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Frisardi V, Brunetti O, Abbinante V, Ardigò M, Caolo G, Di Turi A, Torsello A, Napoli C, Mancini R, Belleudi V, Addis A, Di Bella O, Ciliberto G, Neri A, Corsini R, Ruggieri P, Pollorsi C, Silvestris N. Impact of COVID-19 pandemic on outpatient visit volume in cancer patients: Results of COMETA multicenter retrospective observational study. Front Public Health 2023; 11:1077103. [PMID: 36866103 PMCID: PMC9971950 DOI: 10.3389/fpubh.2023.1077103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To evaluate the impact of the COVID-19 pandemic on first and follow-up visits for cancer outpatients. Methods This is a multicenter retrospective observational study involving three Comprehensive Cancer Care Centers (CCCCs): IFO, including IRE and ISG in Rome, AUSL-IRCCS of Reggio Emilia, and IRCCS Giovanni Paolo II in Bari) and one oncology department in a Community Hospital (Saint'Andrea Hospital, Rome). From 1 January 2020 and 31 December 2021, we evaluated the volume of outpatient consultations (first visits and follow-up), comparing them with the pre-pandemic year (2019). Results were analyzed by quarter according to the Rt (real-time indicator used to assess the evolution of the pandemic). IFO and IRCCS Giovanni Paolo II were "COVID-free" while AUSL-IRCCS RE was a "COVID-mixed" Institute. Depending on the Rt, Sain't Andrea Hospital experienced a "swinging" organizational pathway (COVID-free/ COVID-mixed). Results Regarding the "first appointments", in 2020 the healthcare facilities operating in the North and Center of Italy showed a downward trend. In 2021, only AUSL-IRCCS RE showed an upward trend. Regarding the "follow-up", only AUSL IRCCS RE showed a slight up-trend in 2020. In 2021, IFO showed an increasing trend, while S. Andrea Hospital showed a negative plateau. Surprisingly, IRCCS Giovanni Paolo II in Bari showed an uptrend for both first appointment and follow-ups during pandemic and late pandemic except for the fourth quarter of 2021. Conclusions During the first pandemic wave, no significant difference was observed amongst COVID-free and COVID-mixed Institutes and between CCCCs and a Community Hospital. In 2021 ("late pandemic year"), it has been more convenient to organize COVID-mixed pathway in the CCCCs rather than to keep the Institutions COVID-free. A swinging modality in the Community Hospital did not offer positive results in term of visit volumes. Our study about the impact of COVID-19 pandemic on visit volume in cancer outpatients may help health systems to optimize the post-pandemic use of resources and improve healthcare policies.
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Affiliation(s)
- Vincenza Frisardi
- Department of Neuromotor Diseases, Geriatric Unit, AUSL IRCCS of Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Vincenza Frisardi ✉
| | - Oronzo Brunetti
- Istituto Tumori “Giovanni Paolo II” of Bari, IRCCS, Bari, Italy
| | | | - Marco Ardigò
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | | | | | - Christian Napoli
- Sapienza University of Rome, Saint'Andrea Hospital, Rome, Lazio, Italy
| | - Rita Mancini
- Sapienza University of Rome, Saint'Andrea Hospital, Rome, Lazio, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | | - Antonino Neri
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Romina Corsini
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ruggieri
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Pollorsi
- Department of Neuromotor Diseases, Geriatric Unit, AUSL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy
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Sauro KM, Smith C, Kersen J, Schalm E, Jaworska N, Roach P, Beesoon S, Brindle ME. The impact of delaying surgery during the COVID-19 pandemic in Alberta: a qualitative study. CMAJ Open 2023; 11:E90-E100. [PMID: 36720492 PMCID: PMC9894654 DOI: 10.9778/cmajo.20210330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic. METHODS Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis. RESULTS We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery. INTERPRETATION Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.
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Affiliation(s)
- Khara M Sauro
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta.
| | - Christine Smith
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Jaling Kersen
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Emma Schalm
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Natalia Jaworska
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Pamela Roach
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Sanjay Beesoon
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
| | - Mary E Brindle
- Department of Community of Health Sciences and O'Brien Institute for Public Health (Sauro, Smith, Kersen, Schalm, Jaworska, Roach, Brindle), Cumming School of Medicine; Department of Surgery (Sauro, Brindle), Cumming School of Medicine; Department of Oncology and Arnie Charbonneau Cancer Institute (Sauro), Cumming School of Medicine; Department of Critical Care Medicine (Schalm, Jaworska), Cumming School of Medicine; Department of Family Medicine (Roach, Brindle), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surgery Strategic Clinical Network (Beesoon), Alberta Health Services, Edmonton, Alta
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Sartini M, Del Puente F, Oliva M, Carbone A, Blasi Vacca E, Parisini A, Boni S, Bobbio N, Feasi M, Battistella A, Pontali E, Cristina ML. Riding the COVID Waves: Clinical Trends, Outcomes, and Remaining Pitfalls of the SARS-CoV-2 Pandemic: An Analysis of Two High-Incidence Periods at a Hospital in Northern Italy. J Clin Med 2021; 10:jcm10225239. [PMID: 34830521 PMCID: PMC8624682 DOI: 10.3390/jcm10225239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023] Open
Abstract
Background. Italy was the first western country to face an uncontrolled outbreak of SARS-CoV-2 infection. The epidemic began in March 2020 within a context characterised by a general lack of knowledge about the disease. The first scientific evidence emerged months later, leading to treatment changes. The aim of our study was to evaluate the effects of these changes. Methods. Data from a hospital in Genoa, Italy, were analysed. Patients deceased from SARS-CoV-2 infection were selected. Data were compared by dividing patients into two cohorts: “phase A” (March–May 2020) and “phase B” (October–December 2020). Results. A total of 5142 patients were admitted. There were 274 SARS-CoV-2-related deaths (162 phase A and 112 phase B). No differences were observed in terms of demographics, presentation, or comorbidities. A significant increase was recorded in corticosteroid use. Mortality was 33.36% during phase A, falling to 21.71% during phase B. When subdividing the trend during the two phases by age, we found a difference in people aged 65–74 years. Conclusions. There is scarce evidence regarding treatment for SARS-CoV-2 (especially for severe infection). However, treatment changes improved the prognosis for people under the age of 75. The prognosis for older people remains poor, despite the improvements achieved.
