世界中醫藥學會聯合會腫瘤經方治療研究專業委員會“新型冠狀病毒肺炎疫情期間惡性腫瘤中西醫結合防治及康復專家共識”（中英文 第一版），今天正式發佈。
新型冠狀病毒肺炎Corona Virus Disease 2019已在全球100多個國家蔓延。據統計，在疫情狀態下，腫瘤等低免疫人群受感染的概率遠遠高於普通人群，預後也更差，為充分發揮中西醫結合診療優勢，最大程度降低疫情對腫瘤等低免疫人群造成的不良影響。世界中醫藥學會聯合會腫瘤經方治療研究專業委員會在會長馮利教授的牽頭組織下，以國際專業學術組織為平臺，中國、美國、法國等國內外專家，共同制定了“新型冠狀病毒肺炎疫情期間惡性腫瘤中西醫結合防治及康復專家共識”，為世界範圍中西醫專家應對疫情，指導腫瘤等低免疫力人群，平安度過新冠肺炎疫情流行，貢獻中醫智慧和中國力量。
世界中醫藥學會聯合會腫瘤經方治療研究專業委員會
2020年4月2日
附：新型冠狀病毒肺炎疫情期間惡性腫瘤 中西醫結合防治及康復專家共識（第一版）
新型冠狀病毒肺炎 Corona Virus Disease 2019（以下簡稱新冠肺炎 COVID-19）的流行，已成為全球重大公共衛生問題。2020年 1月 20 日，國家衛生健康委員會公告（2020 年第 1 號）將新冠肺炎納入《中華人民共和國傳染病防治法》規定的乙類傳染病，並採取甲類傳染病的預防、控制措施。腫瘤患者普遍免疫力低、營養狀態差，是新發重大傳染病的高危人群。放化療、手術等引起全身免疫抑制狀態，使之更易感染。根據世衛組織-中國 COVID-19 聯合調查團的報告，癌症患者患 COVID-19 的風險估計是普通人群的 2 倍[2]；武漢地區惡性腫瘤患者新冠肺炎的發病率為 0.79%, 也高於同期武漢地區普通人群 0.37%新冠肺炎的發病率；與非惡性腫瘤患者相比，惡性腫瘤患者發生重症風險更高，發病前接受化療或手術的患者比未接受化療或手術的患者有更高的臨床嚴重事件風險，且惡化更快、預後差。此外，患者外出就醫不便，也造成診療時機的延誤。因此，在當前嚴峻形勢下，亟需科學有效的管理措施及合理的應對策略，使疫情對腫瘤患者的影響降至最低。特別是近期，疫情在全球多國持續蔓延，世衛組織認為新冠肺炎疫情已具有大流行特徵，呼籲各國採取緊急的、積極的行動。在此情況下，世界中醫藥學會聯合會腫瘤經方治療研究專業委員會組織專家，根據全國特別是武漢中西醫結合防治經驗，討論並形成了"新型冠狀病毒肺炎疫情期間惡性腫瘤中西醫結合防治及康復專家共識"，本共識旨在為世界範圍中醫專家指導新冠肺炎期間腫瘤患者合理應對提供範本，平安度過新冠肺炎疫情。充分發揮中西醫結合診療優勢，可以最大程度降低疫情對惡性腫瘤患者造成的不良影響。
關鍵詞：新型冠狀病毒肺炎 腫瘤 中醫藥
一、日常防護
1.減少外出、作息規律
新型冠狀病毒對所有人群普遍易感，尤其對於已遭受癌細胞侵襲的腫瘤患者，如果再感染新型冠狀病毒，將會受到雙重打擊。所以腫瘤患者應減少走親訪友和聚餐，減少到人員密集的公共場所活動，尤其是空氣流動性差的地方；應規律作息，每天睡眠時間不少於 7-8小時。
2.增強意識、做好防護
外出一定要佩戴口罩，隨時做好手衛生、勤洗手。減少接觸公共場所的公共物品、可考慮戴一次性塑料手套。從公共場所返回、咳嗽手捂之後、飯前便後，用洗手液或香皂流水洗手，不少於 15 秒；打噴嚏或咳嗽時，用自己衣袖遮住噴嚏、咳嗽,不噴向他人,同時及時更換口罩。如果必須去醫院看病或開藥，防護措施要加強。
3.居家隔離、適度運動
居室勤開窗，經常通風。不隨地吐痰，口鼻分泌物用紙巾包好，棄置於有蓋垃圾箱內。家中適度運動，避免長期臥床，切勿進行劇烈活動。可以練習太極拳、八段錦、醫學氣功、五禽戲、瑜伽和康復操等，每天 30 分鐘左右，以身體微微汗出為佳。
4.合理膳食、營養充足
日常飲食中適當攝入蛋白質食物如蛋、奶、魚、肉、豆類及堅果等；增加攝入新鮮蔬菜和水果；葷素搭配，避免生、冷食物；不吃野生動物；增加飲水量，每天不少於 1500ml。
5.自我調節、心情舒暢
正視疫情信息。理性、客觀認識疫情的信息，營造安全感、保持放鬆。可以聽快樂輕鬆音樂,音樂療法。如果自己的心理狀況持續惡化，如嚴重的失眠、焦慮、抑鬱等，而且無法通過自我調適得到緩解，可尋求相關專業醫生的幫助。
6.預防方：
方一：適合未感染腫瘤患者的預防。
防毒抗癌湯：薏苡仁 20g 黃芪 10g 生白朮 12g 砂仁 6g 白蔻仁 10g 蘆根 10g 桔梗 10g 紅景天 10g 山藥 10g 蘇葉 10g，梨半個。每天一劑，水煎服或煮水喝，代茶飲。可以連續服用 5-7天。
方二：適用於接觸過疑似新冠肺炎者的腫瘤患者的預防。
生黃芪 9g、北沙參 9g、知母 9g、金蓮花 5g、連翹 9g、蒼朮 9g、桔梗 6g。以上 7味以水煎服，每日 1次，可以連續服用 5-7天。
1.常規復查患者：
腫瘤患者在出院後可能出現一些不適反應或併發症，需要進行定期的常規復查。建議在不影響疾病預後的前提下，稍加延緩複查；複查提倡網絡會診，必要時再門診複查，儘量避免住院複查，減少在院時間，檢查期間避免交叉感染。
2.擇期手術的患者：
