Vaccination for seasonal influenza, pneumococcal infection and SARS-CoV-2 in patients with solid tumors: recommendations of the Associazione Italiana di Oncologia Medica (AIOM).

Patients with cancer have a well-known and higher risk of vaccine-preventable diseases (VPDs). VPDs may cause severe complications in this setting due to immune system impairment, malnutrition and oncological treatments. Despite this evidence, vaccination rates are inadequate. The Italian Association of Medical Oncology [Associazione Italiana di Oncologia Medica (AIOM)] has been involved in vaccination awareness since 2014. Based on a careful review of the available data about the immunogenicity, effectiveness and safety of flu, pneumococcal and anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines, we report the recommendations of the AIOM about these vaccinations in adult patients with solid tumors. The AIOM recommends comprehensive education on the issue of VPDs. We believe that a multidisciplinary care model may improve the vaccination coverage in immunocompromised patients. Continued surveillance, implementation of preventive practices and future well-designed immunological prospective studies are essential for better management of our patients with cancer.

Position paper of the Italian Association of Medical Oncology on the impact of COVID-19 on Italian oncology and the path forward: the 2021 Matera statement.

The coronavirus disease 2019 (COVID-19) pandemic has severely affected cancer care and research by disrupting the prevention and treatment paths as well as the preclinical, clinical, and translational research ecosystem. In Italy, this has been particularly significant given the severity of the pandemic's impact and the intrinsic vulnerabilities of the national health system. However, whilst detrimental, disruption can also be constructive and may stimulate innovation and progress. The Italian Association of Medical Oncology (AIOM) has recognized the impact of COVID-19 on cancer care continuum and research and proposes the '2021 Matera statement' which aims at providing pragmatic guidance for policymakers and health care institutions to mitigate the impact of the global health crisis on Italian oncology and design the recovery plan for the post-pandemic scenario. The interventions are addressed both to the pillars (prevention, diagnosis, treatment, follow-up, health care professionals) and foundations of cancer care (communication and care relationship, system organization, resources, research, networking). The priorities to be implemented can be summarized in the MATERA acronym: Multidisciplinarity; Access to cancer care; Telemedicine and Territoriality; Equity, ethics, education; Research and resources; Alliance between stakeholders and patients.

COVID-19 infection in cancer patients: what has been the contribution of Associazione Italiana Oncologia Medica (AIOM) to oncological care since the beginning of the first pandemic wave?

High mortality rates in elderly patients or in those with underlying chronic illnesses and/or a compromised immune system is a peculiar feature of COVID-19 infection. The possible coexistence of a cancer and COVID-19 infection in the same individual prompted concerns regarding their synergistic effect on prognosis. In order to balance patients' needs with the risks related to the infection, the question oncologists have asked from the beginning of the first wave of the pandemic has been: 'how can we deal with COVID-19 infection in cancer patients?' In pursuing its mission, the Associazione Italiana Oncologia Medica (AIOM) has made every possible effort to support cancer patients, health care professionals and institutions in the decision-making processes the pandemic has engendered within this scenario. The relevant documents as well as the educational and institutional initiatives the AIOM has taken are reported in this article.

Clinical course and outcomes of covid-19 in cancer patients: Early result from 'oncovid-19' study

