key: cord-0827280-gxqf1j4q
authors: Omarini, Claudia; Maur, Michela; Luppi, Gabriele; Narni, Franco; Luppi, Mario; Dominici, Massimo; Longo, Giuseppe; Piacentini, Federico
title: Cancer treatment during COVID-19 pandemic: do not postpone, do it!
date: 2020-05-12
journal: Eur J Cancer
DOI: 10.1016/j.ejca.2020.04.034
sha: 6feb7ed232f6f6334111f4aa2f5bcd0fa5f4ea07
doc_id: 827280
cord_uid: gxqf1j4q

At the end of January 2020, a novel beta-coronavirus, known as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), progressively spread in Italy. Patients with cancer are considered more prone to infections because of the immunosuppressive status due to both malignancy and anticancer treatments. From the first Italian government restrictions (23(rd) February), Modena Cancer Center adopted practical health vigilance recommendations in order to minimize the virus exposure risk without overlooking cancer management. From 23(rd) February to 31(st) March 2020, 1257 patients on active anticancer treatment for oncological or hematological malignancies, attended our Institution. All the staff activities were rescheduled following our practical COVID-19 guideline. During this period, we have tallied 9 cases of COVID-19 infection (0,71%) in cancer patients as well as 3 cases (1,66%) in health workers. The mortality rate of our cancer patients was 22%, consistent with the data reported in literature. In conclusion, following our practical health vigilance recommendations, physicians should be confident in maintaining life-saving anticancer treatment without exceedingly increasing the risk of nosocomial COVID-19 infection. The high rate of mortality suggested that all patients on active anticancer treatment with flu-like symptoms have to be carefully screen for COVID-19 infection.

At the end of January 2020, a novel beta-coronavirus, known as severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), progressively spread in Italy. Patients Patients with cancer are considered more prone to infections because of the immunosuppressive status due to both malignancy and anticancer treatments [2] . A national analysis performed in China showed that cancer patients have a five times higher risk of COVID-19

infection as well as a higher risk of severe events and intensive care assistance needed compared to patients without cancer [3] . For these reasons, authors proposed three major strategies: postpone adjuvant therapies and elective surgery, use stronger personal protection provisions for cancer patients/survivors and consider intensive surveillance in infected patients [3] . In addition, a retrospective cohort study published by Zhang and colleagues identified that anticancer therapies within 14 days from infection was an independent predictor of death or other severe events with a hazard ratio greater than 4 [4] . Actually, the issue on how to manage cancer care during the COVID-19 pandemic is crucial.

From the first Italian government restrictions (23 rd February 2020), Modena Cancer Center adopted practical health vigilance recommendations in order to minimize the virus exposure risk without overlooking cancer management. Of note, we halted everything for few days to analyze the situation and develop the following plan. In spite of the small number of infected patients, the rate of mortality was higher than that of no-cancer population of the same age (22% in our study population vs 8.0% in no-cancer patients aged 70-79 and 14.8% aged ≥80 years) [6] . The mortality rate of our patients is consistent with the data reported in literature (22% vs 28%) as well as the incidence of severe events [7] . All but one of our patients developed serious complications that required hospitalization. For that reason, we are concordant to carefully screen for COVID-19 infection all patients on active anticancer treatment with flu-like symptoms.

Therefore, we propose to apply our practical health vigilance recommendations in all Cancer

Centers. Following these advices, physicians should be confident in maintaining life-saving anticancer treatment without exceedingly increasing the risk of nosocomial COVID-19 infection.

Moreover, by considering the high rate of mortality and/or severe complications, an intensive attention should be paid to patients with cancer and COVID-19 symptoms/infections.

None 

Cancer care during the spread of coronavirus disease 2019 (COVID-19) in Italy: young oncologists' perspective. ESMO Open

Nosocomial infections in patients with cancer

Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China

Clinical characteristics of COVID-19-infected cancer patients: A retrospective case study in three hospitals within Wuhan

Respiratory virus shedding in exhaled breath and efficacy of face masks

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention

COVID-19 Infection in Cancer Patients: Early Observations and Unanswered Questions