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Affiliation(s)
- Marina Sartini
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy;
- Operating Unit (S.S.D. U.O.) Hospital Hygiene, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.O.); (A.C.)
- Correspondence: (M.S.); (F.D.P.)
| | - Filippo Del Puente
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (E.B.V.); (A.P.); (S.B.); (N.B.); (M.F.); (E.P.)
- Correspondence: (M.S.); (F.D.P.)
| | - Martino Oliva
- Operating Unit (S.S.D. U.O.) Hospital Hygiene, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.O.); (A.C.)
| | - Alessio Carbone
- Operating Unit (S.S.D. U.O.) Hospital Hygiene, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.O.); (A.C.)
| | - Elisabetta Blasi Vacca
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (E.B.V.); (A.P.); (S.B.); (N.B.); (M.F.); (E.P.)
| | - Andrea Parisini
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (E.B.V.); (A.P.); (S.B.); (N.B.); (M.F.); (E.P.)
| | - Silvia Boni
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (E.B.V.); (A.P.); (S.B.); (N.B.); (M.F.); (E.P.)
| | - Nicoletta Bobbio
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (E.B.V.); (A.P.); (S.B.); (N.B.); (M.F.); (E.P.)
| | - Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (E.B.V.); (A.P.); (S.B.); (N.B.); (M.F.); (E.P.)
| | - Alessandra Battistella
- Medical Service Management, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy;
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (E.B.V.); (A.P.); (S.B.); (N.B.); (M.F.); (E.P.)
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy;
- Operating Unit (S.S.D. U.O.) Hospital Hygiene, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (M.O.); (A.C.)
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COVID-19 Pandemic: Huge Stress Test for Health System Could Be a Great Opportunity to Update the Workflow in a Modern Surgical Pathology. Cancers (Basel) 2021; 13:cancers13133283. [PMID: 34209009 PMCID: PMC8268969 DOI: 10.3390/cancers13133283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary The COVID-19 pandemic has hit Northern Italy’s regions hard in terms of deaths since February 2020. Containment measures have been applied to avoid contagion and reduce the patient infection rate. In this manuscript, we report the experience of the Pathology Department of the Fondazione IRCCS Istituto Nazionale Tumori in Milan, during the period of the first lockdown that occurred in Lombardy from March to May 2020, focusing on the variation in terms of exams between the pre-COVID-19 and COVID-19 periods and describing the measures applied to guarantee the safeguarding of workers. Moreover, we calculated if changes introduced within the workflow affected the average diagnosis time using Turn-Around-Time (TAT) metrics released by the Lombardy Region. We showed a sharp slowdown in exams during the first wave of COVID-19 and that the measures applied for the safeguarding of the personnel turned out to be feasible and did not affect the overall performance of the Pathology Department. Abstract Background: On December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. This disease, characterized by the rapid human-to-human transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly in more than 200 countries. Northern Italy’s regions have been hit hard in terms of deaths. Here, we report the experience of the Pathology Department of the Fondazione IRCCS Istituto Nazionale Tumori (INT) in Milan, the first Italian public cancer center, in the period of the lockdown that took place in Lombardy from March to May 2020. Method: The variation in terms of exams was calculated in two different timeframes: December 2019–February 2020 (pre-COVID-19) and March–May 2020 (COVID-19). During these periods, Turn-Around-Time (TAT) metrics released by the Lombardy Region were calculated to assess if changes applied to guarantee the safeguarding of workers affected the average diagnosis time. Results: In the COVID-19 period, there was a decrease for all the performed exams. The most considerable decrease was observed for PAP tests (−81.6%), followed by biopsies (−48.8%), second opinions (−41.7%), and surgical (−31.5%), molecular (−29.4%) and cytological (−18.1%) tests. Measures applied within the Pathology Department, such as digital pathology, remote working, rotations and changes in operating procedures, improved the diagnostic performance as required by the guidelines of the Lombardy Region in terms of TAT. At the same time, the measures applied for the safeguarding of the personnel turned out to be feasible and did not affect the overall performance of the Pathology Department. Conclusions: The sharp slowdown in cancer screening during the first wave of COVID-19 could seriously endanger cancer prevention in the near future.
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Ciriaco P, Carretta A, Bandiera A, Muriana P, Negri G. Perspective: Did Covid-19 Change Non-small Cell Lung Cancer Surgery Approach? Front Surg 2021; 8:662592. [PMID: 34055870 PMCID: PMC8149903 DOI: 10.3389/fsurg.2021.662592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
The novel coronavirus (Covid-19), as of January 2021, infected more than 85 million people worldwide, causing the death of about 1,840 million. Italy had more than 2 million infected and about 75,000 deaths. Many hospitals reduced their ordinary activity by up to 80%, to leave healthcare staff, wards, and intensive care unit (ICU) beds available for the significant number of Covid-19 patients. All this resulted in a prolonged wait for hospitalization of all other patients, including those with non-small cell lung cancer (NSCLC) eligible for surgery. The majority of thoracic surgery departments changed the clinical-therapeutic path of patients, re-adapting procedures based on the needs dictated by the pandemic while not delaying the necessary treatment. The establishment of Covid-19-free hub centers allowed some elective surgery in NSCLC patients but most of the operations were delayed. The technology has partly facilitated patients' visits through telemedicine when security protocols have prevented face-to-face assessments. Multidisciplinary consultations had to deal also with the priority of the NSCLC cases discussed. Interpretation of radiologic exams had to take into account the differential diagnosis with Covid-19 infection. All the knowledge and experience of the past months reveal that the Covid-19 pandemic has not substantially changed the indications and type of surgical treatment in NSCLC. However, the diagnostic process has become more complex, requiring rigorous planning, thus changing the approach with the patients.
