key: cord-0879384-p03sl946
authors: Borsa, Stefano; Bertani, Giulio; Gay, Lorenzo; Pirola, Elena; Riva, Marco; Caroli, Manuela
title: Call of duty: neuro-oncology outpatient management during the COVID-19 pandemic in Milan, ITALY
date: 2020-07-10
journal: Neuro Oncol
DOI: 10.1093/neuonc/noaa164
sha: f4571bf31b0b4d54184cb21c3b976fc24aa54ba1
doc_id: 879384
cord_uid: p03sl946

nan

M a n u s c r i p t 2 Dear Editor, After reading the article by Bernhardt et al. 1 , we would like to share our experience from one of the European regions most affected by the SARS-CoV-2. Our hospital's neuro-oncological outpatient clinic is a tertiary center for brain tumor patients, with a regular workload of 15 patients/week.

Since the SARS-CoV-2 outbreak reached the pandemic status, our hospital was identified as a COVID-19 referral center. Complete closure of non-urgent hospital activities followed. Non-deferrable oncological pathologies were among the only exceptions following the re-arrangement 2 .

Within the framework of the emergent plan re-organizing the regional health-care system, we were able to operate 3-4 patients with brain tumors per week and to guarantee neuro-oncological visits three times per week.

From March 8 th to April 30 th , 124 follow-up patients were evaluated: 67, 27, 15, and 3 subjects had previous surgery for High-and Low-Grade Gliomas (HGGs, LGGs), meningiomas, and cerebral metastases, respectively; 12 further patients were evaluated for surgery. We also provided 20 neuro-oncological evaluations to other clinics.

Nine planned visits were rescheduled: 3 LGG patients declared to fear a possible COVID-19 infection in a nosocomial environment; 1 LGG patient could not perform the follow-up MRI; 5 patients (one with LGG, three with meningiomas and one long-survivor with HGG) underwent the prescribed MRI and were evaluated remotely via image-transfer and telephone interview due to their general good condition.

During the outpatient activity, a policy was deployed to mitigate the risk of exposure of patients and further dissemination of COVID-19. Health-care providers and patients followed the hospital A c c e p t e d M a n u s c r i p t 3 guidelines that were drafted accordingly to those the World Health Organization released 3 . Patients underwent a telephone interview 1-2 days before the scheduled appointment to rule out the presence of respiratory signs, symptoms or fever. Before entering into the building, patients crossed a check-point, where a trained operator measured the body temperature with a contactless digital thermometer. Subjects were only allowed into the building with a temperature ≤ 37.4° C. No visitors were allowed aside a caregiver for patients who required one. We wore personal protective equipment 4 they were hospitalized in a rehabilitation unit, where they acquired SARS-CoV-2 pneumonia. They were then transferred to a COVID-19 unit where they deceased three weeks later.

As a further measure to limit the patients' accesses to the outpatient clinic, we encouraged the use of e-mails, telephone, and image-transfer tools to provide continuity of care. We enhanced our multidisciplinary network, with remote consultations and video-conferences, to better share the management of the patients among surgeons, oncologists, radiotherapists and other specialists as needed. Despite the objective difficulties created by the pandemic, we provided an efficient service, while avoiding referrals of symptomatic patients to the emergency ward. Our approach improved patients' safety since hospital exposures were limited, while addressing oncological needs. No patient was infected in the outpatient clinic. Our experience contributes to the management proposed by Bernhardt, without compromising the standard of care. Such a multidisciplinary effort may enhance our response to the pandemic and contribute to the development of shared guidelines for modifying the approach to patients' follow-up, as it is already emerging in other medical fields 5 

A c c e p t e d M a n u s c r i p t

Neuro-oncology Management During the COVID-19

Pandemic With a Focus on WHO Grade III and IV Gliomas

The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy

WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care

Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (2019-nCoV) outbreak

Out Patient Department practices in othopaedics amidst COVID-19: The evolving model

Virtually Perfect? Telemedicine for Covid-19

A c c e p t e d M a n u s c r i p t 5