Abstract
IntroductionCancer patients may have a higher risk of severe events and unfavourable outcomes in the setting of COVID-19. This review addresses the question of whether to test asymptomatic cancer patients before initiating systemic cancer treatments.MethodsThis systematic review was conducted based on the PRISMA framework. Pubmed, Embase, Web of Science and Cochrane Central Register of Controlled Trials were systematically searched, as well as guidelines from international institutions involved in cancer care and COVID-19 research. Studies published in English, from 1 December 2019 to 27 May 2020 were considered eligible. We included studies which mentioned testing strategies for SARS-CoV-2 of asymptomatic cancer patients before starting immunosuppressive treatments.ResultsWe identified 1,163 studies and 4 guidelines through the literature search. A total of 18 articles were considered eligible and were included in the final analysis. Two articles were cohort studies, and the remaining were expert consensuses and published guidelines. The most common recommendation among the studies in this systematic review was to test asymptomatic patients for SARS-CoV-2 prior to treatment.ConclusionThere is a lack of studies which directly address COVID-19 testing of asymptomatic patients before treatment. Our systematic review showed that most of the published data favours routine test for SARS-CoV-2 before initiating systemic treatment but failed to identify a good level of evidence to support these recommendations. Based upon this review, we proposed local recommendations at our centre. Each institution should consider the pros and cons of testing asymptomatic patients, evaluating accessibility to testing resources and local epidemiology.
Highlights
Cancer patients may have a higher risk of severe events and unfavourable outcomes in the setting of COVID-19
In order to optimise and expand the search results, we examined guidelines from some of the main international institutions involved with oncology and COVID-19 research: ASCO (American Society of Clinical Oncology), ESMO (European Society for Medical Oncology), NCCN (National Comprehensive Cancer Network) and IDSA (Infectious Diseases Society of America)
One hundred twenty-six studies were excluded, mainly due to the fact that they did not mention any strategy for testing asymptomatic cancer patients and did not fulfil the inclusion criteria
Summary
Cancer patients may have a higher risk of severe events and unfavourable outcomes in the setting of COVID-19. Special concern is raised for patients with cancer, potentially exposed to a higher incidence of COVID-19. They seem to have a higher risk of severe events, such as admission in intensive care units, invasive ventilation or death [6,7,8,9], and even a higher mortality rate than general population [10]. Previous oncologic treatments may result in a higher risk of severe events [11] These negative outcomes could potentially be explained by advanced age, immunosuppression, treatment-related effects and complications, the need for frequent hospital visits and admissions, and impaired functional status [12]
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