Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario.

INTRODUCTION: COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. METHODS: Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS: A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% versus -3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). CONCLUSIONS: Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.

Oral therapy prescription for oncological patients during sars-cov-2 pandemia

Background: The Sars-CoV-2 pandemic led to a reorganization of all hospitals activities and assistance to cancer patients has also undergone changes. Our Medical Oncology Unit-AOU Careggi, in the lockdown phase, has provided guidelines to assist patients who receive oral cancer treatment with 'telemedicine'. Aim of this work is to analyze the different ways in which the oncological visits scheduled for the prescription of oral therapy were performed. Material and methods: We consulted the agenda of oncology visits for oral therapies scheduled between 09 March and 26 March 2020: 115 patients were included in the study. We retrospectively compared the agenda with the medical records. Most of the patients (74%) scheduled in March followed a 28-day dosing schedule (q28), 13.04% q21, for the remainder the control was less frequently. Moreover, we also recorded subsequent visits, until May 2020. We divided the visits into 3 groups: the first group includes visits scheduled only in March, the second in April (> 90%) and the third in May (> 90%). Results At the first scheduled visit during the lockdown, 1 patient did not come, in 2 cases the caregiver came, 3 patients have postponed the visit, 10 were managed by phone, 53 by phone and e-mail, 46 came to visit. In the first and third phase, patients received the drug or prescription mainly directly in the clinic (40.17% and 47.94% respectively), in contrast, in the second phase, shipping by courier was preferred (37.5%). We noticed a correlation between the basal ECOG performance status (PS), assessed before the pandemic spread, and the modality of the visit (p< .001). Most patients (55.75%) with PS ECOG 0 carried out the first visit in the lockdown phase electronically (e-mail and telephone contact). However, no statistically significant correlation emerged between the Charlson comorbidity index and the method of carrying out the visit (p 0.998). Comparing the baseline PS and that recorded at the last visit, a statistically significant deterioration emerged (p < .001). Considering the baseline ECOG PS 0, at the third visit 52.94% of the evaluable patients maintained the PS. In 18 patients the data is missing. Conclusions: Telemedicine seems to be feasible in some contexts. The challenge is to select the right patient in the right moment. PS could be a screening tool but other factors should be investigated such as availability of appropriate technology for telemedicine.

Sars-cov2 pandemia and delayed cancer treatment: A single centre experience

Background: Pandemic SARS-CoV2 infection was characterized by a severe respiratory syndrome whit a worst course in elderly with comorbidity. Oncology patients (pts) may be at risk for an unfavorable course of infection (1). For this, oncologists had to choose how maintaining therapeutic benefit, minimizing risk of treatments (txs). Oncologist associations had recommended to reduce risk but encouraging continuation of txs. Indeed, one of the risks for oncological pts was inability to receive necessary medical service (2). In this study we reported our experience. Methods: We analyzed pts with solid tumors which received 1 cycle of therapy from 9 to 30 March 2020 at Medical Oncology Unit of Azienda Ospedaliero Universitaria Careggi. We subsequently followed pts over time to evaluate delays in subsequent cycles, and its cause (COVID19 or not related). Results: We analyzed 118 pts (27% affected by lung cancer), divided in age groups (172 were over 50, 96 over 70 and 16 over 80), setting (86% metastatic disease, 8% adjuvant and 7% neoadjuvant/perioperative and type of txs (32% immunotherapy). There were 26 delay in second cycles, 24 in third and only 2 in fourth. In 18 cases delay was scheduled to minimize risk of COVID19 contagion. Expected neutropenia risk did not significantly influenced delay, while age influenced in pts over 60 (13,3% of delay in 80-90 group, 13,3% in 70-79, 17,3% 60-69 and 5,3% in 50-59). Adjuvant txs showed greater delays than metastatic and neoadjuvant /perioperative. 14% of immunotherapies (no difference in lung cancer vs others) was delayed vs 16% of other txs. Conclusions: The SAR-CoV2 pandemic infection obligated oncologists to establish the risk/benefit ratio of a delay in txs, in absence of data. In our experience, the age> 60 and adjuvant setting have more often delayed txs, while type of therapy and the risk of neutropenia have had less impact. In contrast to cancer society's recommendations, there have been no greater delays in immunotherapy in lung cancer than in other diseases. The delay was more frequent in the first phase of the pandemic, probably due to the progressive reorganization of the cancer department.

Follow-up cancer management in covid-19 era: A single center experience

Background: The COVID-19 global pandemic required a great organizational effort to reduce the n. of patient contacts in Hospital. Based on a recent Italian survey 80% of cancer centers adopted alternative modalities to get in touch with patients. However there are no data on the remote management in follow-up. Material and methods: In this study we collected data regarding oncological patients in follow-up whose control visit was scheduled between 11/03 and 15/05 at AOUC. Categorical data were analysed by chi square or Fisher exact test;statistical analysis of continuous variables was performed by Mann Whitney U test. Results: 222 patients were enrolled: 99 man, 123 women (median age 68 yrs). The 43.6% were affected by gastrointestinal tumors, 21.1% genitourinary, 17.5% gynecological/ breast, 8.5% thoracic and 7.2% melanoma. 35% were stage I, 30% stage II, 23% stage III and 12% stage IV. The median time from diagnosis was 3 years. 192 out of 222 (86%) did not underwent the planned medical examination;28% of them postponed (9% managed by call, 1 by email and 89 both). 51% of them were contacted through the caregiver. The % of patients that underwent medical examination was 4.4, 11.7 e 24.25 in March, April and May respectively, suggesting a different compliance with respect to remote management, correlated to a perception of the risk of infection. The median postponement time of was 28 days (5-51). For almost all patients (95.5%) there was no evidence of disease, for 2.7% was registered a relapse and for 1.8% additional examination was ongoing: a correlation was observed between in-person visit and the recurrence (p=0.012) and between elderly patients and caregiver mediated contact (p=0.002). Conclusions: This experience shows that the remote management of cancer patients in follow-up is feasible. Many aspects need to be clarified: lates outcomes, patient satisfaction, type of patients who can benefit. Almost all patients were managed both by telephonic interview and by e-mail, resulting in longer consultation time. Likely, a preventive and exhaustive patient information and a better technological equipment would improve the quality and the duration of the tele-consultation. The incremental percentage of in-person visits is another aspect to be investigated. Lastly, greater attention and training should be addressed to caregivers. The correlation emerged between in person in-visit and recurrence could be explained by a proper physician screening.