Background: Cancer patients (pts) are considered at higher risk of SARS-CoV-2 infection and more serious COVID-19 illness compared to the general population. We present the early results of the 'onCOVID-19' study exploring clinical course and outcomes of SARS-CoV-2 infection in cancer pts. Methods: In this observational study, we collected clinical data of pts referred to our institution with histologically confirmed diagnosis of solid cancer and COVID-19 from Feb 1 to May 20,2020. COVID-19 diagnosis was laboratory or radiologically confirmed or clinically suspected for suggestive symptoms, including fever (>37,5°C) and/or respiratory tract symptoms, without any other causes. Univariate and multivariate analyses were performed to explore the risk factors associated with severe events defined as hospitalization, admission to an intensive care unit, mechanical ventilation or death. Results: Of the 64 pts enrolled, 35 referring to our Oncology Unit were analysed;the remaining 29, treated for cancer in other institutions, will be included in the analysis after data completion. Pts characteristics: male/female (63/37%), current or former/never smokers (76/24%);stage IV/III (83/17%);median age 63 (47-86) years. Lung was the most frequent site of primary tumor (43%) or metastases (37%). Out 26 (74%) pts on active anti-tumor treatment, 6 (23%) received immune checkpoint inhibitors (ICI). Most common symptoms were fever (40%), shortness of breath (34%) and cough (23%);lymphopenia (<1000/mm3) was found in 5/15 (33%) tested pts. The diagnosis of COVID-19 was only clinical suspected in 2 (6%) cases and confirmed by RT-PCR or imaging (ground glass opacity and/or patchy consolidation) in 11 (31%) and 31 (88%) pts, respectively. An anti-microbial (antibiotics, antiretroviral drugs, plasma therapy) treatment was administrated in 19 (54%) pts;oxygen supplementation was required in 11 (31%) pts. Eleven (31%) pts had severe events, death occurred in 7 (20%) cases. Higher risk for developing severe events was associated with active treatment (RR 4.03, 95%CI 1.8-8.9,p=0.007) and lymphopenia (RR 4.0, 95%CI 1.1-14, p=0.007). Conclusions: Early results of our ongoing study confirmed the vulnerability of cancer pts to COVID-19. Although the small sample size, treatment with ICI and lymphopenia seem to be risk factors for death and severe events. Waiting for final results, screening cancer pts for infection should be advisable before starting immunotherapy or in case of lymphopenia.

Clinical course and outcome of COVID-19 in cancer patients: Early results from the “onCOVID-19” study

Background: Cancer patients are considered at higher risk of SARS-CoV-2 infection and more serious COVID-19 illness compared to the general population. We present the early results of the “onCOVID-19” study exploring the clinical course and outcomes of SARS-CoV-2 infection in patients affected by cancer. Methods: In this observational study, we collected clinical data from patients referred to our institution with histologically confirmed diagnosis of solid cancer and COVID-19 from Feb 1 to May 20,2020. COVID-19 diagnosis was laboratory or radiologically confirmed or clinically suspected for suggestive symptoms, including fever (>37,5°C) and/or respiratory tract symptoms. Univariate and multivariate analyses were performed to explore the risk factors associated with severe events defined as hospitalisation, admission to an intensive care unit, mechanical ventilation or death. Results: Of the 64 patients included, 35 had available clinical data on medical and cancer history required for the analysis. Median age was 63 (47-86) years. Male were 22 (63%) and current or former smokers were 25 (76%). Lung was the most frequent site of primary tumor (15, 43%) or metastases (13, 37%). Out 26 (74%) patients on active anti-tumor treatment, 6 (23%) received immune checkpoint inhibitors (ICI). Most common symptoms were fever (40%), shortness of breath (34%) and cough (23%);lymphopenia (<1000/mm3) was found in 5/15 (33%) tested patients. The diagnosis of COVID-19 was only clinically suspected in 2 (6%) cases and confirmed by RT-PCR or imaging (ground glass opacity and/or patchy consolidation) in 11 (31%) and 31 (88%) patients, respectively. An antimicrobial treatment was administered in 19 patients. Eleven (31%) patients had severe events, death occurred in 7 (20%) cases. Higher risk for developing severe events was associated with active treatment with ICI (RR 4.03, 95%CI 1.8-8.9, p=0.007) and lymphopenia (RR 4.0, 95%CI 1.1-14, p=0.007). Conclusions: We confirmed the vulnerability of cancer patients to COVID-19. Although the sample size was small, treatment with ICI and lymphopenia seem to be risk factors for death and severe events. Screening cancer patients for infection is advisable, in particular before starting immunotherapy or in case of lymphopenia. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.