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Affiliation(s)
- Paola Ciriaco
- Department of Thoracic Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, Vita-Salute San Raffaele University, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Bandiera
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Piergiorgio Muriana
- Department of Thoracic Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Giampiero Negri
- Department of Thoracic Surgery, Vita-Salute San Raffaele University, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Milanese G, Sabia F, Sestini S, Ledda RE, Rolli L, Suatoni P, Sverzellati N, Sozzi G, Apolone G, Marchianò AV, Pastorino U. Feasibility and Safety of Lung Cancer Screening and Prevention Program During the COVID-19 Pandemic. Chest 2021; 160:e5-e7. [PMID: 33745992 PMCID: PMC7970789 DOI: 10.1016/j.chest.2021.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gianluca Milanese
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federica Sabia
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Roberta Eufrasia Ledda
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luigi Rolli
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Suatoni
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Sverzellati
- Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | | | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
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Pacheco RL, Martimbianco ALC, Roitberg F, Ilbawi A, Riera R. Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review. JCO Glob Oncol 2021; 7:342-352. [PMID: 33656910 PMCID: PMC8081509 DOI: 10.1200/go.20.00632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.
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Affiliation(s)
- Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Felipe Roitberg
- Instituto do Câncer do Estado de São Paulo/HCFMUSP, World Health Organization (WHO), São Paulo, Brazil.,Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland.,European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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8
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SARS-CoV-2 Serology Monitoring of a Cancer Center Staff in the Pandemic Most Infected Italian Region. Cancers (Basel) 2021; 13:cancers13051035. [PMID: 33801186 PMCID: PMC7957867 DOI: 10.3390/cancers13051035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary Since the beginning of the COVID-19 outbreak, Cancer Centers adopted specific procedures to protect patients as well as to monitor the possible spread of SARS-CoV-2 among healthcare personnel. In April 2020, we implemented a prospective longitudinal study aimed at monitoring the serological response to SARS-Cov-2 in the healthcare personnel of a Comprehensive Cancer Center identified by the Lombardy region (the Italian region most affected by the COVID-19 pandemic) as one of the three oncologic hubs where the Regional Health Authorities referred all the cancer patients in the region. We identified a fraction of healthcare personnel with long-term anti-SARS-CoV-2 antibody response, though negative for viral RNA, who could safely approach fragile cancer patients. Abstract Since the beginning of the COVID-19 outbreak, Cancer Centers adopted specific procedures both to protect patients and to monitor the possible spread of SARS-CoV-2 among healthcare personnel (HCP). In April 2020 at Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, one of the three oncologic hubs in Lombardy where the Health Regional Authorities referred all the cancer patients of the region, we implemented a prospective longitudinal study aimed at monitoring the serological response to SARS-Cov-2 in HCP. One hundred and ten HCP answered a questionnaire and were screened by nasopharyngeal swabs as well as for IgM/IgG levels; seropositive HCPs were further screened every 40–45 days using SARS-CoV-2-specific serology. We identified a fraction of HCP with long-term anti-SARS-CoV-2 antibody responses, though negative for viral RNA, and thus probably able to safely approach fragile cancer patients. Monitoring asymptomatic HCP might provide useful information to organize the healthcare service in a Cancer Center, while waiting for the effectiveness of the active immunization by SARS-CoV-2 vaccines, which will provide protection from infection.
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Barcellini W, Giannotta JA, Fattizzo B. Are Patients With Autoimmune Cytopenias at Higher Risk of COVID-19 Pneumonia? The Experience of a Reference Center in Northern Italy and Review of the Literature. Front Immunol 2021; 11:609198. [PMID: 33574816 PMCID: PMC7870679 DOI: 10.3389/fimmu.2020.609198] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
During COVID-19 pandemic the care of onco-hematologic and autoimmune patients has raised the question whether they are at higher risk of infection and/or worse outcome. Here, we describe the clinical course of COVID-19 pneumonia in patients with autoimmune cytopenias (AIC) regularly followed at a reference center in Northern Italy. The study period started from COVID-19 outbreak (February 22, 2020) until the time of writing. Moreover, we provide a review of the literature, showing that most cases reported so far are AIC developed during or secondary to COVID-19 infection. At variance, data about AIC pre-existing to COVID infection are scanty. The 4 patients here described (2 autoimmune hemolytic anemias, AIHA, 1 Evans syndrome, and 1 immune thrombocytopenia) with COVID-19 pneumonia belong to a large cohort of 500 AIC patients, making this study nearly population-based. The observed frequency (4/501; 0.7%) is only slightly superior to that of the general population admitted to hospital/intensive care unit (0.28/0.03%, respectively) in Lombardy in the same period of observation. All cases occurred between March 21 and 25, whilst no more AIC were recorded later on. Although different in intensity of care needed, all patients recovered from COVID-19 pneumonia, with apparently no detrimental effect of previous/current immunomodulatory treatments. AIHA relapse occurred in two patients, but promptly responded to therapy. With limitations due to sample size, these results suggest a favorable outcome and a lower-than-expected incidence of COVID-19 pneumonia in patients with previously diagnosed AIC, and allow speculating that immunomodulatory drugs used for AIC may play a beneficial rather than a harmful effect on COVID-19 infection.
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Affiliation(s)
- Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Oncohematology, University of Milan, Milan, Italy
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10
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Karacin C, Acar R, Bal O, Eren T, Sendur MAN, Acikgoz Y, Karadurmus N, Imamoglu GI, Oksuzoglu OB, Dogan M. "Swords and Shields" against COVID-19 for patients with cancer at "clean" and "pandemic" hospitals: are we ready for the second wave? Support Care Cancer 2021; 29:4587-4593. [PMID: 33479795 PMCID: PMC7819771 DOI: 10.1007/s00520-021-06001-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
Purpose COVID-19 will continue to disrupt the diagnosis-treatment process of cancer patients. Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital has been considered as a ‘non-pandemic’ center (‘clean’) in Ankara, the capital city of Turkey. The other state hospitals that also take care of cancer patients in Ankara were defined as ‘pandemic’ centers. This study aimed to evaluate hospital admission changes and the precautionary measures in clean and pandemic centers during the pandemic. The effect of these measures and changes on COVID-19 spreading among cancer patients was also evaluated. Methods The patients admitted to the medical oncology follow-up, new diagnosis, or chemotherapy (CT) outpatient clinics during the first quarter of pandemic period (March 15–June 1, 2020) of each center were determined and compared with the admissions of the same frame of previous year (March 15–June 1, 2019). COVID-19 PCR test results in clean and pandemic centers were compared with each other. Telemedicine was preffered in the clean hospital to keep on follow-up of the cancer patients as ‘noninfected’. Results In the clean hospital, COVID-19-infected patients that needed to be hospitalized were referred to pandemic hospitals. COVID-19 test positivity rate was eight-fold higher for outpatient clinic admissions in pandemic hospitals (p < 0.001). The number of patients admitted new diagnosis outpatient clinics in both clean and pandemic hospitals decreased significantly during the pandemic compared with the previous year. Conclusion We consider that local strategic modifications and defining ‘clean’ hospital model during infectious pandemic may contribute to protect and treat cancer patients during pandemic.
