Oncology Treatments during the COVID-19 Pandemic in Israel: the ONCOR Study

Background: The increased susceptibility of cancer patients to coronavirus disease-2019 (COVID-19) infections and complicaions calls for special precautions while treating cancer patientS during COVID-19 pandemic. Thus, oncology departments have had to implement a wide array of prevention measures. Objectives: To address issues associated with cancer care during the COVID-19 pandemic and to assess the implementation of measures aimed at containment of COVID-19 diffusion while allowing continuation of quality cancer care. Methods: A national survey among oncology departments in Israel was conducted between 12 April 2020 and 14 April 2020. Eighteen heads of hospital-based oncology departments completed a self-report questionnaire regarding their institute's preparedness for treatment of cancer patients during the COVI 0-19 pandemic. Results: In this national survey, prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying in the departments. Most participants (78-89%) reported using a quick triage of patients and caregivers prior to their entrance to the oncology units, limiting the entrance of caregivers, and reducing unnecessary visits to the clinic. Switching to oral therapies rather than intravenous ones when possible was considered by 82% and shortage in personal protective equipment was reported by five (28%) heads of oncology departments. Some differences between large and small/medium sized medical centers were observed regarding issues related to COVI D-19 containment measures and changes in treatment. Conclusions: Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity.

[Oncology Care Challenges Treating Covid-19 Confirmed Cancer Patients: A Review and Recommendations]

INTRODUCTION: The highly contagious virus, SARS-CoV-2 causing a human respiratory disease, COVID-19, imposed a global pandemic with significant short- and long-term health consequences. It has challenged the active treatment of oncology patients, having protocols that require frequent monitoring. Some patients' anxiety of the COVID-19 pandemic led to delays in treatment and impaired the effectiveness of anti-cancer therapy. Moreover, the stage migration term was coined to newly referred patients who postponed their doctor's appointment leading to late diagnosis. Prevention of COVID-19 disease among oncology patients is a priority, in order to avert morbidity, complications and mortality. In a recently published article, Waissengrin et al. compared the incidence of COVID-19 disease in oncology patients at Tel-Aviv Medical Center to the general population between March 2020 and October 2020. A lower rate of confirmed cases was demonstrated among oncology patients in comparison to the general population. This difference was attributed to the oncology patients' adherence to COVID-19 avoidance guidelines. In addition, no association was found between a specific type of cancer or oncological treatment and mortality from COVID-19. However, a significant correlation was presented between severe COVID-19 disease, old age and the presence of metastases. Waissengrin et al., support the importance of continuing the oncological care routine to avoid the devastating consequences of postponing treatments. Despite the development of a number of FDA-approved vaccines against the virus, the world is still facing challenges associated with the COVID-19 pandemic, e.g. variant B.1.617.2 ominous of yet more lockdowns due to a rapid rising wave of morbidity.

[Treatment of Oncology Patients during the Corona Virus Era]

BACKGROUND: Cancer patients are more at risk to contract SARS-CoV-2 and may develop many more severe complications, along with high mortality rates relative to the cancer-free population. The outbreak of the epidemic was characterized by a high rate of infection from person to person, however medical systems remained fully functional. Following most international guidelines, adaptations were made to the performance level of oncology treatments, and the service was to continue as usual. Moreover, the corona virus epidemic era was characterized by new challenges such as emergency work schedules, additional hygiene measures and social distancing. Furthermore, the medical staff used Personal Protection Equipment and resource preparedness for a larger outbreak and probable collapse of the health system. Therefore, changes have been made in the form and delivery of patient care and treatments. This article presents the work format employed in the Oncology Unit at Bnai Zion Medical Center during the COVID-19 epidemic. The newly adjusted protocol included four areas: staff, patients, infrastructure and malignant disease types.

