Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

Pietrantonio, Filippo; Morano, Federica; Niger, Monica; Corallo, Salvatore; Antista, Maria; Raimondi, Alessandra; Prisciandaro, Michele; Pagani, Filippo; Prinzi, Natalie; Nichetti, Federico; Randon, Giovanni; Torchio, Martina; Corti, Francesca; Ambrosini, Margherita; Palermo, Federica; Palazzo, Michele; Biamonte, Lavinia; Platania, Marco; Sposito, Carlo; Cosimelli, Maurizio; Mazzaferro, Vincenzo; Pusceddu, Sara; Cremolini, Chiara; Braud, Filippo de; Bartolomeo, Maria Di

doi:10.1016/j.clcc.2020.05.004

Cited by 15 publications

(15 citation statements)

References 78 publications

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“…However, some potentially alarming signals of under-treatment were observed and clinical research and scientific activities resulted in being reduced by 80.3% and 80.1%, respectively. Specific guidelines for the treatment of patients with gastrointestinal cancers [ 22 ] and older patients with cancer [ 23 ] were also published. In fact, older cancer patients may be denied supportive care because of their shorter life expectancy.…”

Section: Discussionmentioning

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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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%

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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“…A tiered approach has been advocated to prioritise various interventions for optimum benefit: i) tier 1 (high priority) includes life threatening conditions or where there is significant improvement in the survival; ii) tier 2 (medium priority) encompasses condition where a 6–8 weeks delay would not hamper the overall outcome; iii) tier 3 (low priority) entails stable patient conditions wherein services can be delayed for the pandemic to be over or situation where there will be no survival gain. European Society for Medical Oncology (ESMO) [ 89 ] and other societies including National Cancer Institute of Milan [ 90 ] have come up with recommendations for management during this pandemic. A synopsis of the recommendations has been outlined in panel 1 .…”

Section: Pancreatic Cancer and Covid-19mentioning

confidence: 99%

Coronavirus disease 2019 and the pancreas

et al. 2020

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Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to a world-wide pandemic since its onset in December of 2019. Although, a primary respiratory pathogen, over the ensuing period, its extra-pulmonary effects have come to the forefront. The virus, having multi-organ tropism, has been shown to affect a host of other organs beyond the lung, including the pancreas. The data on pancreatic involvement by COVID-19, however, have been limited. Moreover, whether the effects on the pancreas are due to the direct effects of the virus or is just an epi-phenomenon is debatable. The prevalence of pancreatic injury and degree of injury are the other issues that need to be addressed. Pancreatic cancer has a dismal prognosis and the management of the same in the COVID era needs to be tailored assessing the risk-benefit ratio for the same. Additionally, pancreatic surgery increases not only the morbidity of the patient, but also the risk of the operator and burden on the health care system. Hence, the decision for such major procedures needs to be rationalized for optimum benefit during this pandemic. Similarly, for the endoscopist, pancreatic endoscopy needs to be carefully regulated to reduce risk to both the patient and the physician and yet deliver optimum patient care. This review gives a concise summary of various aspects of pancreatic involvement and pancreatic disease management during this pandemic.

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“…In the European epicenter of the COVID-19 pandemic (Lombardy in Italy), the adapted institutional recommendations have been proposed for the systemic treatment of patients with GC 44 . For perioperative chemotherapy of patients with locally advanced GC, the choice of multimodality treatment over surgery alone has been made after careful evaluation of each individual risk-benefit profile.…”

Section: Strategy For the Treatment Of Gc During The Covid-19 Pandemicmentioning

confidence: 99%

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

Polkowski¹,

Sędłak²,

Rawicz‐Pruszyński³

2020

CMAR

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The outbreak of the COVID-19 is currently the biggest international concern. Treatment of gastric cancer (GC) patients in the pandemic era with high hospital burden and under severe oncological/surgical resource constraints should implicate a need for resource reallocation with a new "pandemic" GC treatment algorithm. The neoadjuvant/perioperative (radio-)chemotherapy is applied in the majority of advanced GC cases with poor postoperative therapy compliance. In the East, radical surgery is frequently used in the first instance, with adjuvant chemotherapy reserved for patients with a high risk of recurrence. Moreover, the elderly population might be effectively treated by surgery alone, thus saving oncological resources for younger people who need a more aggressive approach. In this framework, prioritization is a key concept based on the severity of symptoms and the need for urgent (surgical) intervention. High-risk and marginally effective surgery should be replaced with definitive radio-and/or chemotherapy. The pandemic framework to provide optimal care for GC patients must be based on multidisciplinary decision-making and include all anti-cancer treatment options: surgery, systemic therapy, and radiotherapy. The priority and staffing dictate adherence to the new algorithm. We believe that these priorities may improve the delivery of care to all, including elderly GC patients.

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Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

Cited by 15 publications

References 78 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)

Coronavirus disease 2019 and the pancreas

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

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