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Optimising triage procedures for patients with cancer needing active anticancer treatment in the COVID-19 era.
ESMO Open. 2020 09; 5(5)EO

Abstract

BACKGROUND

Immunosuppression induced by anticancer therapy in a COVID-19-positive asymptomatic patient with cancer may have a devastating effect and, eventually, be lethal. To identify asymptomatic cases among patients receiving active cancer treatment, the Federico II University Hospital in Naples performs rapid serological tests in addition to hospital standard clinical triage for COVID-19 infection.

METHODS

From 6 to 17 April 2020, all candidates for chemotherapy, radiotherapy or target/immunotherapy, if negative at the standard clinical triage on the day scheduled for anticancer treatment, received a rapid serological test on peripheral blood for COVID-19 IgM and IgG detection. In case of COVID-19 IgM and/or IgG positivity, patients underwent a real-time PCR (RT-PCR) SARS-CoV-2 test to confirm infection, and active cancer treatment was delayed.

RESULTS

Overall 466 patients, negative for COVID-19 symptoms, underwent serological testing in addition to standard clinical triage. The average age was 61 years (range 25-88 years). Most patients (190, 40.8%) had breast cancer, and chemotherapy with or without immunotherapy was administered in 323 (69.3%) patients. Overall 433 (92.9%) patients were IgG-negative and IgM-negative, and 33 (7.1%) were IgM-positive and/or IgG-positive. Among the latter patients, 18 (3.9%), 11 (2.4%) and 4 (0.9%) were IgM-negative/IgG-positive, IgM-positive/IgG-negative and IgM-positive/IgG-positive, respectively. All 33 patients with a positive serological test, tested negative for RT-PCR SARS-CoV-2 test. No patient in our cohort developed symptoms suggestive of active COVID-19 infection.

CONCLUSION

Rapid serological testing at hospital admission failed to detect active asymptomatic COVID-19 infection. Moreover, it entailed additional economic and human resources, delayed therapy administrationand increased hospital accesses.

Authors+Show Affiliations

Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Public Health, University of Naples Federico II, Naples, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.Direzione Sanitaria, Azienda Ospedaliera Universitaria Federico II, Naples, Italy.Direzione Generale, Azienda Ospedaliera Universitaria Federico II, Naples, Italy.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy m.giuliano@unina.it.Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Campania, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32958531

Citation

Arpino, Grazia, et al. "Optimising Triage Procedures for Patients With Cancer Needing Active Anticancer Treatment in the COVID-19 Era." ESMO Open, vol. 5, no. 5, 2020.
Arpino G, De Angelis C, De Placido P, et al. Optimising triage procedures for patients with cancer needing active anticancer treatment in the COVID-19 era. ESMO open. 2020;5(5).
Arpino, G., De Angelis, C., De Placido, P., Pietroluongo, E., Formisano, L., Bianco, R., Fiore, G., Montella, E., Forestieri, V., Lauria, R., Cardalesi, C., Vozzella, E. A., Iervolino, A., Giuliano, M., & De Placido, S. (2020). Optimising triage procedures for patients with cancer needing active anticancer treatment in the COVID-19 era. ESMO Open, 5(5). https://doi.org/10.1136/esmoopen-2020-000885
Arpino G, et al. Optimising Triage Procedures for Patients With Cancer Needing Active Anticancer Treatment in the COVID-19 Era. ESMO open. 2020;5(5) PubMed PMID: 32958531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimising triage procedures for patients with cancer needing active anticancer treatment in the COVID-19 era. AU - Arpino,Grazia, AU - De Angelis,Carmine, AU - De Placido,Pietro, AU - Pietroluongo,Erica, AU - Formisano,Luigi, AU - Bianco,Roberto, AU - Fiore,Giovanni, AU - Montella,Emma, AU - Forestieri,Valeria, AU - Lauria,Rossella, AU - Cardalesi,Cinzia, AU - Vozzella,Emilia Anna, AU - Iervolino,Anna, AU - Giuliano,Mario, AU - De Placido,Sabino, PY - 2020/06/30/received PY - 2020/08/11/revised PY - 2020/08/12/accepted PY - 2020/9/22/entrez PY - 2020/9/23/pubmed PY - 2020/9/29/medline KW - SARS-CoV-2 KW - cancer KW - covid-19 JF - ESMO open VL - 5 IS - 5 N2 - BACKGROUND: Immunosuppression induced by anticancer therapy in a COVID-19-positive asymptomatic patient with cancer may have a devastating effect and, eventually, be lethal. To identify asymptomatic cases among patients receiving active cancer treatment, the Federico II University Hospital in Naples performs rapid serological tests in addition to hospital standard clinical triage for COVID-19 infection. METHODS: From 6 to 17 April 2020, all candidates for chemotherapy, radiotherapy or target/immunotherapy, if negative at the standard clinical triage on the day scheduled for anticancer treatment, received a rapid serological test on peripheral blood for COVID-19 IgM and IgG detection. In case of COVID-19 IgM and/or IgG positivity, patients underwent a real-time PCR (RT-PCR) SARS-CoV-2 test to confirm infection, and active cancer treatment was delayed. RESULTS: Overall 466 patients, negative for COVID-19 symptoms, underwent serological testing in addition to standard clinical triage. The average age was 61 years (range 25-88 years). Most patients (190, 40.8%) had breast cancer, and chemotherapy with or without immunotherapy was administered in 323 (69.3%) patients. Overall 433 (92.9%) patients were IgG-negative and IgM-negative, and 33 (7.1%) were IgM-positive and/or IgG-positive. Among the latter patients, 18 (3.9%), 11 (2.4%) and 4 (0.9%) were IgM-negative/IgG-positive, IgM-positive/IgG-negative and IgM-positive/IgG-positive, respectively. All 33 patients with a positive serological test, tested negative for RT-PCR SARS-CoV-2 test. No patient in our cohort developed symptoms suggestive of active COVID-19 infection. CONCLUSION: Rapid serological testing at hospital admission failed to detect active asymptomatic COVID-19 infection. Moreover, it entailed additional economic and human resources, delayed therapy administrationand increased hospital accesses. SN - 2059-7029 UR - https://www.unboundmedicine.com/medline/citation/32958531/Optimising_triage_procedures_for_patients_with_cancer_needing_active_anticancer_treatment_in_the_COVID_19_era_ L2 - https://esmoopen.bmj.com/lookup/pmidlookup?view=long&pmid=32958531 DB - PRIME DP - Unbound Medicine ER -