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 randomized study of BNT162b2 mRNA vaccine enrolled 43,548 patients (pts) aged between 16 and 91 years, but excluded pts receiving immunosuppressive therapy and those diagnosed with an immunosuppressive condition. Considering the important need of real-life data related to COVID-19 vaccine in older pts with cancer, we decided to conduct a study to evaluate the seroprevalence of the SARS-CoV-2 IgG in cancer patients aged ≥ 80 years one month after administering the second dose of BNT162b2 vaccine. Materials and Methods: This was a spontaneous, notsponsored, mono-institutional, cross-sectional control study conducted at San Camillo-Forlanini Hospital in Rome. We screened 74 older patients with cancer, 45 of them accepted to receive the vaccination and we collected serum samples from 36 pts. A group of medical doctors and nurses of our Hospital was used as a control in a 1:2 ratio. Results: Pts' data are summarized in Table 1. Median serum IgG were 2396,10 AU/ml (range 0-32763,00) in cancer pts and 8737,49 AU/ml (398,90-976280,00) in control group, p<0.0001. Additional subgroup analyses were performed comparing males and females, chemotherapy versus other therapies (immunotherapy, targeted therapy), solid tumors versus hematological malignancies, early (I-II) versus advanced (III-IV) stage of disease, continuative corticosteroid use or not. None of them reached statistical significance. None of the pts enrolled in this study experienced COVID-19 infection after vaccination, regardless of the level of IgG response. Conclusions: Our study shows for the first time that cancer pts cancer aged =80 years can have a serological response to the BNT162b2 COVID-19 vaccine one month after vaccination. Additional serological tests will be performed after 6 and 12 months from vaccination in order to evaluate the duration of immunological response in our pts.
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: The new coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) is a source of concern for the management of patients suffering from rheumatic and musculoskeletal diseases (RMDs) treated with immunomodulatory therapies (1). Objectives: We aimed to analyze the prevalence of SARS-CoV-2 infection in patients with RMDs living in Italy. Methods: During the first wave (March-May 2020) and during the second wave (October-December 2020) of COVID-19, we conducted a survey to investigate the incidence of SARS-CoV-2 infection in patients with RMDs followed at the Rheumatology Unit of the University of Campania, Italy. The demographic data, medication use, the frequency of respiratory symptoms and the incidence of COVID-19 confirmed by nasopharyngeal swab were collected with questionnaires administered by phone. The prevalence of COVID-19 of our cohort was compared to that of the general population (2). Results: During the first wave, we collected data from 900 patients with RMDs (Table 1): 320 patients with rheumatoid arthritis (RA), 295 patients with spondyloarthropathies (SpA), 283 patients with systemic lupus erythematosus (SLE), 2 patients with vasculitis. 546 (60%) were treated with bDMARD/tsDMARDs. Overall, a total of 11/900 (1%) cases were tested for COVID-19 due to compatible symptoms. 2 (0.2%) adult patients treated with bDMARDs were registered as swab test positive by PCR for COVID-19. 2 patients without confirmed COVID-19 developed pneumonia that required admission to hospital. No deaths occurred among the patients with confirmed COVID-19. During the second wave, data were collected from 470 patients who accepted to take part of the study (Table 1). 49 presented with symptoms that were compatible with COVID-19. 139 patients were tested whereas 30 patients (6%) had a swab confirmation of SARS-CoV-2 infection. Among them, 16 (53%) were treated with bDMARDs and a patient was treated with tofacitinib. we found no increase in COVID-19 prevalence in patients treated with bDMARD/tsDMARDs (p≥0.05). A patient with SLE developed pneumonia that required admission to hospital and died. Lacking distinct prevalence data between first and second waves, we found no differences in total COVID-19 prevalence between general population living in Campania (215.752/5.802.000;3.7%) and patients with RMDs (32/900;3.5%). However, we had a significant increase in COVID-19 prevalence in our cohort during the second wave compared to the first. Nevertheless, no increase in mortality or hospitalization was recorded, confirming the safety of immunomodulatory therapies in patients with RMDs. Conclusion: In this cohort of patients with RMDs in a geographical region with a high prevalence of COVID-19, the risk of SARS-CoV-2 infection does not appear different from that observed in the general population.