Boccuzzi, Adriana

Novello, Silvia

Perboni, Alberto

Scagliotti, Giorgio

Terzolo, Massimo

Veltri, Andrea

English

Institutional Research Information System University of Turin

  Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.  Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.  COMMENTARYPatients With Lung Cancer and CoronavirusDisease 2019 Epidemic: An Experience From anItalian University HospitalGiorgio Scagliotti, MD,a,* Silvia Novello, MD,a Andrea Veltri, MD,aAdriana Boccuzzi, MD,b Alberto Perboni, MD,c Massimo Terzolo, MDdaDepartment of Oncology at San Luigi Hospital, University of Torino, Orbassano, Torino, ItalybEmergency Department at San Luigi Hospital, Orbassano, Torino, ItalycRespiratory Medicine Department at San Luigi Hospital, Orbassano, Torino, ItalydDepartment of Clinical and Biological Sciences at San Luigi Hospital, University of Torino, Orbassano, Torino, ItalyReceived 11 May 2020; revised 28 May 2020; accepted 29 May 2020Available online - 05 June 2020*Corresponding author.Disclosure: Dr. Scagliotti received honoraria from AstraZeneca, RocheHoldings AG, Pfizer, Takeda, and Merck Sharp & Dohme for activitiesnot related to the content of this article. Dr. Novello received hono-raria for speaker bureau/advisory boards from AstraZeneca, Boeh-ringer Ingelheim, Merck Sharp & Dohme, Pfizer, Bayer, Takeda, AbbVie,Eli Lilly, Roche Holdings AG, and Bristol-Myers Squibb for activities notrelated to the content of this article. The remaining authors declareno conflict of interest.Address for correspondence: Giorgio Scagliotti, MD, Department ofOncology at San Luigi Hospital, University of Torino, Orbassano, TO10043, Italy. E-mail: giorgio.scagliotti@unito.itCite this article as: Scagliotti G, et al. Patients With Lung Cancer andCoronavirus Disease 2019 Epidemic: An Experience From an ItalianUniversity Hospital. JTO Clin Res Rep 1:100067ª 2020 The Authors. Published by Elsevier Inc. on behalf of theInternational Association for the Study of Lung Cancer. This is anopen access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).ISSN: 2666-3643https://doi.org/10.1016/j.jtocrr.2020.100067The rapid onset of the coronavirus outbreak in Italy,and later on in Europe, forced urgent decisions to betaken by medical oncologists. It is well known that pa-tients suffering from oncological or oncohematologicalneoplastic diseases and other chronic diseases associatedwith immunosuppression (e.g., congenital immunodefi-ciencies, transplants of solid organs or hematopoieticstem cells, and autoimmune pathologies in immunosup-pressive treatment) are particularly at risk, both withregard to morbidity and fatality related to respiratoryvirus infections, such as influenza1 and severe acute res-piratory syndrome coronavirus disease 2 (SARS-CoV-2).2We share here the experience of an oncologydepartment in the context of a university hospital basedin Orbassano (Torino), Italy during the coronavirus dis-ease 2019 (COVID-19) epidemic. All the disease-specificmeasures and interventions outlined in this commentarywere on the basis of institutional discussion and deci-sion. Although some of them can be generalized, othersmay not necessarily apply to hospitals with a differentpatient pattern, hospital settings, and severity of com-munity infections. The strategies described in this com-mentary are, thus, helpful for similar hospitals facingsimilar threats from COVID-19.A few days after the outbreak of the disease, wequickly implemented a series of preventive measures tolimit the spread of the virus and prevent contaminationof the wards, consultation rooms, and outpatient facil-ities. Despite an initial gap in providing personal pro-tective equipment to all health care professionals, thehospital administrators promptly reacted and providedand recommended wearing of appropriate personalprotective equipment (e.g., surgical masks). An exclusiveone-way passage at the entrance of the hospital with avisible sign, through which all patients and relativesentering the hospital were checked for body tempera-ture and presence of respiratory symptoms, was ar-ranged. A second checkpoint was placed at the entranceof the dedicated areas of the consultation rooms andoutpatient facility for patients in oncology. A pretriagecheck form was filled by each patient.Any admitted patient with fever was promptlyinvestigated for COVID-19 with the recommended mo-lecular diagnostic test and, if positive, was moved toisolation rooms with dedicated personnel. Relativeswere not allowed to stay in the waiting rooms, andadequate distancing among waiting patients was advisedand carefully monitored.JTO Clinical and Research Reports Vol. 1 No. 3: 1–22 Scagliotti et al JTO Clinical and Research Reports