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Affiliation(s)
- Cengiz Karacin
- Department of Medical Oncology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, 06200, Ankara, Yenimahalle, Turkey.
| | - Ramazan Acar
- Department of Medical Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Oznur Bal
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Tulay Eren
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Ali Nahit Sendur
- Department of Medical Oncology, Ankara City Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Yusuf Acikgoz
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Nuri Karadurmus
- Department of Medical Oncology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Goksen Inanc Imamoglu
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Omur Berna Oksuzoglu
- Department of Medical Oncology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, 06200, Ankara, Yenimahalle, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, 06200, Ankara, Yenimahalle, Turkey
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11
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Bogani G, Ditto A, De Cecco L, Lopez S, Guerrisi R, Piccioni F, Micali A, Daidone MG, Raspagliesi F. Transmission of SARS-CoV-2 in Surgical Smoke during Laparoscopy: A Prospective, Proof-of-concept Study. J Minim Invasive Gynecol 2020; 28:1519-1525. [PMID: 33373728 PMCID: PMC7833707 DOI: 10.1016/j.jmig.2020.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE There are growing concerns regarding the potential risk of coronavirus disease transmission during surgery and in particular during minimally invasive procedures owing to the aerosolization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) particles. However, no study has demonstrated this hypothesis. Here, we aimed to investigate the presence of SARS-CoV-2 in surgical smoke. DESIGN A prospective pilot study. SETTING A tertiary cancer center in northern Italy. PATIENTS Overall, 17 patients underwent laparoscopic procedures for the management of suspected or documented gynecologic malignancies. The median age was 57 years (range 26-77). The surgical indications included endometrial cancer (n = 11), borderline ovarian tumor (n = 3), early-stage ovarian cancer (n = 1), stage IA cervical cancer after diagnostic conization (n = 1), and an ovarian cyst that turned out to be benign at final histologic examination (n = 1). INTERVENTIONS We evaluated all consecutive women scheduled to have laparoscopic procedures for suspected or documented gynecologic cancers. The patients underwent planned laparoscopic surgery. At the end of the laparoscopic procedures (after extubation), we performed reverse transcription-polymerase chain reaction (RT-PCR) tests for the detection of SARS-CoV-2 from both the endotracheal tube and the filter applied on the trocar valve. MEASUREMENTS AND MAIN RESULTS In 1 patient, both swab tests (endotracheal tube and trocar valve filter) showed amplification of the N gene on RT-PCR analysis. This case was considered to be a presumptive positive case. In another case, the RT-PCR analysis showed an amplification curve for the N gene only in the swab test performed on the filter. No ORF1ab amplification was detected. CONCLUSION Our study suggested the proof of principle that SARS-CoV-2 might be transmitted through surgical smoke and aerosolized native fluid from the abdominal cavity.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Loris De Cecco
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Salvatore Lopez
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Rocco Guerrisi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)..
| | - Federico Piccioni
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Arianna Micali
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Maria Grazia Daidone
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy (all authors)
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12
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Cagnazzo C, Besse MG, Manfellotto D, Minghetti P, Cazzaniga S, Cottini L, Fontanella A, Maruti I, Stabile S, Testoni S, Trogu P, Sinno V, Gussoni G. Lessons learned from COVID-19 for clinical research operations in Italy: what have we learned and what can we apply in the future? TUMORI JOURNAL 2020; 107:6-11. [PMID: 33297885 PMCID: PMC7726625 DOI: 10.1177/0300891620977916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has stressed the
importance of health research as never before. In the specific domain
of clinical research, the effort to rapidly find responses to health
challenges and therapeutic hypotheses has highlighted the need for
efficient, timely, ethically correct research. The guidelines
published by the Agenzia Italiana del Farmaco have shown that some
useful changes are feasible: simple and rapid methods have been
implemented to conduct clinical research in the emergency conditions
of the pandemic, maintaining high levels of quality. In this
perspective, four Italian scientific associations operating in
clinical research have worked together to evaluate which measures,
among the ones implemented during the pandemic, have been particularly
significant and potentially effective under normal conditions or in
case of emergencies, and that therefore will be useful in the future
as well.
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Affiliation(s)
- Celeste Cagnazzo
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | | | - Dario Manfellotto
- Department of Internal Medicine, Hospital Fatebenefratelli-AFaR, Rome, Italy
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | | | | | - Andrea Fontanella
- Department of Internal Medicine, Madonna del Buonconsiglio Fatebenefratelli Hospital, Naples, Italy
| | | | - Stefano Stabile
- Oncology Department, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Sara Testoni
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | | | - Valentina Sinno
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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13
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Biagioli V, Albanesi B, Belloni S, Piredda A, Caruso R. Living with cancer in the COVID-19 pandemic: An Italian survey on self-isolation at home. Eur J Cancer Care (Engl) 2020; 30:e13385. [PMID: 33289205 PMCID: PMC7883078 DOI: 10.1111/ecc.13385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/23/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022]
Abstract
Objective To investigate the perception of self‐isolation at home in patients with cancer during the lockdown period resulting from the COVID‐19 outbreak in Italy. Methods A cross‐sectional descriptive study was conducted through an online survey of patients with cancer who were sheltering at home from 29th March to 3rd May 2020. Perception of self‐isolation was assessed using the ISOLA scale, after evaluation of its psychometric properties. Content analysis was used to analyse two open‐ended questions. Results The participants were 195 adult patients with cancer (female = 76%; mean age = 50.3 ± 11.2; haematological malignancy = 51.3%). They reported moderate isolation‐related suffering (M = 2.64 ± 0.81), problems in their relationships with others (M = 3.31 ± 1.13) and difficulties in their relationships with themselves (M = 3.14 ± 1.06). Patients who experienced significantly more social problems were older, had less education and were living without minor children. Overall, four main categories emerged from the qualitative content analysis: (1) lack of freedom and social life, (2) uncertainty and worries, (3) feeling supported and (4) dealing with isolation. Conclusion Living with cancer in the COVID‐19 pandemic was often perceived as an isolating experience, primarily in terms of detachment from loved ones.
