Results of Multilevel Containment Measures to Better Protect Lung Cancer Patients From COVID-19: The IEO Model

Marinis, Filippo de; Attili, Ilaria; Morganti, Stefania; Stati, Valeria; Spitaleri, Gianluca; Gianoncelli, Letizia; Signore, Ester Del; Catania, Chiara; Rampinelli, Cristiano; Salè, Emanuela Omodeo; Spaggiari, Lorenzo; Mastrilli, Fabrizio; Passaro, Antonio

doi:10.3389/fonc.2020.00665

Cited by 23 publications

(37 citation statements)

References 11 publications

(17 reference statements)

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“…Six papers described the management of cancer patients during the COVID-19 pandemic in Lombardy’s hospitals where specialized centers (hubs) with dedicated multidisciplinary “hub teams” were identified to treat oncologic patients [ 3 , 15 , 16 , 17 , 18 , 19 ]. In particular, these works discussed the hospital strategies to ensure the continuum of the best possible cancer care by estimating the individual patient’s risk of infection based on both the epidemiological considerations and individual clinical characteristics (in particular age and number of comorbidities).…”

Section: Discussionmentioning

confidence: 99%

“…No health care system can be prepared to respond to such a rapid saturation of available beds in intensive care units and in the other departments of the hospitals. This fact translated into an exponential rise of the number of deaths and a reallocation of most of the available health care resources to treat COVID-19 patients, generating competition with other health care needs [ 3 ]. In particular, the Lombardy region created differentiated pathways for COVID-19 and non-COVID-19-related health services to better face the emergency [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 Outbreak on Cancer Patient Care and Treatment: Data from an Outpatient Oncology Clinic in Lombardy (Italy)

Quaquarini

Saltalamacchia

Presti

et al. 2020

Cancers

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Lombardy was the first area in Italy to have an outbreak of coronavirus disease 19 (COVID-19) at the beginning of 2020. In this context, cancer has been reported as a major risk factor for adverse outcomes and death, so oncology societies have quickly released guidelines on cancer care during the pandemic. The aim of this study was to investigate the management of cancer patients and oncological treatments during the COVID-19 pandemic and to describe the containment measures performed in our outpatient clinic at Pavia (Lombardy). A comparison with the same period of the four previous years (2019, 2018, 2017, and 2016) was also performed. Using our electronic databases, we evaluated the number and characteristics of patients accessing the hospital for anticancer drug infusion from 24 February, 2020 to 30 April, 2020 and the number of radiological exams performed. Although a significant reduction in access for therapy was seen when compared with 2019 (2590 versus 2974, access rate ratio (ARR) = 0.85, p < 0.001), no significant differences in access numbers and ARR was evident between 2020 and 2018, 2017, or 2016 (2590 versus 2626 (ARR = 0.07), 2660 (ARR = 0.99), and 2694 (ARR = 0.96), respectively, p > 0.05). In 2020, 63 patients delayed treatment: 38% for “pandemic fear”, 18% for travel restrictions, 13% for quarantine, 18% for flu syndrome other than COVID-19, and 13% for worsening of clinical conditions and death. Only 7/469 patients developed COVID-19. A significant reduction in radiological exams was found in 2020 versus all the other years considered (211 versus 360, 355, 385, 390 for the years 2020, 2019, 2018, 2017, and 2016, respectively, p < 0.001). The low incidence of COVID-19 among our cancer patients, along with the hospital policy to control infection, enabled safe cancer treatment and a continuum of care in most patients, while a small fraction of patients experienced a therapeutic delay due to patient-related reasons.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 Outbreak on Cancer Patient Care and Treatment: Data from an Outpatient Oncology Clinic in Lombardy (Italy)

Quaquarini

Saltalamacchia

Presti

et al. 2020

Cancers

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“…Previous series, including from 3 to 69 COVID-19 positive patients, reported an infection rate ranging from 0.79% to 2.7% among cancer patients and a mortality rate of 0-36% in infected subjects [13][14][15][16][17][18][19][20][21][22][23]. Only a fraction of the cases were receiving active treatment, mainly consisting of chemotherapy and immunotherapy or target therapy, and infection determined in almost all the cases treatment suspension [13][14][15][16][17][18][19][20][21][22][23].…”

Section: Covid-19 Impact On the Staffmentioning

confidence: 99%

Two months of Radiation Oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice.

