ABSTRACT
Background: Over the last few years, the introduction of new systemic therapies (e.g. CDKi) significantly changed the treatment paradigm of patients (pts) with luminal-like MBC. The purpose of this work is to evaluate the impact of CDKi adoption in clinical practice on medical oncology workload. Material and methods: We examined a consecutive series of 492 pts who received therapy for MBC at the Academic Hospital of Udine during two historical cohorts A (2016- 2017) and B (2018-2019), respectively before and after the first CDKi approval in Italy. In order to avoid confounding effect of SARS-CoV-2 pandemic, 2020 data were not collected. The aim of the study was to evaluate differences in terms of number and type of outpatient oncological visits (i.e. planned visits, unplanned presentations and i.v. treatment sessions) between the two cohorts. Results: We analyzed a total number of 5,001 oncology activities deriving from 86 pts (A) and 85 pts (B) who started first line treatment for luminal-like MBC. In the cohort A, HER2, triple negative and luminal-like subtypes were respectively 19%, 19% and 63%. Pts enrolled in clinical trials were 19. In the cohort B, HER2 triple negative and luminal-like subtypes were respectively 20%, 10% and 66%. Notably, 29 pts with luminal-like disease received CDKi. 7 pts were treated in clinical trials. During the period of observation (two years), mean number of planned visits for each patient was 16.5 (A) vs 15.5 (B), mean number of unplanned presentations was 2 (A) vs 2.1 (B) and mean number of treatment i.v. sessions was 11 (A) vs 11.1 (B). Excluding pts with no luminal MBC or enrolled in clinical trials, for each patient the mean number of planned visits was 15.3 (A) vs 15.7 (B), the mean number of unplanned presentations was 1.9 (A) vs 2 (B) and the mean number of treatment i.v. sessions was 9.9 (A) vs 8.7 (B). Conclusions: No differences in terms of medical oncology workload were observed between two historical cohorts of pts with luminal-like MBC. These findings support the handy use of CDKi into clinical practice. Further analyses are ongoing to evaluate the impact in terms of instrumental and blood chemistry tests.
ABSTRACT
Background: SARS-CoV-2 infection and the associated COVID-19 pneumonia have dramatically disrupted the management of cancer care worldwide. Indeed, this crisis has raised the urge of thoughtfully balancing the risk of delaying potentially curative treatments and the risk of developing a life-threatening respiratory infection. In this study, we report the experience of an Italian Reference Cancer Center, where close triage procedures had to be promptly adopted. Patients and methods: We retrospectively analyzed a consecutive cohort of 787 cancer patients (pts) who accessed the Day Hospital (DH) of the Oncology Department of Udine from April 6th to June 19th 2020. Screening NP swabs and RT-PCR analysis were performed at every access in pts who, after passing the triage, were admitted to receive intravenous therapies. Clinicopathological data were collected from electronic health records and include sex, age, tumor type, disease stage, type of treatment, number of swabs received and RT-PCR results. Results: In a population of 787 cancer pts receiving intravenous therapies, 2602 NP swabs were performed. Among all pts 55.7% were female and 44.3% male pts, respectively;54.9% of pts aged ≥65. Of note, 28.2% of pts had gastrointestinal tumors, 23% breast cancer, 19.8% lung cancer and 14.2% tumors of the genitourinary tract. Approximately 32% of pts had early-stage disease whereas 68% of pts received therapies for advanced disease. Treatments most frequently included chemotherapy (60%), immunotherapy (14.7%) and target therapies (9.8%) whereas 11.1% of swabs were performed in pts who entered to DH for supportive therapy. The median number of SARS-CoV-2 tests per patient was 3 and 26% of pts received ≥5 swabs. In the whole population, only 10 SARS-CoV-2 tests (1.3%) resulted positive and the isolating procedures were promptly activated. Conclusions: In the pandemic context, the adoption and gradual improvement of rigorous procedures aimed at minimizing COVID-19 spread among pts and healthcare professionals are mandatory to ensure continuity of care for cancer pts. In our experience systematic triage, sequential screening with NP swabs and the prompt identification of asymptomatic SARS-CoV-2 carriers limited COVID-19 spread among cancer pts accessing the Oncology DH.