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Affiliation(s)
| | - Beatrice Albanesi
- Department of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Silvia Belloni
- School of Nursing, Faculty of Medicine, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Alessio Piredda
- Associazione Italiana degli Infermieri di Area Oncologica (AIIAO), European Institute of Oncology, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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14
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Indini A, Cattaneo M, Ghidini M, Rijavec E, Bareggi C, Galassi B, Gambini D, Ceriani R, Ceriotti F, Berti E, Grossi F. Triage process for the assessment of coronavirus disease 2019-positive patients with cancer: The ONCOVID prospective study. Cancer 2020; 127:1091-1101. [PMID: 33270908 PMCID: PMC7753308 DOI: 10.1002/cncr.33366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 12/30/2022]
Abstract
Background Patients with cancer are considered at high risk for the novel respiratory illness coronavirus disease 2019 (COVID‐19). General measures to keep COVID‐19–free cancer divisions have been adopted worldwide. The objective of this study was to evaluate the efficacy of triage to identify COVID‐19 among patients with cancer. Methods From March 20 to April 17, 2020, data were collected from patients who were treated or followed at the authors' institution in a prospective clinical trial. The primary endpoint was to estimate the cumulative incidence of COVID‐19–positive patients who were identified using a triage process through the aid of medical and patient questionnaires. Based on a diagnostic algorithm, patients with suspect symptoms underwent an infectious disease specialist's evaluation and a COVID‐19 swab. Serologic tests were proposed for patients who had symptoms or altered laboratory tests that did not fall into the diagnostic algorithm but were suspicious for COVID‐19. Results Overall, 562 patients were enrolled. Six patients (1%) were diagnosed with COVID‐19, of whom 4 (67%) had the disease detected through telehealth triage, and 2 patients (33%) without suspect symptoms at triage had the disease detected later. Seventy‐one patients (13%) had suspect symptoms and/or altered laboratory tests that were not included in the diagnostic algorithm and, of these, 47 patients (73%) underwent testing for severe acute respiratory syndrome coronavirus 2 antibody: 6 (13%) were positive for IgG (n = 5) or for both IgM and IgG (n = 1), and antibody tests were negative in the remaining 41 patients. Conclusions The triage process had a positive effect on the detection of COVID‐19 in patients with cancer. Telehealth triage was helpful in detecting suspect patients and to keep a COVID‐19–free cancer center. The overall incidence of COVID‐19 diagnosis (1%) and antibody positivity (13%) in patients with suspect symptoms was similar to that observed in the general population. The adoption of a structured triage process can be useful for the detection of coronavirus disease 2019 symptoms and signs. Oncology activities can be safely carried out during the pandemic with the aid of a triage process and containment measures.
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Affiliation(s)
- Alice Indini
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Monica Cattaneo
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Michele Ghidini
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Erika Rijavec
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Claudia Bareggi
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Barbara Galassi
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Donatella Gambini
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Rosalia Ceriani
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Ferruccio Ceriotti
- Clinical Laboratory, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
| | - Emilio Berti
- Department of Dermatology, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy.,Department of Pathophysiology, Surgery, and Transplantation, University of Milan, Milan, Italy
| | - Francesco Grossi
- Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy
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15
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Nichetti F, Bini M, Ambrosini M, Ottini A, Rametta A, Leporati R, Polastri D, Pircher C, Dotti K, Ferrari L, de Braud F. COVID-19 risk for patients undergoing anticancer treatment at the outpatient clinic of the National Cancer Institute of Milan: the COVINT study. ESMO Open 2020; 5:esmoopen-2020-000883. [PMID: 33158968 PMCID: PMC7650074 DOI: 10.1136/esmoopen-2020-000883] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background In the midst of the COVID-19 pandemic, patients with cancer are regarded as a highly vulnerable population. Overall, those requiring hospital admission for treatment administration are potentially exposed to a higher risk of infection and worse outcome given the multiple in-hospital exposures and the treatment immunosuppressive effects. Methods COVINT is an observational study assessing COVID-19 incidence among patients receiving anticancer treatment in the outpatient clinic of the Istituto Nazionale dei Tumori di Milano. All consecutive patients with non-haematological malignancies treated with intravenous or subcutaneous/intramuscular anticancer therapy in the outpatient clinic were enrolled. The primary endpoint is the rate of occurrence of COVID-19. Secondary endpoints included the rate of COVID-19-related deaths and treatment interruptions. The association between clinical and biological characteristics and COVID-19 occurrence is also evaluated. COVID-19 diagnosis is defined as (1) certain if confirmed by reverse transcriptase PCR assay of nasopharyngeal swabs (NPS); (2) suspected in case of new symptoms or CT scan evidence of interstitial pneumonia with negative/not performed NPS; (3) negative in case of neither symptoms nor radiological evidence. Results In the first 2 months (16 February–10 April 2020) of observation, 1081 patients were included. Of these, 11 (1%) were confirmed and 73 (6.7%) suspected for COVID-19. No significant differences in terms of cancer and treatment type emerged between the three subgroups. Prophylactic use of myeloid growth factors was adopted in 5.3%, 2.7% and 0% of COVID-19-free, COVID-19-suspected and COVID-19-confirmed patients (p=0.003). Overall, 96 (8.9%) patients delayed treatment as a precaution for the pandemic. Among the 11 confirmed cases, 6 (55%) died of COVID-19 complications, and anticancer treatment was restarted in only one. Conclusions During the pandemic peak, accurate protective measures successfully resulted in low rates of COVID-19 diagnosis, although with high lethality. Prospective patients’ surveillance will continue with NPS and serology testing to provide a more comprehensive epidemiological picture, a biological insight on the impact of cytotoxic treatments on the immune response, and to protect patients and healthcare workers.
