ABSTRACT
Background: One of WALCE's aims is to increase the awareness of people with lung cancer and provide them educational initiatives. It has been recently investigated patients' knowledge and attitudes towards clinical trials in order to gain better insights from their experience. Material(s) and Method(s): from January to April 2022, an anonymous questionnaire with 22 multiple-choice and 4 open-ended questions was carried out by WALCE. Result(s): 109 patients from 7 Italian cancer centers have filled out the questionnaire. 58% were women and the average age was 62 years. 86% have heard about clinical trials and 90% said to be interested in knowing more about them, but only 46% acknowledged to have looked for information, using different top sources. The majority of patients prioritized their oncologists (44% of cases), over consulting websites (31%), magazines (11%), family and friends (9%) and social media (8%), they've got it during the news about COVID (7%), or by other medical specialists (6%) and patient associations (5%) and more than half of patients (83%) confirmed to have found the information they were looking for (even if 39% only "sometimes"). However, 66% believe their level of knowledge about it is still poor (i.e. 84% are not aware of the different trail phases). At the same time, 72%said to be more inclined to participate in a clinical trial after the COVID Vaccine and 88% were interested to know more about them. According to 97% of patients, clinical trials generate data about safety (47%), efficacy (40%) and prognosis (27%), only 6% answered that the objective is to evaluate the costs of clinical procedures. Only 26% participated in a trial, but 50% would have liked to and "hope" was the reason for half of them, while the remaining 50% preferred not to participate because of fear and lack of information (16% of cases). The collaboration between researchers and patients is considered beneficial by 73% of the respondents, mainly to bring out the needs of patients (41% of the cases). Finally, 85% are willing to receive more information about clinical trials by newsletters (54%) or through the oncologists (18%). Conclusion(s): the survey has highlighted the need of lung cancer patients to receive more comprehensive information about clinical trials and to cooperate with researchers to include the voice of patients.
ABSTRACT
Background: Soon after the Italian Medicine Agency (AIFA) authorized the first mRNA COVID-19 vaccine, BNT162b2 (ComirnatyR), the Italian Ministry of Health launched a national vaccination campaign. Giving the high risk of mortality from COVID-19, cancer patients were considered a priority group. However, data about BNT162b2 safety in this population are still lacking and the impact on patients' psychological state and social life was not studied. Herein we describe the adverse events (AE) related to the vaccine and the subjective experience of cancer patients treated and vaccinated at San Luigi Gonzaga University Hospital. Materials and methods: All cancer patients who accepted to participate in our campaign were vaccinated with BNT162b2 and included in the descriptive analysis. Patients who tested positive for COVID-19 after January 1st, 2021 were not recruited. An anonymous questionnaire about AE and psycho-social impact of the vaccination was administered to the study population 21 days after the first dose. The short-term AE reported after the second dose were investigated via a telephone questionnaire. Results: A total of 997 patients were included in the study, of whom 618 were affected by advanced cancer. At the time of the vaccination, 223 patients were receiving chemotherapy and/or immunotherapy. 49 patients have been infected and recovered from COVID-19. AE were reported in 37.3% cases after the first dose and in 48.5% cases after the second dose. The most common AE were muscle pain (26.7% and 27.4%, after the first and second dose respectively) and fatigue (10.4% and 16.8%). No severe AE had been reported. Before receiving the vaccine, 18% patients felt fearful and/or insecure about the vaccination, while 76.4% felt hopeful and/or enthusiast. After the first dose, 57.5% patients changed their feelings positively and 79.5% patients stated to feel much more confident in their social life. Patients' opinion about the vaccination was mainly influenced by the specialist/family doctor (38.7%) and by mass-media (25.8%), and the information they were given was considered adequate by 86% patients. Conclusions: Our data support the short-term safety of BNT162b2 in cancer patients, regardless of the disease staging and the concurrent treatment. Before the vaccination, most of our patients consulted the specialist or the family doctor receiving adequate information and being reassured. Moreover, the vaccination showed a positive psychological and social impact.
ABSTRACT
Background: The world, and Italy on the front lines, is experiencing a major medical emergency due to the SARSCoV-2 outbreak. Cancer patients are one of the potentially most vulnerable cohorts of people, but data about their management are still limited. Patients and methods: In this monocentric retrospective study we included all SARS-CoV-2 oncological patients accepted at the Onco-COVID Unit at San Luigi Gonzaga Hospital, one of the few oncological departments dedicated to cancer patients with SARS-Cov-2 infection in Italy. Clinical data were obtained from medical records available until April 24th, 2020. Results: 20 cancer patients were included. The mean (±SD) age of the patients was 66±14 years, 80% were men. Eight (40%) developed infection in their communities and 12 (60%) during the hospitalization. Lung cancer was the most frequent type of cancer (12, 60%), followed by blood/bone marrow cancer (3, 15%). Eight patients (40%) were symptomatic for COVID-19 at the time of diagnosis and symptoms began 2 (±2) days before. The most common were shortness of breath and diarrhea. Fever was present in 7 patients (35%). Among the 12 asymptomatic patients, 8 (67%) became symptomatic during the hospitalization (mean time of symptoms onset 4 days + 4). C-reactive protein increase was detected in 15 (75%) patients, high lactate dehydrogenase levels in 13 (65%), lymphocytopenia and thrombocytopenia in 6 (30%) and 4 (20%), respectively. Seven patients (35%) were on active anti-tumor treatment, 3 (43%) received anti-tumor therapy within two weeks before SARSCoV-2 positivity, and 2 (29%) continued oncological treatment (TKIs and chemotherapy) after the infection diagnosis. Nine (45%) patients were prescribed hydroxychloroquine and 5 (25%) antiviral therapy with lopinavir/ ritonavir or darunavir/ritonavir. Ten (50%) patients died within a mean of 11 days (+ 8) from the diagnosis of COVID-19 infection. Five patients (25%) have been discharged from the hospital, 4 (20%) of them with the indication to best supportive care and 1(5%) to active antitumor treatment. Conclusions: Our series confirms the high mortality rate among cancer patients with COVID-19. The presence of asymptomatic cases suggests that typical symptoms and fever may not be the only useful parameters to suspect COVID-19 in oncological patients. Our Onco-Covid unit suggests the importance of a tailored and holistic approach for cancer patients, even in a challenging situation like SARS-CoV-2 pandemic.