對於近期內需要手術但病情相對穩定的良性腫瘤患者，以及經綜合治療處於緩解期的惡性腫瘤患者，建議適當暫緩手術治療。對於進展期或早中期需儘快手術的惡性腫瘤患者，應在全面詳細評估患者身體狀態及手術風險後，在風險可控的條件下開展手術治療，確保患者圍手術期的安全。
3.化療期的患者：
對於定期進行化療的腫瘤患者，及時與主治醫生聯繫。建議在不明顯影響療效的情況下，適度減少或延長化療週期，或以口服化療為主。對於術後輔助化療患者，建議在非新冠肺炎定點醫院執行化療。對於腫瘤化療期間引起的毒副反應，注重中醫藥對腫瘤的辨證論治的特色，充分發揮中醫藥減毒增效、減除症狀的作用。
4.放療期患者：
對於放療中的患者，建議按照醫生的整體安排有序繼續接受治療，在不影響腫瘤預後的前提下，根據主管醫生安排適度延緩放療。同時充分發揮中醫藥減毒增效的作用，來緩和放療引起的毒副反應。根據新冠流行強度及其對各地醫療機構的影響來決定延遲或更改手術、放化療方案，（有條件的情況下可以考慮在線多學科會診決策）,限制極高風險情況下的手術和放化療；限制人員接觸，尤其是在治療場所。醫院嚴格管控，進入醫院，要追蹤旅遊史等。
5.長期隨診患者：
對於病情比較穩定的緩解期腫瘤患者，目前主要靠藥物控制病情，同時應及時與主治醫師進行溝通，彙報病情及目前藥物使用情況或維持原方案繼續治療。如藥物服用完後，徵求醫師意見，是否可以停藥靜養。如需補充藥物，需帶好相關材料，到定點藥店或定點醫院進行掛號開藥維持治療。
6.癌痛患者：
根據疼痛程度由醫生開具規定天數的藥物，藥物用完後，把資料儘量帶齊，病理、影像、既往出院證和診斷證明等，到就近相關非新冠肺炎定點醫院進行診療。鑑於惡性腫瘤患者自身疾病及體質的特點，和疫情防控特殊時期的條件限制，西醫治療手段中，優先選用保守治療、藥物干預，其次考慮創傷較低的微創治療，而手術等治療則儘量限定在急診情況，且需嚴密防護。雖然一些具體方案要適時改變調整，但腫瘤患者的綜合治療策略和原則不會改變。
三、腫瘤患者感染新型冠狀病毒鑑別
腫瘤患者在放、化療等常規治療後可能出現感染的併發症，如肺部感染時引起的咳嗽、咳痰、發熱、白細胞偏低等情況，或者在腫瘤的病情發展中出現癌性發熱等表現，而新型冠狀病毒感染的患者也可出現上述情況，二者容易混淆，為確診增加了難度。治療上應該首先排除新型冠狀病毒的感染，因此，腫瘤患者患有諸如: 發燒、 乾咳、呼吸困難、倦怠、流鼻水、喉嚨痛、嘔吐、腹瀉、肌肉疼痛等症狀的時候，應該及時到就近發熱門診，做出鑑別診斷及治療。排除新型冠病毒感染以後，與腫瘤主治醫師聯繫，進行相關治療。
此外，腫瘤患者在接受免疫檢查點抑制劑（主要為 PD-1、PD-L1 抑制劑）治療後，由於免疫抑制劑和其他藥物聯合應用時，機體抵抗病原體的能力可能更弱，導致腫瘤患者更加易感，需要進一步加強上述日常防護措施。同時 PD-1 治療後有部分患者出現嚴重不良反應，包括免疫性肺炎等，臨床表現和影像學特徵存在與新冠肺炎極為相似，如出現此類情況尤其是在無發熱情況下，需要進行嚴格鑑別診斷，患者及其家屬需向就診醫院（建議綜合性三甲醫院）提供詳細抗腫瘤藥物史，要求就診醫院醫生與腫瘤專科醫生密切溝通並指導相關治療。
1.中醫藥治療惡性腫瘤在疫情期間的優勢：
既往大量研究及臨床應用均證明，中醫藥治療腫瘤尤其顯著的療效及獨特的優勢。在疫情期間，由於中醫藥治療方法有著不依賴大型設備及基礎建設，相對較少依賴住院治療，副作用相對較少等優勢，可在疫情期間充分發揮其作用，彌補一些由於各方面客觀原因造成患者延誤治療、體質差易感等損失。
2.針對術後、放化療（中）後的體弱患者，以扶正為主，祛邪為輔：
患者經過術後，多出血較多，元氣大傷，大多處於氣血兩傷，正虛邪戀狀態。多見面色晄白或萎黃，乏力，自汗，少氣懶言，食慾差，或刀口生長緩慢，易感染等。此時中醫治療應以補氣養血，扶正為主，兼清餘邪，以儘快幫助患者術後恢復，增強體質，提升免疫力。以對抗新冠病毒，預防腫瘤復發轉移。
對於放、化療治療中（後），因疫情導致後續治療延後的患者，一方面要應用中醫藥調理扶正，以更好地應對疫情過後的西醫治療，另一方面，在身體條件允許的情況下，加大中醫藥抗腫瘤的力度，提高療效。
3.針對初診尚未西醫治療的患者，以祛邪為主，扶正為輔：
如果此時患者正氣尚足，中醫治療應以祛邪為主，扶正為輔，增加中醫藥抗腫瘤的力度，亦可考慮中成藥口服，以期減少患者不能及時西醫治療所造成的不利影響。
4.針對穩定期的患者：
患者經過系統抗腫瘤治療以後，腫瘤處於穩定狀態，除了定期複查外，仍需使用中醫藥進行體質調節、提升免疫力、預防腫瘤復發及轉移。中藥治療應以患者具體情況為基礎，採用兼顧扶正及祛邪相結合的診療策略。
5.疫情期間的中醫藥組方策略調整：
腫瘤患者的中醫治療策略整體原則不變，但結合疫情特點，根據第七版《關於印發新型冠狀病毒肺炎診療方案的通知》，新冠肺炎發病多為寒溼表現。因此，組方時，因人、因地制宜，對於體質偏寒或（和）偏溼的患者，應注意基礎體質的調理，增加祛溼散寒中藥等療法。
6.注重中西醫結合：
腫瘤患者疫情期間使用中藥，與西醫治療不衝突，建議中西醫結合治療，以取得最大療效，儘可能減少毒副作用。中醫藥治療方案，隨著患者自身身體狀況及西醫治療階段，進行相應調整。