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Affiliation(s)
- Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Marta Bini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Margherita Ambrosini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Arianna Ottini
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Alessandro Rametta
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Rita Leporati
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Daniela Polastri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Chiara Pircher
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Katia Dotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Laura Ferrari
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
| | - Filippo de Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
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16
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Haradaa G, Antonacio FF, Gongora AB, Behar MH, Capareli FC, Bastos DA, Munhoz RR, Costa FP, Jardim DL, Arrais-Rodrigues C, Novis Y, Katz A, de Castro Junior G. SARS-CoV-2 testing for asymptomatic adult cancer patients before initiating systemic treatments: a systematic review. Ecancermedicalscience 2020; 14:1100. [PMID: 33082850 PMCID: PMC7532035 DOI: 10.3332/ecancer.2020.1100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Cancer patients may have a higher risk of severe events and unfavourable outcomes in the setting of COVID-19. This review addresses the question of whether to test asymptomatic cancer patients before initiating systemic cancer treatments. Methods This systematic review was conducted based on the PRISMA framework. Pubmed, Embase, Web of Science and Cochrane Central Register of Controlled Trials were systematically searched, as well as guidelines from international institutions involved in cancer care and COVID-19 research. Studies published in English, from 1 December 2019 to 27 May 2020 were considered eligible. We included studies which mentioned testing strategies for SARS-CoV-2 of asymptomatic cancer patients before starting immunosuppressive treatments. Results We identified 1,163 studies and 4 guidelines through the literature search. A total of 18 articles were considered eligible and were included in the final analysis. Two articles were cohort studies, and the remaining were expert consensuses and published guidelines. The most common recommendation among the studies in this systematic review was to test asymptomatic patients for SARS-CoV-2 prior to treatment. Conclusion There is a lack of studies which directly address COVID-19 testing of asymptomatic patients before treatment. Our systematic review showed that most of the published data favours routine test for SARS-CoV-2 before initiating systemic treatment but failed to identify a good level of evidence to support these recommendations. Based upon this review, we proposed local recommendations at our centre. Each institution should consider the pros and cons of testing asymptomatic patients, evaluating accessibility to testing resources and local epidemiology.
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Affiliation(s)
| | - Fernanda F Antonacio
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Aline Bl Gongora
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Marina H Behar
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Fernanda C Capareli
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Diogo A Bastos
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Rodrigo R Munhoz
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Frederico P Costa
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Denis L Jardim
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Celso Arrais-Rodrigues
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Yana Novis
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Artur Katz
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
| | - Gilberto de Castro Junior
- Oncology Centre, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0003-4012-3251
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17
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Impact of COVID-19 Outbreak on Cancer Patient Care and Treatment: Data from an Outpatient Oncology Clinic in Lombardy (Italy). Cancers (Basel) 2020; 12:cancers12102941. [PMID: 33053782 PMCID: PMC7601200 DOI: 10.3390/cancers12102941] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 12/20/2022] Open
Abstract
Lombardy was the first area in Italy to have an outbreak of coronavirus disease 19 (COVID-19) at the beginning of 2020. In this context, cancer has been reported as a major risk factor for adverse outcomes and death, so oncology societies have quickly released guidelines on cancer care during the pandemic. The aim of this study was to investigate the management of cancer patients and oncological treatments during the COVID-19 pandemic and to describe the containment measures performed in our outpatient clinic at Pavia (Lombardy). A comparison with the same period of the four previous years (2019, 2018, 2017, and 2016) was also performed. Using our electronic databases, we evaluated the number and characteristics of patients accessing the hospital for anticancer drug infusion from 24 February, 2020 to 30 April, 2020 and the number of radiological exams performed. Although a significant reduction in access for therapy was seen when compared with 2019 (2590 versus 2974, access rate ratio (ARR) = 0.85, p < 0.001), no significant differences in access numbers and ARR was evident between 2020 and 2018, 2017, or 2016 (2590 versus 2626 (ARR = 0.07), 2660 (ARR = 0.99), and 2694 (ARR = 0.96), respectively, p > 0.05). In 2020, 63 patients delayed treatment: 38% for "pandemic fear", 18% for travel restrictions, 13% for quarantine, 18% for flu syndrome other than COVID-19, and 13% for worsening of clinical conditions and death. Only 7/469 patients developed COVID-19. A significant reduction in radiological exams was found in 2020 versus all the other years considered (211 versus 360, 355, 385, 390 for the years 2020, 2019, 2018, 2017, and 2016, respectively, p < 0.001). The low incidence of COVID-19 among our cancer patients, along with the hospital policy to control infection, enabled safe cancer treatment and a continuum of care in most patients, while a small fraction of patients experienced a therapeutic delay due to patient-related reasons.
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Barcellini A, Filippi AR, Dal Mas F, Cobianchi L, Corvò R, Price P, Orlandi E. To a new normal in radiation oncology: looking back and planning forward. TUMORI JOURNAL 2020; 106:440-444. [PMID: 33045932 PMCID: PMC7727020 DOI: 10.1177/0300891620962197] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Amelia Barcellini
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | - Andrea Riccardo Filippi
- Department of Radiation Oncology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | | | - Lorenzo Cobianchi
- General Surgery Clinic, IRCCS Policlinico San Matteo Foundation, and Department of Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Renzo Corvò
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, and Department of Health Science, University of Genoa, Genoa, Italy
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
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19
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Caravatta L, Rosa C, Di Sciascio MB, Tavella Scaringi A, Di Pilla A, Ursini LA, Taraborrelli M, Vinciguerra A, Augurio A, Di Tommaso M, Trignani M, Nuzzo M, Falco MD, De Nicola A, Adorante N, Patani F, Centofanti G, Gasparini L, Fasciolo D, Di Guglielmo FC, Bonfiglio C, Borgia M, Caravaggio G, Marcucci S, Turchi C, Mancinelli D, Sartori S, Schael T, Muraglia A, Caputi S, D'Amario C, Verì N, Genovesi D. COVID-19 and radiation oncology: the experience of a two-phase plan within a single institution in central Italy. Radiat Oncol 2020; 15:226. [PMID: 32993690 PMCID: PMC7522911 DOI: 10.1186/s13014-020-01670-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 in Italy has led to the need to reorganize hospital protocols with a significant risk of interruption to cancer treatment programs. In this report, we will focus on a management model covering the two phases of the COVID-19 emergency, namely lockdown-phase I and post-lockdown-phase II. METHODS The following steps were taken in the two phases: workload during visits and radiotherapy planning, use of dedicated routes, measures for triage areas, management of suspected and positive COVID-19 cases, personal protective equipment, hospital environments and intra-institutional meetings and tumor board management. Due to the guidelines set out by the Ministry of Health, oncological follow-up visits were interrupted during the lockdown-phase I; consequently, we set about contacting patients by telephone, with laboratory and instrumental exams being viewed via telematics. During the post-lockdown-phase II, the oncological follow-up clinic reopened, with two shifts operating daily. RESULTS By comparing our radiotherapy activity from March 9 to May 4 2019 with the same period in 2020 during full phase I of the COVID-19 emergency, similar results were achieved. First radiotherapy visits, Simulation Computed Tomography and Linear Accelerator treatments amounted to 123, 137 and 151 in 2019 compared with 121, 135 and 170 in 2020 respectively. There were no cases of COVID-19 positivity recorded either in patients or in healthcare professionals, who were all negative to the swab tests performed. CONCLUSION During both phases of the COVID-19 emergency, the planned model used in our own experience guaranteed both continuity in radiotherapy treatments whilst neither reducing workload nor interrupting treatment and, as such, it ensured the safety of cancer patients, hospital environments and staff.
