key: cord-0969160-b1lekw47
authors: Bongiovanni, Alberto; Mercatali, Laura; Fausti, Valentina; Ibrahim, Toni
title: Comment on ‘Reorganisation of medical oncology departments during the novel coronavirus disease-19 pandemic: a nationwide Italian survey” by Alice Indini et al.
date: 2020-05-16
journal: Eur J Cancer
DOI: 10.1016/j.ejca.2020.04.047
sha: 1a95da4a52f4ba81006bc04f6b93c928bfbc9b57
doc_id: 969160
cord_uid: b1lekw47

nan

Comment on 'Reorganisation of medical oncology departments during the novel coronavirus disease-19 pandemic: a nationwide Italian survey" by Alice Indini et al. One of the most interesting aspect not well focused by the survey is the management of patients with bone metastases (BMs). This aspect may not immediately appear to be a priority in an organizational model, but BM patients are known to be very fragile and at risk of skeletal complications defined as skeletal-related events (SREs) (4) .

During this pandemic we must first and foremost be more vigilant than ever to the symptoms reported by patients with bone metastases. This is particularly the case for spinal cord compression (SCC), which requires rapid diagnosis and treatment in order to minimise neurologic complications.

In this scenario a multidisciplinary approach is useful because it permits a more accurate identification of SRE risk , avoiding unnecessary medical visits, orienting patients towards the right procedure/treatment, reducing contact with healthcare operators and consequently lowering the risk of COVID-19 contamination even if the multidisciplinary meeting seems to be contraindicated. (5) .

The first dilemma is how we can reduce the outpatients visits number, try to have multidisciplinary meetings between physician whilst also guaranteeing the same therapeutic and diagnostic quality and continuity of care. Furthermore another issue is the time-saving and to not increasing the work of health operators committed to face the COVID-19 and at the same time to manage adequately patient needs.

In the last years the use of technologies to support and promote long-distance clinical care, education, and health administration is exploded and can helping this particular situation. (6) In the present emergency we have developed different strategies for cancer patients, in particular those with BMs: This approach seem to be not feasible or realistic and due to these reasons we briefly report our experience from 9th of March to 17 th of April. More than 3348 patients were screened with our software. Of those with a diagnosis of BM from different primitive tumors (Fig.1) , 37 from several geographic areas underwent multidisciplinary teleconsultations to evaluate the risk of SREs ( Table 1) In conclusion patients with BM are susceptible to frequent complications and a multidisciplinary approach is has proven highly effective in dealing with them.

However, in the present COVID-19 emergency greater emphasis is needed on risk assessment, prevention strategies and effective therapies in order to optimise oncologic resources and to guarantee the patients' continuum of care. We believe our experience could provide a feasible model of care to manage BM patient and at the same time prevent and reduce COVID-19 infection.

The authors declare that they don't have any potential conflict of interest 

Grossi F Reorganisation of medical oncology departments during the novel coronavirus disease-19 pandemic: a nationwide Italian survey

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Multidisciplinary approach to the treatment of bone metastases: Osteo-Oncology Center

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Efficacy and safety of 12-weekly versus 4-weekly zoledronic acid for prolonged treatment of patients with bone metastases from breast cancer (ZOOM): a phase 3, open-label, randomised, noninferiority trial

Efficacy and safety of de-escalation bonemodifying agents for cancer patients with bone metastases: a systematic review and meta-analysis