Pan American Health Organization · 26 May 2020
Operational guidance for oncology services to maintain cancer care while protecting patients and staff during COVID-19.
- Issuer
- Pan American Health Organization
- Edition
- 26 May 2020
- Audience
- Healthcare managers, oncologists, cancer service providers
- Evidence
- Expert consensus with cited evidence
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO document provides a framework for reorganizing cancer services during the COVID-19 pandemic around five core components: continuity of strategic cancer services, infection prevention and control, restructuring of human and technical resources, management of cancer patients with COVID-19, and iterative review of service reorganization. The guidance recognizes that cancer patients face higher COVID-19 mortality and complications whilst also being at risk of cumulative treatment delays that could increase avoidable cancer deaths.
The document emphasizes treatment prioritization using a three-tier system (high, medium, low priority) based on curability, urgency, and survival benefit. High-priority cases include rapidly evolving cancers (acute leukaemias, aggressive lymphomas), oncological emergencies, and definitive curative treatments. The guidance recommends minimizing in-person visits through telehealth, temporarily suspending screening programmes, pre-screening patients for COVID-19 before chemotherapy or surgery where feasible, and maintaining separate pathways for cancer and COVID-19 patients.
Special considerations are provided for paediatric cancer services, which should continue with minimal prioritization given the high curability of childhood cancers and lower COVID-19 risk in children. The document stresses maintaining adequate supplies, training staff in COVID-19 management, providing psychological support to patients and healthcare workers, and continuously adjusting priorities based on local pandemic curves and resource availability.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Implement three-tier treatment prioritization: high priority (acute leukaemias, aggressive lymphomas, metastatic germ cell tumours, oncological emergencies, definitive curative treatments with substantial survival benefit), medium priority (adjuvant treatments with modest benefit, palliative treatments with symptom control), low priority (treatments with no overall survival benefit)
- Maintain a distance of at least 2 metres between people in cancer centres; provide surgical masks and hand sanitiser to all patients and caregivers upon entry
- Consider pre-screening for COVID-19 using RT-PCR test ideally 24 hours before chemotherapy, radiotherapy, or surgical interventions in cancer patients
- Continue scheduled treatment for children and adolescents with cancer without prioritization criteria, as paediatric patients with cancer have lower risk of severe COVID-19 and most childhood cancers have high curability
- Replace scheduled visits not involving therapy administration with telehealth; delay diagnostic imaging for monitoring response; supply drugs for multiple cycles including home delivery
- Temporarily suspend cancer screening programmes but encourage patients to promptly request consultation for symptoms indicating suspected cancer
- Refer COVID-19-positive patients or suspected cases to designated sites; do not admit them to cancer centres unless exceptional circumstances require immediate intervention as determined by multidisciplinary medical board
- Continuously re-prioritize patient treatments based on local pandemic curve changes, public health interventions, available resources, patient wait times, and number of cancer and COVID-19 patients
Criteria for the prioritization of cancer treatments
Table extracted from the guideline
| Treatment priority | Types of cancer, complications, and treatments |
|---|---|
| High | Rapidly evolving and lethal cancer; Imminent risk of death (acute leukaemias, aggressive lymphomas, metastatic germ cell tumours); Potential high morbidity and/or impaired quality of life (refractory pain crisis, radiation therapy for soft tissue spinal cord compression), oncological emergencies; Definitive curative treatments (concurrent chemotherapy for head and neck, cervical, or rectal cancer. Categorically prioritize Hodgkin's disease, diffuse large B-cell lymphoma, acute promyelocytic leukaemia); Neoadjuvant or adjuvant treatment indications with substantial benefits in terms of overall disease-free survival (adjuvant chemotherapy for stage III colon cancer, chemotherapy or radiation therapy for high-risk breast cancer) |
| Medium | Neoadjuvant or adjuvant treatment indications with modest survival benefits (adjuvant chemotherapy for bladder cancer); Palliative indications with substantial survival benefits (immunotherapy for melanoma, systemic therapy for metastatic breast cancer); Palliative indications with modest survival benefits and/or symptom control (palliative chemotherapy for gastrointestinal cancer, radiation therapy for metastatic bone cancer that is unresponsive to other treatments) |
| Low | Palliative indications with no benefits in terms of overall survival or symptom control (second- and third-line chemotherapy for solid tumours); Alternative treatments that do not affect the principal health outcomes |
Source: Pan American Health Organization, Considerations for the Reorganization of Cancer Services during the COVID-19 Pandemic. Reproduced in summary form.
