COVID-19 and NETs – an update

This year has been an incredibly difficult time for healthcare professionals, patients, carers and wider society. When our lives were first affected by Coronavirus Disease 2019 (COVID-19), caused by the SARS-CoV-2 Virus, we were still in a period of unfamiliarity. Whilst the expansion of knowledge of COVID-19 studies around the world continues, we have learnt a great deal through our experience earlier in the year.

Our general advice is to follow government and public health guidance on prevention of the spread of the virus. Neuroendocrine tumours (NETs) are a varied group of tumours and management of each case needs to be managed by a multidisciplinary NET MDT with factors taken into consideration on an individual basis. Regions of the country have had NHS services affected in different ways and it will be down to local teams to work together to find the best way to manage NET services including timing of investigations and treatments.

We have learnt that most patients can undergo systemic treatments safely. Patients have received somatostatin analogue injections throughout the pandemic, especially if these are undertaken through a homecare service, reducing visits to hospital. Chemotherapy with capecitabine, and other treatments including sunitinib and Peptide Receptor Radionuclide Therapy (PPRT) have been received without any obvious negative consequences from COVID-19. Surgery still carries a high risk of complications if a patient is affected by COVID-19 and some cases may have to be postponed during a peak. However, some procedures are a high priority, for instance surgery (or radiotherapy) for spinal cord compression; surgery  for small bowel obstruction or ischaemia; and heart valve surgery for severe carcinoid heart disease. As should be the case in normal times, the risks and benefits of therapies should be discussed with patients on an individual basis as part of a NET MDT.

Fortunately, most consultations have been undertaken remotely using phone or video facilities, and as already occurs in some centres, we have seen an increase in scans and other tests being done in smaller hospitals, closer to home, and non-essential tests postponed. Although most remote reviews are appropriate and adequate in the current situation, the lace of face-to-face interactions may have negative effects in terms of quality of assessment, patient satisfaction and lost opportunities for learning and teaching.

Anxiety has been a feature for everyone in the current pandemic and coping with uncertainty can have negative consequences on mental health. This has affected may patients, carers and healthcare workers. Fortunately, we have a good network of specialist nurses and patient support groups that can help reassure everyone. We must also acknowledge that the patient support groups and charities have suffered financially during this crisis and finances in the the NHS will be uncertain.

We continue to learn about COVID-19 but we have already gained valuable experience for our patients with NETs throughout the country. We hope the future becomes more certain but, for now, we wish you and your families a safe autumn and winter.