ABSTRACT
Background: The outbreak of SARS-CoV-2 infection and the associated COVID-19 pneumonia have dramatically disrupted the delivery of cancer care worldwide. Indeed, this crisis has raised the urge of thoughtfully balancing the risk of delaying potentially curative treatments against the harm of developing a life-threatening respiratory infection. In this study, we report the experience of an Italian Reference Cancer Center, where strict triage procedures had to be promptly adopted. Methods: We retrospectively analyzed a consecutive cohort of 787 cancer patients (pts) who accessed the Day Hospital (DH) of the Oncology Department of Udine from April 6th to June 19th 2020. Screening NP swabs and RT-PCR analysis were performed at every access in pts who, after passing the triage, were admitted to receive intravenous therapies. Clinicopathological data were collected from electronic health records and include sex, age, tumor type, disease stage, type of treatment, number of swabs received and RT-PCR results. Results: Overall, 2602 NP swabs were performed in a population of 787 cancer pts receiving intravenous therapies, including 55.7% female and 44.3% male pts, respectively, with 54.9% aged ≥65. Of note, 28.2% of pts had gastrointestinal tumors, 23% breast cancer, 19.8% lung cancer and 14.2% tumors of the genitourinary tract. Approximately 32% of pts had early-stage disease whereas 68% of them was receiving therapies for advanced disease. Treatments most frequently included chemotherapy (60%), immunotherapy (14.7%) and target therapies (9.8%) whereas 11.1% of swabs were performed in pts entering the premises for supportive therapy. The median number of SARS-CoV-2 tests per patient was 3 and 26% of pts received ≥5 swabs. In the whole population, only 10 SARS-CoV-2 tests (1.3%) resulted positive and were promptly isolated. Conclusions: In the pandemic context, the adoption and gradual refinement of rigorous procedures aimed at minimizing COVID-19 diffusion among pts and healthcare professionals are mandatory to ensure continuity of care. In our experience systematic triage, sequential screening with NP swabs and the prompt identification of asymptomatic SARS-CoV-2 carriers limited COVID-19 spread among cancer pts accessing the Oncology DH. Legal entity responsible for the study: ASUFC. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Background: Over the last few years, the introduction of newer systemic therapies (e.g. CDKi) significantly changed the treatment paradigm of patients (pts) with MBC. The purpose of this work is to evaluate the impact of CDKi introduction in clinical practice in terms of medical oncology workload. Methods: We examined a consecutive series of 492 pts who received therapy for MBC in Academic Hospital of Udine during two historical cohorts A (2016-2017) and B (2018-2019), respectively before and after the first CDKi approval in Italy. Data about 2020 were not collected due to confounding effect of SARS-CoV-2 pandemic. Pts with no luminal MBC or enrolled in clinical trial were excluded. We performed descriptive analyses to examine any differences in terms of number and type of outpatient visits to the oncology department (i.e. planned visits, unplanned presentations and i.v. treatment sessions) between the two cohorts. Results: We analyzed a total number of 2,645 oncology activities deriving from 42 pts (cohort A) and 57 pts (cohort B) who started first line treatment for luminal MBC. Median age was 66 and 70 years respectively. In the first group, pts receiving chemotherapy were 23.8% and those treated with CDKi were 7,14%. In the second group, chemotherapy was administered in 22.8% of pts and CDKi in 49.12%. In cohort A, number of planned visits, unplanned presentations and i.v. treatment sessions were respectively 643, 82 and 418. In cohort B, number of planned visits, unplanned presentations and treatment sessions were 892, 114 and 496. During the period of observation (two years), for each pts mean number of planned visits were 15,30 (cohort A) vs 15,64 (cohort B), mean number of unplanned presentations were 1,95 (cohort A) vs 2 (cohort B), treatment i.v. sessions were 9,9 (cohort A) vs 8,7 (cohort B). Conclusions: With the limits of a retrospective analysis, no differences were found between two cohorts of pts. Notably, there was a slight decrease of i.v. treatment sessions after CDKi introduction. Other analysis are ongoing to evaluate the workload in terms of instrumental and blood chemistry tests. This data further support the handy use of this drugs into clinical practice. Legal entity responsible for the study: Azienda Sanitaria Universitaria Friuli Centrale (ASUFC) Funding: Has not received any funding. Disclosure: M. Mansutti: Financial Interests, Institutional, Advisory Board: AstraZeneca;Financial Interests, Institutional, Advisory Board, invited speaker: Novartis;Financial Interests, Institutional, Advisory Board, invited speaker: Eli Lilly;Financial Interests, Institutional, Advisory Board, invited speaker: Pfizer;Financial Interests, Institutional, Advisory Board: MSD Italia;Financial Interests, Institutional, Advisory Board, invited speaker: EISAI;Financial Interests, Institutional, Advisory Board: Pierre Fabre;Financial Interests, Institutional, Advisory Board: Roche;Financial Interests, Institutional, Advisory Board: Celgene. All other authors have declared no conflicts of interest.