7.充分利用遠程診療平臺等：
疫情期間，現場就診不便，應充分利用遠程診療平臺或手機微信手段。雖然中醫診斷需要望聞問切，但是在條件受限的情況下，望聞（聽語音部分）問還是可以通過平臺實現。基層醫院如果配有脈診儀等設備，可以作為切診的補充。開展中藥或西藥郵寄服務，使用中藥顆粒劑等，都是可以減少患者外出，減輕患者操作難度的有效措施。
五、腫瘤患者合併新型冠狀病毒肺炎恢復期中醫康復推薦
依據：北京市中醫管理局關於印發《北京市新型冠狀病毒肺炎中醫藥防治方案（試行第四版）》。
1、氣陰兩虛證
【症狀】神疲倦怠，自汗，心悸，納呆，口乾咽燥，舌紅少津或舌嫩紅，苔黃或稍膩。見於恢復期病例。
【治法】益氣養陰
【參考方藥】沙參 15g 麥冬 15g生黃芪 15g神曲 20g赤芍 15g桑白皮 15g 地骨皮 15g 枳殼 10g青蒿 10g生地 15g
【加減】 氣短氣喘加五味子 10g；心煩失眠加炒棗仁 15g; 肺脾氣虛見納差、便溏加黨參 15g、山藥15g、茯苓 15g、半夏 9g、陳皮 10g、甘草 6g。
【參考中成藥】口服：生脈飲等。
2、餘邪未盡證
【症狀】氣短，胸悶，咳嗽，痰少，舌紅或暗，苔稍膩。見於恢復期仍有肺部炎症的病例。
【治法】活血祛溼 宣透餘邪
【參考方藥】丹參 15g炒薏米 30g黨參 15g沙參 15g 桃仁 6g瓜蔞 20g厚朴 10g 蘆根 30g敗醬草 30g生麥芽 30g紅景天 10g。
可以在醫生指導下選擇穴位貼敷、艾灸、針灸、八段錦、太極拳、呼吸導引操、氣功康復、運動鍛鍊、心理疏導、音樂療法等。
目前有一小部分新冠肺炎患者核酸轉陰出院後再次檢測出核酸復陽，是否意味著病情復發或加重，復陽患者是否還具有傳染性，尚無確定結論。所以我們建議出院患者繼續口服中藥進行康復治療 1-2月，激發體內持續產生抗體，爭取達到核酸完全陰性。
六、腫瘤患者感染新型冠狀病毒解除隔離和出院後注意事項
依據國家衛生健康委員會發布的《新型冠狀病毒肺炎診療方案（試行第七版）》項下新型冠狀病毒解除隔離和出院後注意事項以及武漢市新肺炎治癒出院患者實施康復隔離的通告。
（一）解除隔離和出院標準
1.體溫恢復正常 3 天以上；
2.呼吸道症狀明顯好轉；
3.肺部影像學顯示急性滲出性病變明顯改善；
4.連續兩次呼吸道標本核酸檢測陰性(採樣時間至少間隔 1 天)；
滿足以上條件者,可解除隔離出院，繼續回家隔離 14 天。
（二）出院後注意事項
1.定點醫院要做好與患者居住地基層醫療機構間的聯繫,共享病歷資料,及時將出院患者信息推送至患者轄區或居住地居委會和基層醫療衛生機構。
2.患者出院後,因恢復期機體免疫功能低下,有感染其它病原體風險,新冠肺炎治癒出院患者完成醫院治療後，應到指定場所統一實施為期 14 天免費的康復隔離和醫學觀察。
3.建議在出院後第 2 周、第 4 周到醫院隨訪、複診。
七、 總結與展望
新冠肺炎疫情形勢依然嚴峻，惡性腫瘤患者的診治受到不同程度的限制，這就需要我們及時調整診治策略，充分發揮中醫藥的優勢，將疫情對診治的影響降至最低，實現最佳治療療效。中西醫結合，醫患攜手，最終將取得戰勝疫情和腫瘤診治的共同勝利。
本共識指導意見得到了世界中醫藥學會聯合會腫瘤經方治療研究專業委員會及湖北省中醫藥學會腫瘤專業委員會的大力支持，並徵求部分疫情防控相關學科專家的意見，在此一併表示感謝。
專家組成員:
馮利教授 國家癌症中心/國家腫瘤臨床醫學研究中心/中國醫學科學院北
陸衛東教授 哈佛大學醫學院丹娜法伯癌症研究院整合醫學中心 中醫師
林慶鍾教授 中臺科技大學 衛福部豐原醫院中醫主任
王曉輝副教授 法國消化道腫瘤診療中心裡昂分中心副主任
Specialty Committee of Classical TCM Formula for CancerTreatment and Research of World Federation of Chinese Medicine Societies Expert Consensus on integrated traditional and western medicine prevention and rehabilitation of malignant tumor during the epidemics of Corona Virus Disease 2019 (First edition)
Corona Virus Disease 2019(referred to as COVID-19) has caused a global outbreak and become a major public health issue. On January 20, 2020, the announcement of National Health Commission (No. 1 of 2020) included COVID-19 as a category B infectious disease in Law of the people's Republic of China on prevention and control of Infectious