key: cord-0956607-xox41wr3
authors: Indini, Alice; Pinotti, Graziella; Artioli, Fabrizio; Aschele, Carlo; Bernardi, Daniele; Butera, Alfredo; Defraia, Efisio; Fasola, Gianpiero; Gamucci, Teresa; Giordano, Monica; Iaria, Antonino; Leo, Silvana; Ribecco, Angela Stefania; Rossetti, Riccardo; Savastano, Clementina; Schena, Marina; Silva, Rosa Rita; Grossi, Francesco; Blasi, Livio
title: Management of Cancer Patients during the COVID-19 Pandemic: the Italian perspective on the Second Wave
date: 2021-02-25
journal: Eur J Cancer
DOI: 10.1016/j.ejca.2021.01.040
sha: 31930d13e4952c11eede40eb2713eee983db878e
doc_id: 956607
cord_uid: xox41wr3

The novel Coronavirus Disease 2019 (COVID-19) pandemic has been an overwhelming challenge for worldwide health systems. Since the beginning of year 2020, COVID-19 has represented a potential harm for cancer patients and has often hindered oncology care. The Collegio Italiano dei Primari Oncologi Medici (CIPOMO) is an Italian association of head physicians in oncology departments, which promotes working and research activities in oncology on a national basis. During the second wave of COVID-19 pandemic, the CIPOMO promoted a national survey aiming to evaluate the impact of COVID-19 on oncologists’ clinical activity and what changes have been made compared with the Italian situation during the first wave of the pandemic. Overall, 138 heads of medical oncology departments participated in this survey: 75 (54%) from the North, 24 (17%) from the Center, and 39 (28%) from the South of Italy and islands. This survey provides an overview of Italian oncologists facing the second wave of COVID-19 pandemic. The lesson learned during the first wave of COVID-19 pandemic has led to a better organization of clinical activities, and regular testing among healthcare practitioners, with better chances to grant patients’ protection. However, the lack of standardized informatic platforms results in serious challenges in replacing frontal visits, often making a concrete reduction of patients’ hospital accesses unfeasible. Oncologists need to keep preserving the continuum of care of patients. Standardization of safety measures, together with the implementation of informatic platforms, can significantly improve oncology pathways during this second wave of COVID-19 pandemic.

The novel Coronavirus Disease 2019 (COVID- 19) pandemic has been an overwhelming 38 challenge for worldwide health systems. Since the beginning of year 2020, COVID-19 has 39 represented a potential harm for cancer patients and has often hindered oncology care. The to a better organization of clinical activities, and regular testing among healthcare practitioners, 50 with better chances to grant patients' protection. However, the lack of standardized informatic 51 platforms results in serious challenges in replacing frontal visits, often making a concrete 52 reduction of patients' hospital accesses unfeasible. 53

Oncologists need to keep preserving the continuum of care of patients. Standardization of safety 54 measures, together with the implementation of informatic platforms, can significantly improve 55 oncology pathways during this second wave of COVID-19 pandemic. 56 thereby making this work possible to be shared in the oncologists' community. 61 62 Fundings: no funding was obtained for the present investigation. 63 an overwhelming challenge for worldwide health systems 1 . As with other serious infectious 65 diseases, available data suggest that cancer patients might be more at risk for an increased 66 mortality in case of COVID-19 2,3 . Namely selected populations of cancer patients, as elderly 67 subjects and those affected by hematological malignancies or lung cancer seem to be at increased 68 risk of poor outcomes 4 . During the first wave of COVID-19 pandemic, several efforts have been 69 made to reduce the risk of infection among cancer patients accessing oncology facilities, with the 70 aid of structured recommendations and guidelines 5, 6 . The use of telemedicine has frequently 71 allowed effective remote monitoring of patients, even in case of confirmed COVID-19 72 diagnosis 7 . Nevertheless, oncology activities have been severely endangered by this infectious 73 threat, also due to the significant reduction of health-care activities related to the contamination 74 of physicians and caregivers 8 . 75

Since March 2020, Italy has been heavily hit by COVID-19 9, 10 . The subsequent overburden of 76 the national health system required oncologists to implement measures to safely carry on the 77 everyday clinical activity 11, 12, 13 shown in Figure 1 . 90