From the guideline
Verbatim
“Studies have demonstrated that delays in cancer diagnosis and treatment have an impact on the progression of cancer. This could lead to future peaks in mortality from potentially curable cancers, as a result of not receiving standard treatment.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Georgia continues to strengthen its cancer control infrastructure through regional oncology centres and the Universal Health Care programme, this PAHO framework offers immediately actionable guidance for our context. The three-tier prioritization system is particularly relevant for Georgian oncology services, which already face resource constraints and would benefit from standardized triage criteria that multidisciplinary teams can apply consistently across facilities. I would emphasize to Georgian clinicians the recommendation to continue paediatric cancer services without delay—our national cancer registry shows improving childhood cancer outcomes, and we must not lose ground during this pandemic. The practical challenge for Georgia will be implementing pre-procedural COVID-19 testing where RT-PCR capacity remains limited in some regions; facilities should work with their regional public health centres to establish clear protocols based on local testing availability rather than attempting universal screening that may create bottlenecks and paradoxically delay urgent cancer treatment.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia’s cancer services, which have been strengthened through recent investments in regional oncology centres and the 2013 Universal Health Care programme covering cancer treatment, must balance COVID-19 response with maintaining oncological care. The prioritization framework is directly applicable to Georgian settings where resource constraints already require careful triage decisions. National cancer programmes should assess current telehealth infrastructure for remote monitoring, establish clear referral pathways separating COVID-19 from cancer services, ensure adequate supplies of personal protective equipment for oncology staff, and develop protocols for pre-procedural COVID-19 testing where RT-PCR capacity allows. The emphasis on continuing paediatric cancer services without delay aligns with Georgia’s commitments under its national cancer control strategy, whilst the infection prevention measures build on existing IPC programmes in Georgian hospitals.
Questions this guideline answers
Quick answers
Should cancer screening programmes continue during the COVID-19 pandemic?
Temporary suspension of cancer screening programmes is suggested during the pandemic. However, patients should be encouraged to promptly request a consultation if they have any symptoms that indicate suspected cancer, and the health team will determine whether treatment needs to be adjusted based on individual risk.
How should cancer treatment be prioritized during COVID-19?
Use a three-tier system: high priority for rapidly evolving cancers (acute leukaemias, aggressive lymphomas), oncological emergencies, and curative treatments with substantial survival benefit; medium priority for treatments with modest benefit; low priority for treatments with no overall survival benefit. Decisions should be made by multidisciplinary boards, ideally conducted virtually.
Should children with cancer continue treatment during the pandemic?
Yes. Timely diagnosis and treatment of children and adolescents with cancer has high priority due to the high curability of most childhood cancers. Evidence shows paediatric patients with cancer have lower risk of severe COVID-19 compared to adults, so services should continue with scheduled treatment without applying prioritization criteria.
Should patients be tested for COVID-19 before starting chemotherapy or surgery?
Some guidelines recommend pre-screening using RT-PCR test ideally 24 hours before chemotherapy, radiotherapy, or surgical interventions. If negative, continue with proposed treatment; if positive, follow COVID-19 management guidelines and postpone intervention if possible. However, consider local test availability, turnaround time, and that negative results don't rule out asymptomatic infection.
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Quality & accreditation
- ASF Hospital — Standard 14 — Oncology & Cancer Care
- ASF Hospital — Standard 20 — Supporting the Care Workforce
- ASF Laboratory — Standard 3 — Personnel & Competence
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- The Immunization Program in the Context of the COVID-19 Pandemic
- Considerations on Social Distancing and Travel-Related Measures in the Context of the Response to COVID-19 Pandemic
- Guidance for Ethics Oversight of COVID-19 Research in Response to Emerging Evidence
- Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19
- Care for health workers exposed to the new coronavirus (COVID-19) in health facilities
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- 26 May 2020
- Status
- Current
- Published
- 2020-01-01
- Scope
- Reorganization of cancer services during COVID-19 pandemic
- Audience
- Healthcare managers, oncologists, cancer service providers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus with cited evidence
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Considerations for the reorganization of cancer services during the COVID-19 pandemic. Washington, D.C.: PAHO; 2020. Available from: https://iris.paho.org/handle/10665.2/52263GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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