Diseases, and took preventing and controlling measures like those of category A infectious diseases. Tumor patients are more susceptible to infection because of their poor nutritional state and systemic immunosuppressive state caused by antitumor treatments, such as radiotherapy, chemotherapy and surgery. Cancer patients had an estimated 2-fold increased risk of COVID-19 than the general population according to the Report of the WHO-China Joint Mission on COVID-19; The incidence rate of COVID-19 in cancer patients in Wuhan is 0.79%, while the general population is 0.37% in the same period. And the COVID-19 cancer patients were with higher risk to become severe condition and worse prognosis, especially in those patients who received chemotherapy or surgery recently, than those without cancer . In addition, the inconvenience for patients going out to see doctors also leads to the delay of diagnosis and treatment. As a result, under the current severe situation, scientific and effective management measures and reasonable responsive strategies are urgently needed to minimize the impact of the epidemic on tumor patients. Especially recently, the outbreak continues to spread in many countries around the world. World Health Organization (WHO) believes the COVID-19 epidemic has the characteristics of a pandemic, calling on all countries to take urgent and active action. Under such circumstances, experts organized by Classical Traditional Chinese Medicine Prescription for Cancer Treatment and Research Committee of World Federation of Chinese Medicine Societies, discussed and formed "Expert consensus on integrated traditional and western medicine prevention and rehabilitation during the epidemics of Corona Virus Disease 2019",according to national prevention and treatment experience of COVID-19, especially in Wuhan. This consensus aims to provide a model for TCM experts around the world to guide tumor patients to respond reasonably and safely through COVID-19. Giving full play to the advantages of integrated traditional and western medicine in diagnosis and treatment can minimize the adverse side effects of the epidemic on malignant tumor patients.