Buglione

Spiazzi

Guerini

et al. 2020

Preprint

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Abstract Background: Coronavirus Disease 2019 (COVID-19) pandemic had an overwhelming impact on healthcare worldwide. Outstandingly, the aftermath on neoplastic patients is still largely unknown, and only isolated cases of COVID-19 during radiotherapy have been published. We will report the two-months experience of our Department, set in Lombardy “red-zone”.Methods: data of 402 cancer patients undergoing active treatment from February 24 to April 24, 2020 were retrospectively reviewed; several indicators of the Department functioning were also analyzed.Results: dedicated measures allowed an overall limited reduction of the workload. Decrease of radiotherapy treatment number reached 17%, while the number of administration of systemic treatment and follow up evaluations kept constant. Conversely, new treatment planning faced substantial decline. Considering the patients, infection rate was 3.23% (13/402) and mortality 1.24% (5/402). Median age of COVID-19 patients was 69.7 years, the large majority were male and smokers (84.6%); lung cancer was the most common tumor type (61.5%), 84.6% of subjects were stage III-IV and 92.3% had comorbidities. Remarkably, 92.3% of the cases were detected before March 24. Globally, only 2.5% of ongoing treatments were suspended due to suspect or confirmed COVID-19 and 46.2% of positive patients carried on radiotherapy without interruption. Considering only the last month, infection rate among patients undergoing treatment precipitated to 0.43% (1/232) and no new contagions were reported within our staff. Conclusions: although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during SARS-Cov-2 pandemic by endorsing consistent preventive measures.

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“…We introduced proactive management and containment measures that helped us better identify those patients with suspected symptoms related to COVID-19, thereby limiting the virus spread throughout the hospital. These measures are reported elsewhere ( 9 ). National and international guidelines were published to help manage patients with cancer, especially those with lung cancer ( 10 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

“…Measures included deferring follow-up visits and sending cancer medications to the patients’ homes. Our staff also contacted all patients to ascertain how they were feeling, whether they had experienced any symptoms of COVID-19, whether they used masks and observed all safety measures and to communicate to them any changes to appointments ( 9 ). We had varying responses to these calls; some accepted our recommendations and thanked us; others became irate for fear that the disease could progress.…”

Section: Introductionmentioning

confidence: 99%

Fears and Perception of the Impact of COVID-19 on Patients With Lung Cancer: A Mono-Institutional Survey

et al. 2020

Self Cite

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In February 2020, Italy became one of the first countries to be plagued by the SARS-CoV-2 pandemic, COVID-19. In March 2020, the Italian government decreed a lockdown for the whole country, which overturned communication systems, hospital organization, and access to patients and their relatives and carers. This issue had a particular regard for cancer patients. Our Thoracic Oncology Division therefore reorganized patient access in order to reduce the risk of contagion and, at the same time, encourage the continuation of treatment. Our staff contacted all patients to inform them of any changes in treatment planning, check that they were taking safety measures, and ascertain their feelings and whether they had any COVID-19 symptoms. To better understand patients’ fears and expectations of during the pandemic period, we created a nine-question interview, administered from April to May 2020 to 156 patients with lung cancer. Patients were classified by age, sex, comorbidity, disease stage, prior treatment, and treatment type. The survey showed that during the pandemic period some patients experienced fear of COVID-19, in particular: women (55% vs. 33%), patients with comorbidities (24% vs. 9%), and patients who had already received prior insult (radiotherapy or surgery) on the lung (30% vs. 11%). In addition, the patients who received oral treatment at home or for whom intravenous treatment was delayed, experienced a sense of relief (90% and 72% respectively). However, only 21% of the patients were more afraid of COVID-19 than of their cancer, in particular patients with long-term (> 12 months) vs. short-term cancer diagnosis (28% vs. 12.5%, respectively). Furthermore, the quarantine period or even just the lockdown period alone, worsened the quality of life of some patients (40%), especially those in oral treatment (47%). Our data demonstrate how lung cancer patients are more afraid of their disease than of a world pandemic. Also this interview indirectly highlights the clinician’s major guiding principle in correctly and appropriately managing not just the patient’s expectations of their illness and its treatment, but also and especially of the patient’s fears.

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Results of Multilevel Containment Measures to Better Protect Lung Cancer Patients From COVID-19: The IEO Model

Cited by 23 publications

References 11 publications

Impact of COVID-19 Outbreak on Cancer Patient Care and Treatment: Data from an Outpatient Oncology Clinic in Lombardy (Italy)

Impact of COVID-19 Outbreak on Cancer Patient Care and Treatment: Data from an Outpatient Oncology Clinic in Lombardy (Italy)

Two months of Radiation Oncology in the heart of Italian “red zone” during COVID-19 pandemic: paving a safe path over thin ice.

Fears and Perception of the Impact of COVID-19 on Patients With Lung Cancer: A Mono-Institutional Survey

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