Optimising triage procedures for patients with cancer needing active anticancer treatment in the COVID-19 era

Abstract

BackgroundImmunosuppression induced by anticancer therapy in a COVID-19-positive asymptomatic patient with cancer may have a devastating effect and, eventually, be lethal. To identify asymptomatic cases among patients receiving active cancer treatment, the Federico II University Hospital in Naples performs rapid serological tests in addition to hospital standard clinical triage for COVID-19 infection.MethodsFrom 6 to 17 April 2020, all candidates for chemotherapy, radiotherapy or target/immunotherapy, if negative at the standard clinical triage on the day scheduled for anticancer treatment, received a rapid serological test on peripheral blood for COVID-19 IgM and IgG detection. In case of COVID-19 IgM and/or IgG positivity, patients underwent a real-time PCR (RT-PCR) SARS-CoV-2 test to confirm infection, and active cancer treatment was delayed.ResultsOverall 466 patients, negative for COVID-19 symptoms, underwent serological testing in addition to standard clinical triage. The average age was 61 years (range 25–88 years). Most patients (190, 40.8%) had breast cancer, and chemotherapy with or without immunotherapy was administered in 323 (69.3%) patients. Overall 433 (92.9%) patients were IgG-negative and IgM-negative, and 33 (7.1%) were IgM-positive and/or IgG-positive. Among the latter patients, 18 (3.9%), 11 (2.4%) and 4 (0.9%) were IgM-negative/IgG-positive, IgM-positive/IgG-negative and IgM-positive/IgG-positive, respectively. All 33 patients with a positive serological test, tested negative for RT-PCR SARS-CoV-2 test. No patient in our cohort developed symptoms suggestive of active COVID-19 infection.ConclusionRapid serological testing at hospital admission failed to detect active asymptomatic COVID-19 infection. Moreover, it entailed additional economic and human resources, delayed therapy administrationand increased hospital accesses.

Management of patients with cancer during the COVID-19 pandemic: The Italian perspective on the second wave

“…First, there is need to preserve cancer patients and cancer-related activities. This includes preservation of medical staff, whose commitment to COVID-19 wards should be minimized, and of cancer patients by ensuring triage procedures and regular COVID-19 testing for both healthcare practitioners and patients 17 . The psychological impact of COVID-19 on cancer patients should not be underestimated, and psycho-oncological support for patients and caregivers should be considered, as forthcoming COVID-19 outbreaks are expected in the next future 18 .…”

A comprehensive review of the challenges posed by COVID-19 in cancer patients

“…Nevertheless, a delay in treating metastatic cancers can result in a much worse prognosis, significantly higher disease progression, and more hospitalizations. However, it is worth mentioning that some early-stage hormone-positive breast cancer patients can be kept on their hormone therapy if needed (28).…”

One Public Health Crisis into Many Others: The impact of COVID-19 on Upstaging of Gastric Cancer

“…On the other hand, it was proposed that cancer patients may have higher susceptibility to be affected by COVID-19 and have excess mortality rate from COVID-19 compared to patients without cancer due to higher hospital visits, poor nutritional state, systemic underlining disease and immune-suppression [8,9]. Thus, for many patients chemotherapy treatments were postponed, elective curative surgeries were delayed or changed into urgent palliative ones, radiotherapy session were abbreviated, and even intravenous therapies changed to oral therapies at home [10,11].…”

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