Triage procedure for covid-19 in an oncology department: An Italian monocentric experience

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.

What to do in an oncology department to face the new COVID-19 era challenges?

Italy was the first European country to be hit by COVID-19 pandemic. As a consequence, Italian oncologists had to guarantee essential treatments although minimizing exposure to the virus, and accidental infection, of patients and healthcare professionals. As Department of Medical Oncology of the University Hospital of Udine, in this short report, we describe the measures that we have taken, and gradually updated, since February 26, 2020. All accesses to our Oncology facilities are currently regulated by entrance check-points where patients are screened for infections following dedicated algorithms. Up to date, after 6 weeks of systematic execution of swabs no physician, nurse or other individual of the staff has been found positive to COVID-19. Only one patient admitted for therapy has been identified as COVID-19 positive. The aim of our work is to propose a model, made up of a set of operative procedures, that may be adopted by all the oncologists that daily struggle to guarantee safety and care in Oncology during this COVID-19 emergency.