Key words: COVID-19; Oncology; Traditional Chinese Medicine
1. Daily protection.
1.1 Refrain from going outdoors and keep a regular schedule.
COVID-19 is generally susceptible to all population. If tumor patients, who have been attacked by cancer cells, get infected with COVID-19, it would be a double whammy. Therefore, tumor patients should reduce visits to relatives and friends,avoid going out to densely populated public places, especially with poor air mobility.Keep regular schedule and sleep no less than 7-8 hours a day.
1.2 Enhance awareness of protection.
Be sure to wear a mask when you go out and wash your hands frequently.Reduce exposure to staff in public places and consider wearing disposable plastic gloves. Wash hands with hand sanitizer or soap water no less than 15 seconds after returning from public places, coughing (covered by your own hands), before meals and after using toilet. Do not spray at others but using your own sleeves to cover when coughing or sneezing; and change your mask in time. If it is necessary to go to the hospital or to get medication, these protective measures should be strengthened.
1.3 Home quarantine and Moderate exercise.
Open windows frequently for ventilating. Do not spit anywhere. Oral and nasal secretions should be wrapped in paper towels and discarded in covered dustbins. Exercise moderately at home, avoid being bedridden for a long time and strenuous activity. You can practice tai chi, baduanjin, medical qigong, five-animal exercise, yoga and rehabilitation exercises and so forth for about 30 minutes every day.Sweating slightly is best.
1.4 Reasonable diet and Adequate nutrition.
Proper intake of protein food such as eggs, milk, fish, meat, beans, nuts, etc., and increasing intake of fresh vegetables and fruits in daily diet is suggested. Balance portions of vegetables and meat, avoid raw and cold food. Do not eat wild animals. It is recommend to increase the amount of drinking water to no less than 1500ml perday.
1.5 Self-regulation and Keep good spirits
Face up to the epidemic information rationally and objectively. Create a sense of security and stay relaxed through listening to relaxing music(called music therapy). If your psychological condition continues to deteriorate, such as severe insomnia,anxiety, depression, etc., and it cannot be relieved through self-adjustment, you can seek the help of relevant professional doctors.
1.6 Prevention prescription:
Prescription one: suitable for the prevention of commen tumor patients.Fang Du Kang Ai Decoction: Semen Coicis(Yi Yi Ren) 20g ,Radix Astragali(Huang Qi) 10g,Rhizoma Atractylodis(Bai Zhu) 12g, Fructus Amomi Villosi(Sha Ren) 6g,Fructus Ammomi Rotundus(Bai Dou Kou) 10g, Rhizoma Phragmitis(Lu Gen)10g, Radix Platycodonis(Jie Geng) 10g, Herba Rhodiolae(Hong Jing Tian) 10g, Rhizoma Dioscoreae(Shan Yao) 10g, Folium Perillae(Zi Su Ye) 10g, Half a pear.One dose a day. Decocted with water or taken as tea. Take it continuously for 5-7days.
Prescription two: suitable for the prevention of tumor patients with direct contact with suspected cases or close contacts.Radix Astragali(Huang Qi) 9g, Radix Glehniae(Bei Sha Shen) 9g,Rhizoma Anemarrhenae(Zhi Mu) 9g, Trollius chinensis bunge(Jin Lian Hua) 5g,Fructus Forsythiae(Lian Qiao) 9g, Rhizoma Atractylodis(Cang Zhu) 9g,Radix Platycodonis(Jie Geng) 6g.The above 7 herbs are decocted with water once a day and can be taken continuouslyfor 5-7 days.
2. Suggestions on the treatment of tumor patients during the epidemics.
2.1 For patients with routine reviews:
Cancer patients may have some uncomfortable reactions or complications after discharge, which needs to be reexamined regularly. It is suggested that thereexamination should be delayed slightly under the premise of not affecting the prognosis of disease. Network consultation is recommended and outpatient reexamination when necessarily. Avoid hospitalization reexamination as far as possible and reduce the time spent in hospital. Avert cross-infection during the examination.
2.2 For patients undergoing elective surgery:
Moderate deferment of surgical treatment is recommended for patients with benign tumors that do not affect their health in the near future, or in the remission stage of malignant tumor after comprehensive treatment. For patients in the advanced or early and middle stage of malignant tumor who need to be operated as soon as possible, surgical treatment should be carried out under the condition of controllable risk after a comprehensive and detailed assessment of the patient's physical status and surgical risk, to ensure the safety of the patient during the perioperative period.
2.3 Patients during chemotherapy:
For patients treated by regular chemotherapy, contact the attending doctor in time. It is suggested that if the curative effect is not significantly affected, the chemotherapy cycle should be moderately reduced or prolonged, or oral chemotherapy should be given priority to. Chemotherapy is recommended in non-COVID-19 designated hospitals for patients with postoperative adjuvant chemotherapy. For the toxic and side effects caused by chemotherapy, pay attention to the characteristics of TCM treatment based on syndrome differentiation, give full play to the role of TCM reducing the toxicity, increasing the curative effect and relieving the symptoms.
