A Statewide Multi-Institutional Study of Asymptomatic Pretreatment Testing of Radiation Therapy Patients for SARS-CoV-2 in a High-Incidence Region of the United States

Abstract

Purpose/Objective(s) To establish the prevalence of SARS-CoV-2 in asymptomatic patients scheduled to receive radiation therapy and its impact on management decisions. Materials/Methods Between April 2020 and July 2020, patients without influenza-like-illness (ILI) symptoms at four radiation oncology departments (2 academic university hospitals and 2 community hospitals) underwent polymerase chain reaction (PCR) testing for SARS-CoV-2 prior to the initiation of treatment. Patients were tested either prior to radiotherapy simulation or after simulation but prior to treatment initiation. Patients tested for indications of ILI symptoms were excluded from this analysis. Management of SARS-CoV-2-positive patients was individualized based on disease site and acuity. Results Over a three-month period, a total of 385 tests were performed in 336 asymptomatic patients either prior to simulation (n=75), post-simulation, prior to treatment (n=230), or on-treatment (n=49). A total of 5 patients tested positive for SARS-CoV-2, for a pre-treatment prevalence of 1.3% (2.6% in North/Central NJ and 0.4% in Southern NJ/Southeast PA). The median age of positive patients was 58 years (range: 38-78 years). All positive patients were white and were relatively equally distributed with regard to gender (2 male, 3 female) and ethnicity (2 Hispanic and 3 non-Hispanic). The median Charlson comorbidity score among positive patients was 5. All 5 patients were treated for different primary tumor sites, the large majority had advanced disease (80%), and all were treated for curative intent. The majority of positive patients were being treated with either sequential or concurrent immunosuppressive systemic therapy (80%). Initiation of treatment was delayed for 14 days with the addition of re-testing for 4 patients, while one patient was treated without delay but with additional infectious-disease precautions. Conclusion Broad-based pre-treatment asymptomatic testing of radiation oncology patients for SARS-CoV-2 is of limited value, even in a high-incidence region. Future strategies may include focused risk-stratified asymptomatic testing.

Risk stratification by anamnesis increases SARS-CoV-2 test efficiency in cancer patients

“…Modi et al recently reported their results of preradiotherapy testing in four US institutes and also found low prevalences (0.4-2.6%) in asymptomatic patients despite a high incidence of cases in the area. The authors concluded that future test strategies may focus on risk stratification [22].…”

“…Since there is no consensus on the utility of systematic testing in cancer patients under active treatment [18][19][20][21][22][23], increasing test efficiency by risk stratification might indeed be desirable. The rational first step of risk stratification should clearly be the clinical assessment of patients.…”

Outcome of Gynecologic Cancer Patients With The Covid-19 Infection : A Systematic Review And Meta Analysis

“…S12. 15,17,23,29,31,34,43,46,60 Covid-19 death was comparable in among cancer treatment between gynecologic cancer and other cancer gathered from 8 studies (OR 0.90, CI 0.41-1.96, p 0.78, I 2 3%) Fig. S13.…”

“…Lastly, 20 studies provided data on overall Covid-19 infectivity (99601 gynecologic cancer, 8311468 overall control population). 15,17,23,29,31,[33][34][35]39,43,44,46,49,51,54,55,58,60 Covid-19 infection was comparable between gynecologic cancer and control (OR 0.97, CI 0.81-1.15, p 0.69, I 2 47%) Fig. S6.…”

“…S18. 15,17,23,29,33,39,43,49,50,55,60 Data from 28 studies revealed that gynecologic cancer had fewer Covid-19 death than lung cancer patients (OR 0.52, CI 0.43-.063, p < 0.0001, I 2 4%) Fig. 6A.…”