The survey focused on six key points. The first question regarded the organization of oncology 91 staff during the pandemic, and specifically whether oncologists had been assigned COVID-19 92 ward duties. Answers to this question suggest that medical oncologists have been largely spared 93 from this activity (63%); still, a significant proportion of them were committed to COVID-19 94 ward duties (37%), with a superimposable distribution on the national territory (36% in the 95 North, 37.5% in the Centre, and 38% in the South of Italy and islands). Compared with the 96 results of the previous survey, there has been a substantial increase in the employment of 97 oncology resources in COVID-19 dedicated wards, which are now equal to those observed in the 98 high-risk areas (so-called "Red Zone") during the first wave 14 . 99

The following two questions focused on testing methods for patients and healthcare practitioners 100 within oncology facilities. At the present time, regional council decisions have stated that 101 healthcare practitioners should undergo COVID-19 rhynopharingeal swabs on a regular basis 102 (ideally every 14 days) only in 7 out of 20 Italian regions (4 in the North, 2 in the Centre, and 1 103 in the South of Italy). However, according to the results of our survey, following hospital 104 recommendations the majority of oncology departments perform regular (i.e. every 14 days) 105 COVID-19 surveillance among healthcare practitioners (85%). However, there is a significant 106 difference among Italian regions, with the totality of oncology departments in the South, 87% in 107 the North, and 54% in the Centre of Italy performing regular COVID-19 swabs. Regarding 108 COVID-19 testing measures among patients, more than half of oncology departments regularly administration. Similarly, there is a high discrepancy over the National territory, with 53% and 111 54% of patients undergoing regular swabs in the North and Centre, respectively, compared with 112 85% of patients in the South of Italy and islands. Since these two items were not specifically 113 addressed in the previous survey, it is not possible to compare the actual situation with the first 114 wave of COVID-19 pandemic. However, these data suggest that even in this second wave, 115 COVID-19 surveillance practices are inhomogeneously distributed through the Italian territory, 116 presumably due to the lack of standardized procedures but also to limited resources. tracing, quarantine, and isolation); redesigning triage and treatment systems; and mobilization of 154 resources for case management 16 . However, dealing with this emergency has often collided with 155 impact of the pandemic on the economic systems 5 . 157 Results of this survey suggest there are several issues that need to be further implemented, with 158 the aid of standardized procedures. First, there is need to preserve cancer patients and cancer-159 related activities. This includes preservation of medical staff, whose commitment to COVID-19 160 wards should be minimized, and of cancer patients by ensuring triage procedures and regular 161 COVID-19 testing for both healthcare practitioners and patients 17 . The psychological impact of 162 COVID-19 on cancer patients should not be underestimated, and psycho-oncological support for 163 patients and caregivers should be considered, as forthcoming COVID-19 outbreaks are expected 164 in the next future 18 . Cancer research should also be preserved, as the COVID-19 has prolonged 165 over months with potentially negative impact on the conduction of clinical trials 19 . 166

Second, adequate allocation of working resources should be implemented, in order to reinforce 167 territory health services thus reducing the working burden of medical oncologists and allowing to 168 carry on hospital activities. Lastly, data are needed regarding risk categorization of cancer 169 patients as well as prioritization of treatment procedures, in order to better define oncology 170 pathway over the second wave of COVID-19 pandemic. Available data suggest that, with due 171 precautions and dedicated devices, oncology care can be safely preserved during COVID-19 172 emergency situation 20 . Over the last months, a novel clinical care has been established with the 173 aid of continuous research and international cooperation, and will be implemented to 174 successfully face COVID-19.

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We thank all the CIPOMO members for participating in the present survey,

• COVID-19 has revolutionized healthcare worldwide 2

The second wave of COVID-19 pandemic is a challenge for cancer care 3

Oncologists need to safeguard clinical activity and patients' continuum of care 4• Standardized procedures and guidelines should be implemented 5•Data are needed on risk categorization and prioritization of treatment procedures 6 J o u r n a l P r e -p r o o f

☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:J o u r n a l P r e -p r o o f