Infection Control of 2019 Novel Corona Virus Disease (COVID-19) in Cancer Patients Undergoing Radiotherapy in Wuhan

Abstract

Background: A pandemic of 2019 novel corona virus disease (COVID-19), which was first reported in Wuhan city, has affected more than 100,000 patients worldwide. Patients with cancer are at a higher risk of COVID-19, but currently, there is no guidance on the management of cancer patients during this outbreak. Here, we report the infection control measures and early outcomes of patients who received radiotherapy (RT) at a tertiary cancer centre in Wuhan. Methods: We reviewed all patients who were treated at the Zhongnan Hospital of Wuhan University (ZHWU) from Jan 20 to Mar 6, 2020. This preceded the city lock-down date of Jan 23, 2020. Infection control measures were implemented, which included a clinical pathway for managing suspect COVID-19 cases, on-site screening, modifications to the RT facility, and protection of healthcare workers. Primary end-point was infection rate among patients and healthcare staff. Diagnosis of COVID-19 was based on the 5th edition criteria. Findings: 209 patients completed RT during the study period. Median age was 55 y (IQR = 48-64). Thoracic, head and neck, and lower gastrointestinal and gynaecological cancer patients consisted the majority of patients. Treatment sites included thoracic (38.3%), head and neck (25.4%), and abdomen and pelvis (25.8%); 47.4%, 27.3%, and 25.4% of treatments were for adjuvant, radical, and palliative indications, respectively. 188 treatments/day were performed prior to the lock-down, in contrast to 12.4 treatments/day post-lock-down. Only one (0.48%) patient was diagnosed with COVID-19 during the study period. No healthcare worker was infected. Interpretation: Herein, we show that in a susceptible population to COVID-19, strict infection control measures can curb human-to-human transmission, and ensure timely delivery of RT to cancer patients. Funding Statement: Dr Chua is supported by National Medical Research Council Clinician-scientist award (NMRC/CSA/0027/2018). Prof. Xie is supported by Health Commission of Hubei Province Scientific Research Project (WJ2019H002), Health Commission of Hubei Province Medical Leading Talent Project, Fundamental Research Funds for the Central Universities (2042018kf1037, 2042019kf0329), Medical Science Advancement Program (Basic Medical Sciences) of Wuhan University (TFJC2018005), Zhongnan Hospital of Wuhan University Science, Technology and Innovation Seed Fund (znpy2017049, znpy2018070). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was approved by the institutional review board of ZHWU (2020039). As aggregated, anonymised patient data was used in this study, waiver of consent was approved by the ethics committee.