Impact of COVID-19 Outbreak on Cancer Patient Care and Treatment: Data from an Outpatient Oncology Clinic in Lombardy (Italy)

Erica Quaquarini,Giulia Caldana,Giuseppe Saltalamacchia,Ludovica Mollica,Daniele Presti,Federico Sottotetti,Emanuela Balletti,Alberto Malovini,Mara Frascaroli,Antonio Bernardo,Valentina Tibollo,Raffaella Palumbo,Cristina Maria Teragni,Elisa Biscaldi

doi:10.3390/cancers12102941

Erica Quaquarini, Giulia Caldana + Show 12 more

Open Access

https://doi.org/10.3390/cancers12102941

Copy DOI

Journal: Cancers	Publication Date: Oct 12, 2020
Citations: 38	License type: CC BY 4.0

Affiliation: Istituti Clinici Scientifici Maugeri, University of Pavia

Abstract

Simple SummaryCancer has been reported as a major risk factor for adverse outcomes and death during COVID-19 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 ICS Maugeri outpatient clinic (Pavia, Italy). A comparison with the same period of the four previous years was performed. A significant reduction in access for therapy was seen between the year 2020 and 2019 but not between 2020 and 2018, 2017, or 2016. In 2020, the “pandemic fear” was the most common cause of treatment delay. Only few patients developed COVID-19. A significant reduction in radiological exams was found in 2020 versus all the other years considered. 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.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.

Highlights

Coronavirus disease 2019 (COVID-19) is a systemic infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first recognized in China at the end of December 2019, later becoming a pandemic [1].On 20 February, 2020, a severe case of pneumonia due to SARS-CoV-2 was diagnosed in NorthernItaly, in the Lombardy region [2]
The primary objective of this study was to evaluate the performance of the Oncology Unit during the COVID-19 pandemic using an endpoint represented by the number of accesses for cancer therapy and start of new patients’ treatment in 2020, compared with the same period for the four previous years
This study investigated the management of cancer patients during the COVID-19 outbreak in a Lombardy hospital and presented a report of the effects of the actions taken

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is a systemic infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first recognized in China at the end of December 2019, later becoming a pandemic [1].On 20 February, 2020, a severe case of pneumonia due to SARS-CoV-2 was diagnosed in NorthernItaly, in the Lombardy region [2]. On 20 February, 2020, a severe case of pneumonia due to SARS-CoV-2 was diagnosed in Northern. The number of cases identified in Italy rapidly increased, principally in the northern regions, with the major numbers of infections recorded in Lombardy. No health care system can be prepared to respond to such a rapid saturation of available beds in intensive care units and in the other departments of the hospitals. This fact translated into an exponential rise of the number of deaths and a reallocation of most of the available health care resources to treat COVID-19 patients, generating competition with other health care needs [3]. The Lombardy region created differentiated pathways for COVID-19 and non-COVID-19-related health services to better face the emergency [4]

Objectives

Methods

Results

Discussion

Conclusion