Prevalence and Clinical Impact of SARS-CoV-2 Silent Carriers Among Actively Treated Patients with Cancer During the COVID-19 Pandemic

Abstract

Introduction In Europe, the SARS‐CoV‐2 pandemic had its first epicenter in Italy. Despite a significant mortality rate, the severity of most cases of COVID‐19 infection ranges from asymptomatic to mildly symptomatic, and silent infection affects a still‐unknown proportion of the general population. No information is available on the prevalence and clinical impact of SARS‐CoV‐2 silent infection among patients with cancer receiving anticancer treatment during the pandemic. Materials and Methods From April 1, 2020, to the end of the same month, 560 consecutive patients with cancer, asymptomatic for COVID‐19 and on anticancer treatment at Papa Giovanni XXIII Hospital in Bergamo, were evaluated and tested for SARS‐CoV‐2. We implemented a two‐step diagnostics, including the rapid serological immunoassay for anti–SARS‐CoV‐2 immunoglobulin (Ig) G/IgM and the nasopharyngeal swab reverse transcriptase‐polymerase chain reaction (RT‐PCR) test in case of seropositivity to identify SARS‐CoV‐2 silent carriers. Results In 560 patients, 172 (31%) resulted positive for anti–SARS‐CoV‐2 IgM/IgG antibodies, regardless of different type of cancer, stage, and treatment. The Ig‐seropositive patients were then tested with RT‐PCR nasopharyngeal swabs, and 38% proved to be SARS‐CoV‐2 silent carriers. At an early follow‐up, in the 97 SARS‐CoV‐2–seropositive/RT‐PCR–negative patients who continued their anticancer therapies, only one developed symptomatic COVID‐19 illness. Conclusion Among patients with cancer, the two‐step diagnostics is feasible and effective for SARS‐CoV‐2 silent carriers detection and might support optimal cancer treatment strategies at both the individual and the population level. The early safety profile of the different anticancer therapies, in patients previously exposed to SARS‐CoV‐2, supports the recommendation to continue the active treatment, at least in cases of RT‐PCR–negative patients. Implications for Practice This is the first study evaluating the prevalence and clinical impact of SARS‐CoV‐2 silent infection in actively treated patients with cancer, during the epidemic peak in one of the worst areas of the COVID‐19 pandemic. Lacking national and international recommendations for the detection of asymptomatic SARS‐CoV‐2 infection, a pragmatic and effective two‐step diagnostics was implemented to ascertain SARS‐CoV‐2 silent carriers. In this series, consisting of consecutive and unselected patients with cancer, the prevalence of both SARS‐CoV‐2–seropositive patients and silent carriers is substantial (31% and 10%, respectively). The early safety profile of the different anticancer therapies, in patients previously exposed to SARS‐CoV‐2, supports the recommendation to continue the active treatment, at least in case of RT‐PCR–negative patients.

Universal Screening of Patients with Cancer for COVID-19: Results from an Observational, Retrospective Cohort Study in Kerala, India

“…In a similar study from Chennai, India, the testing of 761 patients was planned for chemotherapy using RT-PCR, out of which 11 (1.45%) patients were positive for COVID-19. 28 Our data was comparable to the low prevalence reported from developed nations like the United States of America (New York: 0.64%), 29 United Kingdom (Birmingham: 0.6%), 17 and Austria (Vienna: 0.4%). 30 The low prevalence of asymptomatic infections in our patients with cancer could be because they were more cautious and followed social distancing, hygiene, and masking rigorously.…”

Impact of the COVID-19 pandemic on the oncologic activities (diagnosis, treatment, clinical trials enrollment) of a general hospital in a district with high prevalence of SARS-COV-2 in Italy

“…According to Italian oncologists, other types of preventive measures were established to reduce virus spread, such as subjecting patients to triage before hospital admission, and more specifically, using triage screening tools such as phone calls, virtual consultations, and telemedicine [ 9 – 11 ]. Furthermore, laboratory test diagnostics of SARS-CoV-2 infection, including nasopharyngeal swab RNA reverse transcriptase-polymerase chain reaction (RT-PCR) assay and rapid serological immunoassay, were implemented [ 12 , 13 ].…”

Clinical outcomes in cancer patients with COVID-19 in Sweden

“…Taken together, the PCR positivity mirrored the general population. Reports of SARS-CoV-2 antibodies seroprevalence in cancer patients before the introduction of vaccine at single centers in Italy also correlate well with the viral spread at different regions, ranging from 0.7% at low transmission region up to 31% at high transmission region [16,17].…”