recommended to delay or interrupt cancer treatments in some circumstances to avoid risk of infections caused by bringing patients into hospital or by provoking lymphopenia, myelosuppression or other types of immunosuppression. I am not going to discuss the convenience or relevance of this advice, which necessarily requires adaptation to the difficult situation we are facing. However, in line with Professor Porta’s remarks, I would like to express my strong opposition to the futile application of anticancer agents with proven limited or marginal benefit in prolonging survival or in contributing to a better symptom control or quality of life. Avoiding futile treatments may significantly reduce the burden of toxicity at any time, but it is particularly relevant in these challenging times when resources are even more scarce. Protecting cancer patients in all senses, avoiding futile therapies and promoting those that may lead to cure or prolonged survival has to be established as the main priority.
A last point should be added. Our profession is not considered a liberal one any more. We are mostly public servants and we work in integrated teams with different levels of responsibility. The confinement measures may put ourselves at risk of isolation from our colleagues, making us feel we are alone and helpless in this fight. We have a terrific opportunity to reinforce a team building attitude. It is important that we keep strong lines of communication among the members of our teams, defining and sharing aims, commenting and discussing failures and opportunities, settling priorities, and strengthening our integration with common purpose. At the very minimum, holding a daily video conference to share relevant information—providing education to all members, staff and trainees on all the many new issues we have to address and resolve—will be certainly helpful. Our teams may become more motivated and efficient, relieved from the burden of feeling helpless and lonely. Coping in these hard times will be more tolerable if we stay together. Our patients will also benefit from this achievement.
Contributors I am the sole author.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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