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Affiliation(s)
- Luciana Caravatta
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy.
| | - Consuelo Rosa
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | | | - Angelo Di Pilla
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Lucia Anna Ursini
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Maria Taraborrelli
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Annamaria Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Antonietta Augurio
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Monica Di Tommaso
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Marianna Trignani
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Marianna Nuzzo
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Andrea De Nicola
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Nico Adorante
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Fabiola Patani
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Giuseppe Centofanti
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Lucrezia Gasparini
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - David Fasciolo
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Fiorella Cristina Di Guglielmo
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Cecilia Bonfiglio
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Marzia Borgia
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Gabriella Caravaggio
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Stefano Marcucci
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Consalvo Turchi
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Domenico Mancinelli
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | - Stephanie Sartori
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy
| | | | | | | | | | - Nicoletta Verì
- Abruzzo Region Health Policy Department, L'Aquila, Italy
| | - Domenico Genovesi
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via Dei Vestini, 66100, Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
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20
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Ribeiro R, Wainstein AJA, de Castro Ribeiro HS, Pinheiro RN, Oliveira AF. Perioperative Cancer Care in the Context of Limited Resources during the COVID-19 Pandemic: Brazilian Society of Surgical Oncology Recommendations. Ann Surg Oncol 2020; 28:1289-1297. [PMID: 32980998 PMCID: PMC7519702 DOI: 10.1245/s10434-020-09098-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND As the COVID-19 pandemic moves from rich to poor nations, the healthcare systems of developing countries have to deal with this extra burden. As cancer care cannot stop and surgery is the main mechanism for cure and palliation, it is important to provide safe and rational access to cancer surgery during the COVID-19 pandemic. METHODS From April 1st to May 1st, the committee of the Brazilian Society of Surgical Oncology (BSSO) was responsible for reviewing the literature and writing recommendations for perioperative cancer care in the context of limited resources during the pandemic. The recommendations were submitted to the BSSO board of directors. The orientations that were not consensual were removed and the suggestions were added to the text. From May 15 to 30th, the committee revised the recommendations, aligned them with the objectives of the work and standardize the text. DISCUSSION The rational use of resources to reduce the risk of surgical cancer patients being operated on during the incubation period of a corona virus infection is important in this context. Prevalence of corona virus in the region, the need for surgery, surgical complexity, patient age and comorbidities, and availability of corona virus testing are central aspects in this matter and are discussed. CONCLUSIONS We present a protocol, focused on the patients' outcomes, for safe and rational use of resources to reduce the risk of surgical cancer patients being operated on during the virus incubation period, in the context of areas with limited resources.
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Affiliation(s)
- Reitan Ribeiro
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil. .,Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil.
| | - Alberto Julius Alves Wainstein
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,School of Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Heber Salvador de Castro Ribeiro
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,Abdominal Surgery Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Rodrigo Nascimento Pinheiro
- COVID-19 Crisis Committee, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,Department of Surgical Oncology, Base Institute Hospital, Brasília, Brazil
| | - Alexandre Ferreira Oliveira
- Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil.,Department of Surgery, Juiz de Fora Federal University, Juiz de Fora, Brazil
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21
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Romanzi A, Vannelli A. Comment on "Response of a comprehensive cancer center to the COVID-19 pandemic: the experience of the Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano". TUMORI JOURNAL 2020; 106:524-525. [PMID: 32867623 DOI: 10.1177/0300891620953471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although European governments have launched the so-called phase 2 in the coronavirus disease 2019 (COVID-19) pandemic (a transitional phase of beginning to downsize containment measures), intensive care units are not COVID-19-free and this restricts our therapeutic strategies. Moreover, minimally invasive surgery and general anesthesia are under debate as they are both aerosol-generating procedures and may contribute to contamination spread inside operating theatres. During this pandemic, 13 fragile patients needing abdominal surgery underwent awake open surgery under locoregional anesthesia at our department. This approach was feasible, safe, and, in specific cases, the only viable option. In the COVID-19 era, this approach could allow surgeons to carry out undeferrable surgeries, preventing viral transmission inside the operating room.
