ABSTRACT
The public emergency caused by Covid-19 has forced health services to reorganize in order to separate positive patients from negative ones. In nephrology, this reorganization involves several levels of assistance concerning hospitalizations, ambulatory care and haemodialysis. Within the Complex Unit of Nephrology in Ragusa, the distribution of nephro-dialytic resources has involved four different hospitals, hence ensuring haemodialysis services for asymptomatic and pauci-symptomatic Covid-19 patients as well as for patients in Covid-Unit, Sub-Intensive Therapy and Intensive Care Unit. In this complex context, we had to create a common protocol involving all the professionals who provide assistance in our Unit, across the different structures. We also report some encouraging data that seem to indicate the effectiveness of the protocols put in place.
ABSTRACT
Background: COVID-19 pandemic started in Italy with clusters identified in Northern Italy. Since the beginning, the Veneto region started a proactive approach, including testing for SARS-CoV-2 part of the asymptomatic population and healthcare providers. The Veneto Oncology Network ROV licensed a dedicated PDTA to ensure proper care minimizing the risk of infection in cancer patient (pts). At the same time, a regional registry (ROVID) has been set up, to describe epidemiology and clinical course of SARS-CoV-2 infection in cancer pts. Materials and methods: All pts with cancer diagnosis and documented SARS-CoV-2 infection are eligible. The following information are recorded: age, cancer diagnosis, stage, tumor biology, comorbidities, presence of COVID- 19 symptoms, anticancer treatment at the time infection (type, aim, line of therapy, discontinuation, recovery), other medical treatments, hospitalization, treatments for SARS-CoV-2 infection, fate of the infection. Results: 144 pts from 18 centers have been enrolled. Mean age at the time infection: 69 yrs (25 to 95 yrs). The 5 most common cancer types were breast cancer (n=26), colorectal, prostate, lung cancer (n=16 each), melanoma (n=10). Distribution by stage was as follows: I 19%, II 9%, III 13%, IV 59%. Lung metastases were documented in 15% of the cases. 77% of the pts had at least one comorbidity. COVID-19 symptoms were reported in 78% of the pts. Active anticancer therapy at the time of the infection was reported for 71 pts (chemotherapy n=37, targeted therapy n=14, hormonal therapy n=13, immunotherapy n=6). Treatment was discontinued because of infection in 44 case. 101 pts were hospitalized;45 received low flow oxygen support and 26 received non-invasive mechanical ventilation, high flow nasal cannula or endotracheal intubation. The fate of infection is available for 95 cases so far: 44 infection resolution with confirmed negative swab, 16 with clinical resolution discharged with positive swab, and 35 deaths. Among cases with fatal exitus, 22 were attributable to COVID-19. Conclusions: Data collection is still ongoing, including further follow up and results of serological tests, where available. The mortality rate reported in this study is in line with other registry of cancer patients, confirming the frailty of this population. These data reinforce the need to protect cancer patients from SARS-CoV2 infection.
ABSTRACT
Background: The prospective, multicenter, observational INVIDIa-2 study was designed to investigate the clinical efficacy of influenza vaccination in advanced cancer patients receiving immune checkpoint inhibitors (ICIs) from October 2019 to January 2020. The primary endpoint was the incidence of influenza-like illness (ILI) until April 30, 2020. All ILI episodes, laboratory tests, complications, hospitalizations and pneumonitis were recorded. Therefore, the INVIDIa-2 study prospectively recorded all the COVID-19 ILI events. Methods: Patients were included in this non-prespecified COVID-19 preliminary analysis if potentially exposed to Sars-Cov-2 infection, namely alive on January 31, 2020, when the Italian government declared the National emergency. The incidence of confirmed COVID-19 was assessed among patients with ILI symptoms, describing the hospitalization rate and mortality. Cases with clinicalradiological diagnosis of COVID-19 without laboratory confirmation (COVID-like ILIs), were also reported. The COVID-incidence was exploratively compared basing on influenza vaccination. Results: 1260 patients receiving ICI were enrolled between October 2019 and January 2020;955 patients were analyzed according to the inclusion criterion. Of them, 66 patients had ILI from January 31, to April 30, 2020. 9 were COVID-19 ILIs with laboratory test confirmation. The COVID-19 ILI incidence was 0.9% (9/955 cases), with hospitalization rate of 100% and mortality rate of 67%. Including 5 COVID-like ILIs, the overall COVID-19 incidence was 1.5% (14/955), with hospitalization in 100% of cases and mortality rate of 64%. COVID-19 incidence was 1.2% for patients vaccinated against influenza (6/482 cases) and 1.7%, among unvaccinated patients (8/473 including 3 confirmed COVID-19 and 5 COVID-like), p = 0.52. The difference was not statistically significant, and the clinical trend in favor of vaccinated patients was lost when considering only confirmed COVID-19 (1.2% in vaccinated vs 0.6% in unvaccinated patients, p = 0.33), probably due to the greater presence of male and elderly patients in the vaccinated group (p = 0.009). Conclusions: We obtained the first prospective epidemiological data about symptomatic COVID-19 in advanced cancer patients receiving ICIs. The overall symptomatic COVID-incidence is meaningful, requiring hospitalization in all cases and leading to a high mortality rate, likely due advanced cancer more than to ICI therapy [Mengyuan Dai, Cancer Discov 2020].