Abstract
BackgroundThe COVID‐19 outbreak has posed considerable challenges to the health care system worldwide, especially for cancer treatment. We described the activity and the care organisation of the Hospitalisation At Home (HAH) structure during the pandemic for treating patients with anti‐cancer injections.MethodsWe report the established organisation, the eligibility criteria, the patient characteristics, the treatment schemes and the stakeholders’ role during two 5‐week periods in 2020, before and during the French population's lockdown.ResultsThe increase of activity during the lockdown (+32% of treated patients, +156% of new patients and +28% of delivered preparations) concerned solid tumour, mainly breast cancer, even if haematological malignancies remained the most frequent. Thirty different drugs were delivered, including three new drugs administered in HAH versus 19 during the routine period (p < 0.01). For those clinical departments accustomed to using HAH, the usual organisation was kept, but with adjustments. Five clinical departments increased the number of patients treated at home and widened the panel of drugs prescribed. Three oncology departments and one radiotherapy department for the first time solicited HAH for anti‐cancer injections, mainly for immunotherapy. We adjusted the HAH organisation with additional human resources and allowed to prescribe drugs with an infusion time of <30 min only for the new prescribers.ConclusionHAH allowed for the continuation of anti‐cancer injections without postponement during the pandemic, and for a decrease in unnecessary patient travel to hospital with its concomitant COVID‐19 transmission risk. Often left out of guidelines, the place of HAH in treating cancer patients should be reappraised, even more so during a pandemic.
Highlights
The COVID-19 outbreak has posed considerable challenges to the health care system worldwide, especially for cancer treatment
According to the Chinese experience, patients with cancer may have a higher risk of contracting COVID-1 9 and developing complications, due either to the immunosuppressed condition linked to the disease or to the anti-cancer treatment.[4]
Our study related how Hospitalisation At Home (HAH) allowed anti-c ancer injection to continue during the pandemic without delays to treatment, to decrease unnecessary patient travel to hospital and to decrease the COVID-1 9 transmission risk and how follow-up of patients during the pandemic was possible thanks to the adaptation of HAH, community health care and clinical ward organisation
Summary
The COVID-19 outbreak has posed considerable challenges to the health care system worldwide, especially for cancer treatment. In December 2019, an outbreak of a new coronavirus disease 2019 (COVID-2019) spread in Wuhan, a city in the Chinese province of Hubei It was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 ) and, though mild in most cases, represented a potentially fatal disease.[1] COVID-19 spread mainly through close contact from person-to-person in respiratory droplets. It rapidly became a major international issue.[2] On 11 March 2020, the World Health Organisation officially declared the COVID-19 outbreak a pandemic.[3] As there was neither a vaccine nor a specific treatment to limit the COVID-19 outbreak, social distancing and reduction of face-to-face contact were required to slow down disease transmission. When ‘Home’ is mentioned in the guidelines on how to treat cancer patients during the COVID-19 pandemic, ‘Home’ is considered suitable only for follow-up or for the use of elastomeric pumps delivered in outpatient clinics.[4,6,8]
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