SARS-CoV-2 infection and lung cancer management in Europe

Background: Patients (pts) with lung cancer (LC) are at high risk for hospitalization and mortality from COVID-19. Patients and physicians don‘t feel safe to continue LC diagnosis and treatments. Modifications of LC management varied between countries. ESMO guidelines in the COVID-19 era were published promptly, during the COVID-19 epidemic in Europe aiming to guide all stakeholders in lung cancer. Methods: A virtual meeting among LC experts from Belgium, Switzerland, Portugal, Slovenia, Norway, Croatia, Poland, Romania, Greece and Israel was held on April 27 to discuss the impact of the COVID-19 pandemic on the lung cancer care in each country. The discussion was based on the ESMO recommendations. Each participant described the SARS-CoV2 epidemic phase in country and filled a questionnaire based on the enforcement of each statement from the ESMO guidelines. Results: All countries are in the community level SARS-CoV2 transmission. In 3 countries health care services exceeded their capacities. Four countries have implemented the ESMO guidelines without any modification (Switzerland, Norway, Israel and Croatia). High Level of recommendations in the outpatient and inpatient services were implemented in all countries with minor modifications. Intermediate level recommendations were implemented in 9 of 10 countries. Low priority level was implemented in 7 of 10 countries. Main modifications were: surgery for stage I NSCLC as a high priority, all non-curative surgical interventions postponed, differences in imaging priorities. In 5 of 10 countries local oncology societies issued recommendations mainly consistent with ESMO but medical oncologists also follow recommendations issued by the health ministry. Conclusions: ESMO guidelines prioritizing LC management are implemented in all participating countries. High and intermediate level recommendations are implemented with minor modification regardless the phase of the pandemic. The differences among countries are not related to the phase of pandemic but mostly to the health system capacity and socioeconomic factors in each country. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A. Agbarya: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: MSD;Roche;AstraZeneca;BI;Pfizer;Takeda;Advisory/Consultancy: Novartis;Honoraria (self), Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: BMS;Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony: Eli Lilly;Honoraria (self), Speaker Bureau/Expert testimony: Merck Serono;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Sanofi. A. Addeo:Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;Honoraria (self): AZD;Honoraria (self), Travel/Accommodation/Expenses: Merck;Honoraria (self), Advisory/Consultancy: Pfizer;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Takeda;Roche;Advisory/Consultancy: AstraZeneca;MSD;BI. A. Charpidou: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: AZ;Honoraria (self), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: BMS;Honoraria (self), Travel/Accommodation/Expenses: Roche;Honoraria (self), Advisory/Consultancy: BI;Honoraria (self): MSD. A. Araújo: Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis;Eli Lilly;BMS;MSD;Roche;Sanofi;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (self): Astellas;Janssen;Advisory/Consultancy: Hospira;BMS;Pfizer;Clovis;BI;Takeda;Research grant/Funding (self): Pharmamar. K. Cuppens: Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;MSD;AZ;BI;Roche;Travel/Accommodation/Expenses: Pfizer;Research grant/Funding (self): Belgian Respiratory Society. O.T. Brustugun: Honoraria (self), Honoraria (institution), Research grant/Funding (institution), Travel/Accommodation/Expenses: AZ;onoraria (self), Honoraria (institution), Travel/Accommodation/Expenses: Roche;Honoraria (self), Travel/Accommodation/Expenses: Novartis;Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: BI;Honoraria (self), Travel/Accommodation/Expenses: Eli Lilly;Honoraria (self), Honoraria (institution), Travel/Accommodation/Expenses: MSD;BMS;Takeda;Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Honoraria (institution): GSK. M. Rajer: Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony: AZ;Roche;BMS;MSD;Lilly;Amgen;Travel/Accommodation/Expenses, Full/Part-time employment: Institute Of Oncology Ljublijana. M. Jakopovic: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;AZ;BI;MSD;Novartis;Pfizer. M.V. Marinca: Honoraria (self), Travel/Accommodation/Expenses: Merck;Astellas;Pfizer;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;Honoraria (self): Accord;Amgen;Angelini;Eli Lilly;Johnson and Johnson;Sandoz;MSD;Solacium;BI;Honoraria (self), Advisory/Consultancy: AZ;Novartis;Ispen;Roche;Egis;Full/Part-time employment: Medical Oncology (IRO Iasi), Grigore T. Popa University of Medicine & Pharmacy, Iasi, Romania;Non-remunerated activity/ies: Comission For Treatment In Foriegn Countries. A. Pluzanski: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: BI;Pfizer;BMS;Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: AZ;Speaker Bureau/Expert testimony: MSD.