To Treat or Not to Treat—Balancing Benefits and Risks of Treatment Delay Among Patients With Cancer During the COVID-19 Pandemic

Decisions regarding the initiation of cancer therapy have become increasingly complex in the era of coronavirus disease 2019 (COVID-19). Health care professionals and patients must balance the benefits and risks of immediate treatment for cancer with the potential subsequent increases in the risk of COVID-19 and its associated complications, including death. Unlike approaches that triage cancer treatment using a tiered approach, Hartman et al¹ have developed a web-based comprehensive model (OncCOVID) to estimate the risk of delaying the initiation of cancer treatment for an individual patient with cancer. This model estimates risk for patients with cancer of varying types and stages, and it incorporates other known risk factors for COVID-19, such as comorbidities, patient age, local COVID-19 prevalence, and reproduction number (which reflects the mean number of new patients with infections by each case in a region). The model is based on the use of epidemiologic data regarding treatment delays and outcomes from patients with cancer to estimate the risk of delayed treatment for a specific patient based on individual risk profile. The model has been developed into a useful application with a simple and intuitive interface. The web-based interface provides an accessible platform that can be used on a smartphone. Many of the necessary inputs for the model have default values that can be modified (for quantities such as relative risk [RR] of infection and other parameters that may vary across cancer care practice or treatment setting), but the user is required to input data on patient-level characteristics.