ABSTRACT
Background: To minimize the risk of COVID-19 infection spreading, we developed a triage procedure, consisting of body temperature measuring and a structured questionnaire that each patient (pt) was asked to fill-in before accessing to our department. This questionnaire explored 4 items: fever, respiratory tract symptoms (flue syndrome, sore throat, cough, dyspnea, loss of taste or smell), previous contacts or personal positivity for COVID-19. From 06 April 2020 we also started to perform nasopharyngeal swabs in all pts who, receiving intravenous therapy, had to stay in the Day hospital (DH) administration area. Material and methods: We evaluated a consecutive series of outpatients with diagnosis of solid tumor, accessing the DH of Oncology Department at the Udine Academic Cancer Center from 30 March 2020 to 10 April 2020. A multivariate logistic regression model was used to identify factors associated with positive triage (≥1 item). Results: 1054 triage procedures were performed out of 586 pts, with a median of 2 triage per pt. The median age was 64.9 years. The most common reason for triage submission was programmed access for oncological therapy (82.5%), followed by scheduled procedures, radiological exams or non-oncological consultations (10.7%) and unplanned access for urgencies (1.2%). In 30.7% of cases the neoplasm was in early stage, while was advanced in 69.3%. 58.2% of triage procedures were performed in pts receiving chemotherapy, 10.8% immunotherapy, 18.9% target therapy, 5.2% other therapies and 6.9% in pts without active treatment. In 5.5% of cases the triage resulted positive. 2.9% of all triage were positive for fever, 2.9% for respiratory symptoms and 0.1% for previous contact with a COVID-19 case. Body temperature was ≥37°C in 7 pts. Among negative triage, in 6 cases pts were further evaluated and considered as clinically suspect. Overall, in 0.9% of triage procedures the oncologic program was postponed, while a test for COVID-19 was performed for clinical suspect in 0.5%: interestingly no one resulted positive. At multivariate analysis factors associated with positive triage were diagnosis of thoracic cancer (OR 2.06;95%CI 1.02-4.12;p 0.04) and prior COVID-19 test (OR 2.81;95%CI 1.46-5.41;p 0.001). As of May 20th, no operator was positive to surveillance swabs. Conclusions: A well-structured triage procedure for COVID-19 can reduce the risk of further spreading of infection in Oncology facilities with limited impact on scheduled activities.
ABSTRACT
Background: The recent COVID-19 outbreak in Italy required timely adoption of efficient triage procedures (TPs) with the aim to minimize the risk of infection spreading in the hospitals. We developed a written questionnaire (items explored: fever, respiratory symptoms, previous contacts or personal positivity for COVID-19) together with body temperature (BT) measurement, to intercept patients (pts) with suspect of COVID-19 infection. Methods: We conducted a monocentric observational study of a consecutive series of outpatients with diagnosis of solid tumor, accessing the Day Unit of Oncology Department at Udine Academic Cancer Center (Northern Italy) from 30 March 2020 to 30 April 2020. In this abstract we present the preliminary results of the TPs performed until 10 April 2020. Results: 1054 TPs were performed out of 586 pts, with a median of 2 TPs per pt. Median age was 64.9 years, males were 35.4%. Overall, 82.5% of TPs were made because of access for therapy, 10.7% for programmed procedures, radiological exams or non-oncological consultations, 1.2% for unplanned presentation (e.g. urgencies). The stage of neoplasm was early in 30.7% and advanced in 69.3% of pts. TPs were made in pts receiving chemotherapy (58.2%), immunotherapy (10.8%), targeted therapy (18.9%), other therapies (5.2%) and in pts without active oncological therapy (6.9%). The questionnaires resulted positive in 5.5% of cases;2.9% were positive for fever, 2.9% for respiratory symptoms, 0.1% for previous contact with a case of COVID-19. Concomitant presence of 2 or more items was observed in 0.5% of questionnaires. Of note, 6 TPs required medical evaluation despite a negative questionnaire and were considered to be clinically suspect. BT≥37°C was observed in 7 TPs. Overall, the oncologic program was postponed in 0.9% of the TPs, while in 0.5% a test for SARS-CoV-2 was performed for clinical suspect: no one resulted positive. At multivariate analysis, factors associated with positive triage were diagnosis of thoracic cancer (OR 2.06;95%CI 1.02-4.12;p=0.04) and prior test for SARS-CoV-2 (OR 2.81;95%CI 1.46-5.41;p=0.001). Conclusions: A well-structured triage for COVID-19 could reduce the risk for further spreading of infection in Oncology facilities with limited impact on scheduled activities. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: F. Puglisi: Honoraria (self): MSD;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Roche;Honoraria (self), Advisory/Consultancy: Eli Lilly;Honoraria (self): Takeda;Pfizer;Advisory/Consultancy: Amgen;Novartis;Pierre Fabre;Research grant/Funding (self): Astrazeneca;Eisai;Travel/Accommodation/Expenses: Celgene;Servier. C. Andreetta: Advisory/Consultancy: AstraZeneca;GlaxoSmithKline;MSD. A.M. Minisini: Advisory/Consultancy: Novartis;MSD;Pierre Fabre. G. Fasola: Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Bristol-Myers Squibb srl;Eli Lilly SpA.;Servier Italia SpA.;Speaker Bureau/Expert testimony: Astrazeneca;Travel/Accommodation/Expenses: Merck Sharp and Dohme S.p.A.;Boehringer-Ingelheim S.p.A. All other authors have declared no conflicts of interest.