Vol. 1 No. 3Physicians educated patients to help prevent thefurther spread of COVID-19 and provided instructions onthe proper wear of surgical masks, handwashing tech-niques, cough etiquette, and home quarantine.At the early stages of the epidemic, the uncertaintyrelated to the management of patients with lung cancerprompted several initiatives from various advocacygroups in Italy, including Women Against Lung Cancer inEurope, with requests for direction from the Ministry ofHealth and the Scientific Committee of the Civil Protec-tion Department.We were advised to quickly identify and apply themethods necessary to guarantee the oncological treat-ments necessary for patients residing in the “red zones”(areas with a higher incidence of COVID-19) to ensurethat the principle of dose intensity was not in any waynegatively influencing the prognosis of the pathologybeing treated. We tried to continue the treatmentsconsidered nondeferrable, whereas others (e.g., adjuvanttreatments) were postponed. Regarding immunotherapy,we decided to continue the treatment of patients in theinduction or short-term maintenance phases; althoughwe discussed (with each patient) whether to interruptthe therapy for those in the long-term maintenancephase (more than 1 year) or for those with initialworsening of the radiological picture.Furthermore, the recommendation was to postpone,when possible, the follow-up consults to decreaseattendance in the health care facilities to limit both therisk of exposure to SARS-CoV-2 and the workload of the(already) partially overloaded hospital manpower andstructures. We consequently implemented a system ofremote consultation for all patients in follow-up, and thesame approach was adopted for patients on oral thera-pies. For drug resupply, whenever possible, we delivereddrugs at home through express couriers.Regarding the conduct of clinical trials, we put onhold any study monitor visits, and the activity of the datacenter has been limited to essential activities, favoring,when possible, any type of remote working.Despite all these detailed plans and preventive mea-sures, one inpatient with no COVID-19–related symp-toms during admission, had an onset of fever on day 7and was subsequently found to be positive for COVID-19.Unfortunately, some health care professionals and pa-tients with cancer were infected, and the situation forcedus to transform our oncology ward into a COVID-19ward for all types of patients with cancer.Because of this recognized threat, we promptlyimplemented a diagnostic algorithm for any patient withcancer who was admitted from the emergency room orthe outpatient facility. This algorithm takes the followinginto account: (1) the suboptimal sensitivity of thereverse transcriptase–polymerase chain reaction diag-nostic method on the nasal swab for SARS-CoV-2 alongwith the waiting time for report availability (5–6 h); and(2) risk stratification for the likelihood of COVID-19,which integrates the use of low-dose chest computedtomography in the decision algorithm to minimize therisk of contamination and to optimize patient allocationin different areas of the hospital.The lessons we learned from our experience withCOVID-19 and patients with cancer clearly indicatedthat, in emergencies, it is quite difficult to make a dif-ferential diagnosis between symptoms related to lungcancer (regardless of whether the cases are mild or se-vere) and COVID-19; the risk of hospital admission ofpatients with lung cancer in the asymptomatic phaseshould be carefully considered. In addition, all patientswith lung cancer are extremely frail in the context of theCOVID-19 epidemic, and further measures should beimplemented to protect patients and health care pro-fessionals involved in the diagnosis and treatment of thisoncological disease.AcknowledgmentsThe authors thank all physicians, nurses, hospitalpersonnel, and cleaning services who, with dedicationand passion, spent their entire days working tirelesslyduring the critical time of the epidemic.References1. El Ramahi R, Freifeld A. Epidemiology, diagnosis, treat-ment, and prevention of influenza infection in oncologypatients. J Oncol Pract. 2019;15:177–184.2. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. LancetOncol. 2020;21:335–337.

Patients With Lung Cancer and Coronavirus Disease 2019 Epidemic: An Experience From an Italian University Hospital

https://iris.unito.it/bitstream/2318/1768867/1/Patients%20with%20lung%20cancer%20and%20coronavirus%20disease%202019%20pandemic.pdf

Patients With Lung Cancer and Coronavirus Disease 2019 Epidemic: An Experience From an Italian University Hospital

Abstract

Similar works

Full text

Available Versions

Institutional Research Information System University of Turin