2.4 Patients during radiotherapy:
For the patients undergoing radiotherapy, continuing to receive treatment in an orderly manner according to the overall arrangement of doctors is recommended.Moderate delay radiotherapy according to the attending doctors' arrangement under the premise of not affecting tumor prognosis. Meanwhile, give full play to the role of TCM reducing the toxicity and increasing the curative effect, mitigating the toxic and side effects caused by radiotherapy.The decision to postpone or change the plan of surgery, radiotherapy and chemotherapy should be made according to the epidemic intensity of COVID-19 and its impact on medical institutions. Under suitable condition, online multidisciplinary consultation can be considered. Limit surgery, radiotherapy and chemotherapy in extremely high-risk cases, and restrict personnel exposure, especially in treatment sites. The hospitals should have strict control, for example, tracking the travel history of the visitors before entering the hospital, and so forth.
2.5 Long-term follow-up patients:
For tumor patients in remission stage with relatively stable condition, the disease is mainly controlled by drugs at present. Meanwhile you should communicate withthe attending physician in time to report your condition and current drug use, todecide whether or not continuing the original treatment. If drugs are used up, consult with the doctors to see if you can take a break to stop the medication. If you need more medication, take relevant materials and go to the designated drugstores or hospitals for registered prescription and maintenance treatment.
2.6 Patients with cancer pain:
According to the degree of pain, doctors prescribe drugs for specific days. After the medication is used up, bring all the data as many as possible, such as pathological report, imaging, previous discharge certificate and diagnosis certificate and so forth,to the nearest non-designated hospital of COVID-19.Based on the characteristics of the malignant tumor patients, and the limitations during the special period of epidemic, conservative treatment and drug intervention should be given priority, followed by minimally invasive treatment among western medical treatments. While surgery and other treatments are limited to emergency conditions as far as possible, which needs strict protection. Although some specific plans should be adjusted in time, the comprehensive treatment strategy and principle of tumor patients will not be changed.
3. Differential diagnosis of covid-19 infection in cancer patients
Tumor patients may have complications of infection, such as cough,expectoration, fever and leucopenia caused by pulmonary infection, or cancerous fever caused by disease progress, after routine therapy of radiotherapy and chemotherapy. COVID-19 infection patients can also have the above conditions,resulting in confusion of the two easily, making the diagnosis more difficult. In treatment, COVID-19 infection should be excluded at first. Therefore, if tumor patients suffer from symptoms such as fever, dry cough, dyspnea, tiredness, runny nose, sore throat, vomiting, diarrhea, muscle pain, etc., they should go to the nearest fever outpatient department in time to make differential diagnosis and treatment.
After excluding the COVID-19 infection, contact the oncology physician for related treatment.In addition, tumor patients may have weaker ability to resist pathogens if they are treated with immune checkpoint inhibitors (mainly PD-1 and PD-L1 inhibitors).The combined application of immunosuppressant and other medicine result in more susceptibility of tumor patients, so the above daily protective measures need to be further strengthened. Meanwhile, some patients had serious adverse side effects after PD-1 treatment, including immune-related pneumonia, etc., and their clinical manifestations and imaging features were very similar to those of COVID-19. If such a situation occurs, especially without fever, strict differential diagnosis is required.Patients and their family members should provide a detailed history of antineoplastic application to the hospital (a 3A comprehensive hospital is recommended) and require the doctors to communicate closely with the oncology physicians, who can guide the related treatment.
4. TCM treatment strategy of malignant tumor during the epidemic of COVID-19
4.1 Advantages of TCM treatment of malignant tumor during the epidemic of COVID-19:
A large number of previous studies and clinical applications have proved thatTCM treatment of malignant tumor has a significant curative effect and unique advantages. The TCM treatment, which has the advantages of not relying on large-scale equipment, infrastructure and relatively fewer hospitalization and side effects, can play a vital role during the epidemic and compensate for some losses,such as delayed treatment, poor constitution increasing susceptibility and so forth caused by various objective reasons.
4.2 For frail postoperative patients, during(or after) radiotherapy and chemotherapy, strengthening the vital qi is main focus while eliminating pathogen is auxiliary:
Most postoperative patients are in a state of qi and blood impairment, deficient with evil-lingering. Most of them have pallid or sallow complexion, fatigue and no intention to talk, spontaneous sweating, poor appetite, or operative incision recovering slowly and being susceptible to infection. The TCM treatment should take tonifying qi and blood and strengthening as the main focus while clearing residual pathogens, to help patients recover after operation, enhance constitution and immunity as soon as possible. Therefore, they can combat COVID-19 and prevent tumor recurrence and metastasis.
