Mitigating the risk of COVID-19 in a large community oncology clinic and its impact on the patient experience

Background: Cancer patients have a high risk of severe illness from COVID-19 infection, and the William Osler Health System oncology clinic (WOHS-OC) is in Brampton, ON, Canada, a COVID-19 hotspot with high community COVID-19 prevalence. As such, heightened symptom screening prior to entering the WOHS-OC, asymptomatic COVID-19 testing pre-chemotherapy, staff personal protective equipment (PPE) use, enhanced cleaning, and clinic capacity limits (including implementation of virtual visits) were employed in the outpatient WOHS-OC. This study examined patient's perspectives regarding the implemented containment and mitigation strategies in the WOHS-OC during the second wave of the COVID-19 pandemic. Methods: Consenting patients in the WOHS-OC from Dec 01 2020 to Feb 01 2021 were provided a written questionnaire regarding their care during the second wave of the COVID-19 pandemic. Questions about satisfaction with COVID-19 protocols were rated on an analogue scale from 1-5, with 1 being the worst and 5 being the best possible satisfaction. Patient demographics (age, sex, type of cancer, and treatment type) were obtained through electronic medical records. Patients also consented to a second survey should they contract COVID-19 regarding, symptoms and risk factors for contracting the virus. Results: Fifty-six patients with various solid and hematological malignancies consented to the study;median age 59.5, male (30%), type of treatment;chemotherapy (55%), immunotherapy (9%), targeted therapy (23%), biologic therapy (14%), endocrine therapy (11%). Patients felt safe coming to the oncology clinic (95% of respondents), and 100% of patients were screened for symptoms on entry. Prior to cancer treatment, 49% of participants were contacted to do a screening COVID-19 swab. In 57% of patients, at least one clinic visit was changed to virtual (telephone or video). Communication during virtual visits was felt to be adequate with 89% of patients rating communication 4 or 5. Rating of virtual visits compared to in-person visits was widely distributed (57% rated virtual 4 or 5 compared to in person). Infection control practices were rated highly (4 or 5;physical distancing 83%, enhanced cleaning 93%, staff screening 89%, and staff PPE 96%). No patients that consented to the survey contracted COVID-19 during the study period. Conclusions: COVID-19 mitigation strategies in the WOHS-OC made patients feel safe during the second wave of the pandemic. Additionally, despite high levels of community transmission, no patients responding to the survey tested positive for COVID-19 during the study period. Patients were satisfied with communication during virtual visits, however there was a wide distribution of follow-up preferences. Future interventions should be aimed at standardizing pre-treatment COVID-19 testing and delineating areas of virtual care that patients identify as needing improvement.

Management of chronic lymphocytic leukemia in Canada during the coronavirus pandemic.

The emergence of the covid-19 disease pandemic caused by the 2019 novel coronavirus has required a re-evaluation of treatment practices for clinicians caring for patients with chronic lymphocytic leukemia (cll). The American Society for Hematology (ash) has provided a series of recommendations for the treatment of patients with cll during the pandemic, covering a range of topics, including testing for covid-19, cll treatment initiation and selection, use of immunoglobulin therapy, in-person monitoring, and treatment of patients with cll and covid-19. We summarize the ash recommendations and discuss their applicability as guidelines for the treatment of cll during the covid-19 pandemic in Canada.