key: cord-0834117-f1h230kx
authors: Scagliotti, Giorgio; Novello, Silvia; Veltri, Andrea; Perboni, Alberto; Terzolo, Massimo
title: Lung cancer patients and COVID-19 epidemic: an experience from an Italian university hospital
date: 2020-06-05
journal: JTO clinical and research reports
DOI: 10.1016/j.jtocrr.2020.100067
sha: baf3bd865f1a0547a2b73adef6550c6afc53080b
doc_id: 834117
cord_uid: f1h230kx

nan

The rapid onset of the coronavirus outbreak in Italy and, later on, in Europe posed urgent 4 decisions to be taken by medical oncologists. It is well known that patients suffering from 5 oncological or onco-hematological neoplastic diseases, as well as other pathologies associated 6 with immunosuppression (e.g., congenital immunodeficiencies, transplants of solid organ or 7 hematopoietic stem cells, autoimmune pathologies in immunosuppressive treatment), are 8 particularly at risk, both as regards the morbidity that lethality related to respiratory virus 9

infections, such as influenza [1] and SARS-CoV-2 [2]. 10

We share here the experience of an oncology department in the context of a University Hospital 11 based in Orbassano (Torino), Italy during COVID-19 epidemic. All the disease-specific measures 12 and interventions outlined in this commentary were based on institutional discussion and decision 13 and, although same of them can be generalized, others may not necessarily apply to hospitals with 14 different patient pattern, hospital settings and severity of community infections. The strategies 15 describe in this commentary is thus helpful for similar hospitals facing similar COV19 threat. 16

After few days from the outbreak of the disease we quickly implemented a series of preventive 17 measures to limit the spread of the virus and the contamination of the wards, consultation rooms 18 and outpatient facilities. Despite an initial gap in providing personal protective equipment (PPE) to 19 all healthcare professionals the hospital administrators promptly reacted, provided and 20 recommended to wear appropriate PPE (e.g. surgical masks). An exclusive one-way passage at the 21 entrance of the hospital with a visible sign was adopted through which all patients and relatives 22 entering the hospital were checked for body temperature and presence of respiratory symptoms. We were recommended to identify and apply as quickly as possible the methods necessary to 37 guarantee the oncological treatments necessary for patients residing in the "red zones" (areas at 38 higher incidence of COVID-19 disease) in order to ensure the principle of dose intensity, in a way 39 was not negatively influencing the prognosis of the pathology being treated. We tried to continue 40 those treatments considered undeferrable while others, such for instance adjuvant treatments, 41

were postponed. In relation to immunotherapy we decided to continue treatment for those 42 patients in the induction or short-term maintenance phase while we decided to discuss with each 43 individual patient if to interrupt therapy for those in long maintenance phase (more than 1 year) 44 or those with initial worsening of the radiological picture. 45

It was recommended to postpone, where possible follow-up checks, in order to limit the 46 attendance to the healthcare facilities as much as possible (both to limit the risk of exposure to 47 SARS-CoV-2 and to limit the workload of hospital structures already partially overloaded). We 48 consequently implemented a system of remote consultations for all patients in follow up and the 49 same approach was adopted for patients on oral therapies. For drug resupply every time possible 50

we delivered drugs at home through express couriers. 51

For what is related to clinical trials we put on hold any study monitor visits and the activity of the 52 data center has been limited to the essential activities favoring, when possible, any type of remote 53 working. 54 the risk of contamination and to optimize the patients' allocation in the different areas of the 66

The lesson we learned from our experience about COVID19 disease and oncology patients clearly 68

indicate that firstly, in the context of emergency conditions it is quite difficult, for mild to severe 69 cases, to make a differential diagnosis between symptoms related to lung cancer and COVID-19 70 related symptoms but also the risk of hospital admission of lung cancer patients in an 71 asymptomatic phase should be carefully considered. Secondly, all lung cancer patients in the 72 context of the COVID-19 epidemic are extremely frail and additional measures should be 73 implemented to protected all the patients and healthcare professionals involved in the diagnosis 74 and treatment of the oncology disease. 75

Epidemiology, Diagnosis, Treatment, and Prevention of Influenza 78 Infection in Oncology Patients

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