For patients during(or after) radiotherapy and chemotherapy with delayed treatment because of the epidemic, on the one hand, use TCM to regulate and strengthen the body to better respond to western medicine after the epidemic; on the other hand, to enhance the anti-tumor intensity of TCM to improve the curative effect when physical conditions allow.
4.3 For patients who have not been treated by western medicine at the first vist,eliminating pathogen is main focus while strengthening the vital qi is auxiliary:
TCM treatment should take eliminating pathogen as main focus and strengthening as auxiliary if patients' vital qi not yet reduced. Meanwhile, we can consider enhancing the anti-tumor intensity of TCM or using oral Chinese patent medicine (CPM) to reduce the adverse effects caused by inability to be treated by western medicine timely.
4.4 For stable patients:
The tumor is in a stable state after systematic anti-tumor treatment. In addition to regular reexamination, Using TCM to regulate constitution, enhance immunity and prevent tumor recurrence and metastasis is still necessary. TCM treatment, which should be based on the specific conditions of patients, adopts the strategy of combining eliminating pathogen and strengthening.
4.5 Adjustment of TCM prescribing strategy during the epidemic of COVID-19:
The overall principle of TCM treatment strategy for tumor patients remains unchanged, with the combination of the characteristics of the epidemic. According to"notice on issuing COVID-19 's diagnosis and treatment plan(trial the 7th edition)",the incidence of COVID-19 mostly manifests as cold-damp ; therefore, we should prescribe herbal medicine in accordance with local conditions and the patient's individuality. For patients with cold tendency or(and) dampness tendency constitution,we should pay attention to the regulation of basic constitution and increase the TCM treatment of eliminating dampness and dispelling cold and so forth.
4.6 Pay attention to the integration of traditional and western Medicine:
The application of TCM does not conflict with Western Medicine during the epidemic of tumor patients. Integration of TCM and western Medicine is recommended to achieve maximum curative effects and minimum side effects. The TCM treatment plan should be adjusted accordingly with the physical condition of patients and the Western Medicine treatment stage.
4.7 Make full use of remote diagnosis and treatment platform:
We should make full use of the remote diagnosis and treatment platform such as We-chat due to the inconvenience of seeing doctor on site during the epidemic.Although the TCM diagnosis needs four ways-inspection, listening and smelling,inquiry, palpation, the inspection, listening and inquiry can still be realized through the platform under the limited conditions. The pulse-diagnosis-instrument can be used as a supplement to palpation if primary hospitals have such equipment.Effective measures such as mailing service of traditional Chinese medicine orwestern medicine, using TCM granules and so forth, can reduce the patients going out and make it easy for them.
5. Recommendation of TCM recovery for tumor patients with COVID-19 in convalescence:
Basis: Beijing Administration of Traditional Chinese Medicine issued "Beijing COVID-19's TCM prevention and treatment Plan (trial the 4th edition)".
5.1 Qi and Yin deficiency Syndrome
Symptoms: fatigue and burnout, spontaneous sweating, palpitation, anorexia, dry mouth and throat, red tongue with less fluid or tender red tongue, yellow fur or few greasy fur.Seen in convalescent cases.Treatment principle: tonify qi and nourish yin.Prescription as reference:Radix Adenophorae(Sha Shen) 15g, Radix ophiopogonis(Mai Dong) 15g,Radix Astragali(Huang Qi) 15g, Medicated leaven(Liu Shen Qu) 20g,Radix Paeoniae Rubra(Chi Shao) 15g, Cortex Mori(Sang Bai Pi) 15g,Cortex Lycii(Di Gu Pi) 15g, Fructus Aurantii(Zhi Qiao) 10g,Herba Artemisiae Annuae(Qing Hao) 10g,Radix Rehmanniae Recens(Sheng Di Huang) 15g
Addition and subtraction:
add Fructus Schisandrae Chinensis(Wu Wei Zi) 10g if shortness of and breathlessness occurs; add stir-frying Semen Ziziphi Spinosae(Suan Zao Ren) 15g if insomnia and irritability occurs; add Radix Codonopsis(Dang Shen) 15g, Rhizoma Dioscoreae(Shan Yao) 15g, Poria(Fu Ling) 15g, Rhizoma Pinelliae(Ban Xia) 9g,Pericarpium Citri Reticulatae(Chen Pi) 10g, Radix Glycyrrhizae(Gan Cao) 6g if anorexia and liquid stool occurs, which is spleen and lung qi-deficiency syndrome.Chinese patent medicine(CPM): oral: Sheng Mai Yin, etc.5.2 Remnant Lingering Pathogen Syndrome Symptoms: shortness of breath, chest tightness, cough, less phlegm, red or tongue, a little greasy fur.Seen in convalescent cases still with pulmonary inflammation.Treatment principle: promoting blood circulation and eliminating dampness,dispersing the remaining pathogen.Prescription as reference:Radix Salviae Miltiorrhizae(Dan Shen) 15g, stir-frying Semen Coicis(Yi Yi Ren)30g, Radix Codonopsis(Dang Shen) 15g, Radix Adenophorae(Sha Shen) 15g,Smen Persicae(Tao Ren) 6g, Fructus Trichosanthis(Gua Lou) 20g,Cortex Magnoliae Officinalis(Hou Po) 10g, Rhizoma Phragmitis(Lu Gen) 30g,Herba Patriniae(Bai Jiang Cao) 30g, Fructus Hordei Germinatus(Mai Ya) 30g,Herba Rhodiolae(Hong Jing Tian) 10g.
