COVID-19 risk for patients undergoing anticancer treatment at the outpatient clinic of the National Cancer Institute of Milan: the COVINT study. ESMO open

Federico Nichetti, Marta Bini, Margherita Ambrosini, Arianna Ottini, Alessandro Rametta, Rita Leporati, Daniela Polastri, Chiara Pircher, Katia Dotti, Laura Ferrari, Filippo de Braud

Research output: Contribution to journalArticlepeer-review

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.
Original languageEnglish
JournalESMO Open
Volume5
Issue numberSuppl 3
DOIs
Publication statusPublished - 2020

Keywords

  • Adult
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Aged
  • Young Adult
  • Aged, 80 and over
  • Mortality
  • Italy/epidemiology
  • *COVID-19
  • Betacoronavirus
  • Pandemics
  • Antineoplastic Agents/*therapeutic use
  • COVID-19
  • SARS-CoV-2
  • *chemotherapy
  • Neoplasms/*drug therapy/epidemiology/pathology
  • Time-to-Treatment
  • *anticancer treatment
  • *cancer care
  • *pandemic
  • Ambulatory Care
  • Cancer Care Facilities
  • Coronavirus Infections/*epidemiology/mortality
  • Pneumonia, Viral/*epidemiology/mortality

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