Abstract
BackgroundThe first confirmed case of COVID-19 in Ireland was on February 29th 2020. From March until late April, the number of cases increased exponentially. The delivery of anti-cancer therapy during the COVID-19 pandemic was extremely challenging. In order to balance the benefits of continuing anti-cancer therapy with the associated increased hospital visits, combined with the risk of COVID-19 infection, we undertook a series of system changes in the delivery of cancer care.MethodsPatients who attended our dayward over a 4-month period were included. Data were obtained from patient and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 at two separate timepoints: prior to their visit via telephone, and using a symptom questionnaire on arrival at the hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab arranged.ResultsA total of 456 patients attended from January 1st to April 30th. The numbers of visits from January to April were 601, 586, 575, and 607, respectively. During this period, there were 2369 patient visits to the dayward and 1953 (82%) intravenous regimens administered. Of the 416 visits that did not lead to treatment, 114 (27%) were scheduled non-treatment review visits, 194 (47%) treatments were held due to disease-related illness, and 108 (26%) treatments were held due to treatment-related complications.Screening measurements were implemented on March 18th due to rising COVID-19 prevalence in the general population. Overall, 53 treatments were held due to the screening process: 19 patients (36%) elicited COVID-19 symptoms via telephone screening; 34 patients (64%) were symptomatic in our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week.ConclusionsWith careful systematic changes, safe and continued delivery of systemic anti-cancer therapy during the COVID-19 pandemic is possible.
Highlights
The delivery of systemic anti-cancer therapy during the COVID-19 pandemic has been challenging
There is an ever-growing body of evidence reporting on the outcomes of COVID-19 infection in early versus advanced malignancies, with haematological and lung malignancies being associated with more severe infection and a higher death rate [2,3,4,5]
Our aim was to determine whether these system changes would allow systemic anti-cancer treatments to proceed as planned according to well established protocols, as well as attempting to limit patients from contracting COVID-19 infection at our healthcare facility
Summary
The delivery of systemic anti-cancer therapy during the COVID-19 pandemic has been challenging. There is an ever-growing body of evidence reporting on the outcomes of COVID-19 infection in early versus advanced malignancies, with haematological and lung malignancies being associated with more severe infection and a higher death rate [2,3,4,5] It is a concerning time for immunosuppressed patients, especially in the case where treatments can both prolong life from a cancer perspective, yet potentially increase the risk of a poor outcome with COVID-19 infection [6]. 53 treatments were held due to the screening process: 19 patients (36%) elicited COVID-19 symptoms via telephone screening; 34 patients (64%) were symptomatic in our pre-assessment area and referred for swabs, of which 4 were positive Those with a negative swab were rescheduled for chemotherapy the following week. Conclusions With careful systematic changes, safe and continued delivery of systemic anti-cancer therapy during the COVID19 pandemic is possible
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