5.3 Other treatments.
Treatments such as acupoint plastering, moxibustion, acupuncture, ba duanj in,tai chi, respiratory guidance exercise, qigong recovery, physical exercise,psychological counseling, music therapy, etc., can be chosen under the guidance of doctors.A small number of COVID-19 patients have nucleic acid re-positive after they have been cured and discharged at present. There is no definite conclusion about whether the disease has relapsed or aggravated and the patients with re-positive nucleic acid have infectivity. Therefore we suggest that discharged patients continue to take oral traditional Chinese medicine for recovery treatment for 1-2 months to stimulate the continuous production of antibodies, striving to achieve complete negative nucleic acid.
6. Caveats for tumor patients with COVID-19 who was terminated quarantine and discharged from hospital.
According to caveats about COVID-19 patients who terminate quarantine and being discharged from hospital, as well as notice on recovered quarantine of cured and discharged COVID-19 patients in Wuhan, written in the "COVID-19 's diagnosis and treatment plan(trial the 7th edition)" issued by National Health Commission of the People's Republic of China.
6.1 Terminate quarantine and discharge criteria.
Ⅰ. The temperature returns to normal over 3 days.
Ⅱ. Respiratory symptoms significantly improved.
Ⅲ. Pulmonary images show that acute exudative lesions significantly improved.
Ⅳ. The nucleic acid tests of respiratory sample are negative for two consecutive times(sampling time at least 1 day interval).Those who fulfil the above conditions can be terminated quarantine and discharged, continuing to quarantine at home for 14 days.
6.2 Caveats after discharge.
Ⅰ. Designated hospitals should make good contact with primary medical institutions where patients go to, share case information, and timely send out the information of discharged patients to their jurisdiction or the neighborhood committee of their residence or primary medical institutions.
Ⅱ. The discharged patients have risky infection with other pathogens due to the low immune function during the convalescence. COVID-19 patients who were cured and discharged should go to the designated place for free recovery quarantine and medical observation for 14 days after completing their hospital treatment.
Ⅲ. It is recommended to go to the hospital for follow-up visit in the second and fourth week after discharge.
7. Summary and prospect.
The severe situation of COVID-19 epidemic and the various degrees of limitation of malignant tumor patients' diagnosis and treatment requires us to adjust the diagnosis and treatment strategy in time, give full play to the advantages of TCM,minimize the impact of the epidemic on diagnosis and treatment, to achieve the best curative effect. The integration of traditional Chinese medicine and western medicine and the cooperation of doctors and patients will eventually win the battle of the epidemic and tumor diagnosis and treatment.
This consensus guidance is strongly supported by the Specialty Committee of Classical TCM Formula for Cancer Treatment and Research of World Federation of Chinese Medicine Societies and the Oncology Professional Committee of Hubei Association of Chinese Medicine, and solicits the opinions of some experts in disciplines related to epidemic prevention and control. Hereby, I would like to acknowledge you all.
The members of expert group:
Prof. Li Feng, chief physician, National Cancer Center/National Clinical Research
Center for Cancer/Department of Traditional Chinese Medicine, Cancer Hospital,
Chinese Academy of Medical Science and Peking Union Medical College.
Prof. Yuguang Wang, chief physician, Department of Respiratory medicine, Beijing
Hospital of Traditional Chinese Medicine, Capital Medical University.
Prof. Zuowei Hu, chief physician, Department of Oncology, WuHan No.1 Hospital.
Prof. Heng Fan, chief physician, Department of Traditional Chinese Medicine, Union
Hospital, Tongji Medical College of Huazhong University of Science and Technology.
Prof. Yingwen Zhang, chief physician, Department of Chinese with Western Medicine,
Zhongnan Hospital of Wuhan University, Wuhan, China.
Prof. Chenguang Yang, chief physician, Department of Oncology, Shanxi Traditional
Chinese Medicine Hospital.
Prof. Dongxin Tang, chief physician, Department of Oncology, The First Affiliated
Hospital of Guizhou University of Traditional Chinese Medicine.
Prof. Weidong Lu, TCM physician, Center for Integrative Therapies, Dana-Farber
Cancer Institute, Harvard Medical School.
Prof. Qingzhong Lin, Central Taiwan University of Science and Technology, director
of Department of Traditional Chinese Medicine, Fengyuan Hospital of Health
Promotion Administration of Taiwan, China.
Dr. Xiaohui Wang, associate professor, French federation of digestive cancer.
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