ABSTRACT
Background: During COVID-19 pandemic, timely diagnosis of SARS-CoV-2 infection was crucial, especially in pts with cancer. Real-time polymerase chain reaction (RT-PCR) on nasopharyngeal swab (NPS) is hampered by ≈30% of false negatives. Clinical and radiological features may identify potentially infected cases in presence of negative test. Materials and methods: We retrospectively retrieved records from 30 pts admitted to our Onco-Covid Unit. Clinical (fever, cough, respiratory failure) and radiological (ground glass opacities-GGO with or without lung consolidation) criteria were assessed. NPS RT-PCR was performed (VIASURE SARS COV-2 RT-PCR Detection Kit) at admission and at 48 hours. Pts underwent laboratory and radiological assessments (chest x-ray, bedside lung ultrasonography, thorax CT scan). Other sources of infection were ruled out (blood cultures, pneumococcal/legionella urinary antigen tests) as well as radiological differential diagnoses (e.g. disease progression). Results: From March 21st to May 9th 2020, 9 NPS negative pts with both clinical and radiological features suggestive for COVID-19 were identified. Mean age was 65.1 (31-78), 4 were female, all with ECOG PS 1. 4 pts had COPD, 8 were stage IV. All pts were on active antitumor treatment. Most common symptoms were dyspnea (n 8), fever (n 5), dry cough (n 3);radiological features include: GGOs alone (n 6), consolidation (n 1), consolidation + GGOs (n 1). 3 pts had baseline lymphopenia, 7 high lactate dehydrogenase, 8 high C-reactive protein. All pts presented with respiratory failure: PaO2/FiO2 ratio <200 (n 3), 200-300 (n 5), > 300 (n 1). All pts received antibiotics (azithromycin + ceftriaxone 3;piperacillin/tazobactam 6), glucocorticoids, O2-therapy: nasal cannula (n 3), Venturi mask (n 2), non-invasive ventilation (n 4). 4 pts died and 5 were discharged from the hospital, 4 with the indication to active antitumor treatment and 1 to best supportive care. Conclusions: High suspicion index is necessary in NSCLC pts with respiratory symptoms during COVID-19 pandemic as NPS may not identify all infected pts and the number of 'gray cases' is expected to increase in Phase II. Clinical and radiological findings correlation is pivotal in this subgroup.
ABSTRACT
Background: At the end of 2019, a novel viral pneumonia, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was described in China. Since then, Italy has soon become one of the most affected countries. In this challenging situation, the oncological community was called to protect cancer patients (pts), especially those affected by lung cancer, considered one of the most vulnerable population due to older age, multiple comorbidities and type of infection. This study aimed to investigate the clinical management of NSCLC pts, in order to provide a reliable picture of real-word practice during the COVID-19 outbreak. Materials and Methods: A 29-questions survey focusing on the clinical management and therapeutic indications for NSCLC pts during COVID-19 pandemic was sent to 95 medical/thoracic oncologists across different Italian regions. Results: From April 12th to May 2nd, 79 responses were received, with an overall response rate of 83%. The majority (77.3%) of oncologists declared a significant change in the outpatient management of NSCLC pts. The number of consultations in case of suspected NSCLC decreased in about half of cases (46.8%), with a major reduction when considering the number of pts coming from the emergency department for a first oncological evaluation (60% of cases). The total number of pts with any stage, newly diagnosed NSCLC, within the observational period, was reported to be lower than the pre-pandemic era by the 56% of oncologists. For pts candidates to adjuvant chemotherapy and concurrent chemoradiation, the therapeutic indications followed guidelines in 62% and 72% of cases, respectively. As regards the metastatic disease, the majority of oncologists confirmed their clinical indication to first-line treatment. The collected data revealed major changes in the second line therapeutic options, most related to timing and schedules of administration. Lung cancer pts' accrual in clinical trials dramatically has fallen for 79% of oncologists and follow-up consultations were mostly managed by telemedicine. Conclusions: This survey showed that Italian oncologists are determined to follow the available guidelines for the clinical management of NSCLC pts during this emergency time, while more complicate is to deal with clinical trials. In this tough landscape, telemedicine provides a valid support to facilitate patient-healthcare interactions.