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Affiliation(s)
- Andrea Romanzi
- Department of General Surgery, Valduce Hospital, Como, Italy
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22
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Zaniboni A, Ghidini M, Grossi F, Indini A, Trevisan F, Iaculli A, Dottorini L, Moleri G, Russo A, Vavassori I, Brevi A, Rausa E, Boni L, Dondossola D, Valeri N, Ghidini A, Tomasello G, Petrelli F. A Review of Clinical Practice Guidelines and Treatment Recommendations for Cancer Care in the COVID-19 Pandemic. Cancers (Basel) 2020; 12:E2452. [PMID: 32872421 PMCID: PMC7565383 DOI: 10.3390/cancers12092452] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic has inevitably caused those involved in cancer care to change clinical practice in order to minimize the risk of infection while maintaining cancer treatment as a priority. General advice during the pandemic suggests that most patients continue with ongoing therapies or planned surgeries, while follow-up visits may instead be delayed until the resolution of the outbreak. We conducted a literature search using PubMed to identify articles published in English language that reported on care recommendations for cancer patients during the COVID-19 pandemic from its inception up to 1st June 2020, using the terms "(cancer or tumor) AND (COVID 19)". Articles were selected for relevance and split into five categories: (1) personal recommendations of single or multiple authors, (2) recommendations of single authoritative centers, (3) recommendations of panels of experts or of multiple regional comprehensive centers, (4) recommendations of multicenter cooperative groups, (5) official guidelines or recommendations of health authorities. Of the 97 included studies, 10 were personal recommendations of single or multiple independent authors, 16 were practice recommendations of single authoritative cancer centers, 35 were recommendations provided by panel of experts or of multiple regional comprehensive centers, 19 were cooperative group position papers, and finally, 17 were official guidelines statements. The COVID-19 pandemic is a global emergency, and has rapidly modified our clinical practice. Delaying unnecessary treatment, minimizing toxicity, and identifying care priorities for surgery, radiotherapy, and systemic therapies must be viewed as basic priorities in the COVID-19 era.
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Affiliation(s)
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | - Francesco Grossi
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | - Alice Indini
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | | | - Alessandro Iaculli
- Oncology Unit, ASST Bergamo Est, 24068 Seriate (BG), Italy; (A.I.); (L.D.)
| | - Lorenzo Dottorini
- Oncology Unit, ASST Bergamo Est, 24068 Seriate (BG), Italy; (A.I.); (L.D.)
| | - Giovanna Moleri
- Centro Servizi, Direzione Socio-Sanitaria, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Alessandro Russo
- Surgical Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Ivano Vavassori
- Urology Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Alessandra Brevi
- Otorhinolaryngology-Head and Neck Surgery Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Emanuele Rausa
- General Surgery 1 Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | - Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, Università degli Studi of Milan, 20122 Milan, Italy
| | - Nicola Valeri
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London SW7 3RP, UK;
- Department of Medicine, The Royal Marsden Hospital, London SW3 6JJ, UK
| | | | - Gianluca Tomasello
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | - Fausto Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy
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23
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Cancer patients affected by COVID-19: Experience from Milan, Lombardy. Gynecol Oncol 2020; 158:262-265. [PMID: 32534808 PMCID: PMC7286266 DOI: 10.1016/j.ygyno.2020.06.161] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
Abstract
Objective SARS-CoV-2 pandemic is continuing to spread. There are growing concerns on the impact of COVID-19 in cancer patients. Several papers reporting recommendations and guidelines are published. But few data on cancer patients affected by COVID-19 are available. Methods This is a retrospective study including all consecutive patients affected by gynecological cancer who developed COVID-19. All patients were treated in an academic setting (in Milan, Lombardy, Italy) between February and March 2020. Results Overall, 355 patients had active treatment during the study period due to newly diagnosed or recurrent gynecological disease. Among those, 19 (5.3%) patients affected developed COVID-19. All patients were asymptomatic at the time of COVID-19 detection. Six patients were diagnosed before starting planned treatments; while the remaining 13 were diagnosed for COVID-19 after their started their treatments. Considering the first group of six patients, one patient died due to COVID-19 3 days after the diagnosis; while the other patients recovered from COVID-19 after a median of three weeks. The latter group of 13 patients (treatments started) included five patients who underwent surgery and eight patients who underwent chemotherapy. Focusing on five patients who were diagnosed after surgery, we observed that two patients died during postoperative course, while in other two cases prolonged hospitalization was needed. One patient had no issues. Chemotherapy was delayed for the remaining patents without sequelae. Conclusions Our report highlights that COVID-19 impacts the quality of treatments for cancer patients. Mortality rate is high, especially after surgery. More important, patients under active treatment for cancer are at high risk of developing severe evolution of COVID-19. Prioritizing patients journey during COVID-19 is of paramount importance. There are growing concerns on the impact of COVID-19 in cancer patients. COVID-19 is impacting oncologic practice directly and indirectly. Prioritizing patients journey during COVID-19 is of paramount importance.
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Scarcia M, Ludovico GM, Fortunato A, Fiorentino A. Patients with cancer in the COVID-19 era: the clinical trial issue. TUMORI JOURNAL 2020; 106:271-272. [PMID: 32508257 DOI: 10.1177/0300891620933672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Coronavirus disease 2019 (COVID-19) hospital reorganization may result in reduced ability for the hospital to fully use its armamentarium for battling cancer. Thus different therapeutic modalities have been recommended. During the pandemic, despite regulatory agencies' recommendations, several considerations and doubts remain for oncologic clinical trials. Considering patients who had been enrolled before the pandemic, and who plan to take the study medication, the situation becomes complicated. These patients should undergo monitoring visits, blood sampling, questionnaire, physical examination, and drug and radiation administration. To avoid deviations from the protocol and trial discontinuation, follow-up should be performed regularly, in concordance with safety guidelines. Here we report several considerations.
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Affiliation(s)
- Marcello Scarcia
- Urology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti (BA), Italy
| | | | - Angela Fortunato
- Urology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti (BA), Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti (BA), Italy
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25
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Bilkhu R, Billè A. Elective lung cancer surgery in the COVID-19 era: how do we do it? TUMORI JOURNAL 2020; 106:300891620931568. [PMID: 32462984 DOI: 10.1177/0300891620931568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The coronavirus 2019 (COVID-19) pandemic has caused significant mortality around the world and the focus has been on reducing the number of infections. In order not to compromise treatment of oncology patients, reducing the number of patients with COVID-19 undergoing treatment is mandatory. We reviewed the experience of the National Institute of Cancer in Milan and compared it with our experience.
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Affiliation(s)
- Rajdeep Bilkhu
- Department of Thoracic Surgery, Guy's Hospital, London, UK
| | - Andrea Billè
- Department of Thoracic Surgery, Guy's Hospital, London, UK
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
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26
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The simulation-CT: Radiotherapy's useful tool in the race against COVID-19 pandemic. A serendipity approach. Radiother Oncol 2020; 147:151-152. [PMID: 32447034 PMCID: PMC7242183 DOI: 10.1016/j.radonc.2020.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/19/2023]
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