ABSTRACT
Background: The Sars-CoV-2 pandemic led to a reorganization of all hospitals activities and assistance to cancer patients has also undergone changes. Our Medical Oncology Unit-AOU Careggi, in the lockdown phase, has provided guidelines to assist patients who receive oral cancer treatment with 'telemedicine'. Aim of this work is to analyze the different ways in which the oncological visits scheduled for the prescription of oral therapy were performed. Material and methods: We consulted the agenda of oncology visits for oral therapies scheduled between 09 March and 26 March 2020: 115 patients were included in the study. We retrospectively compared the agenda with the medical records. Most of the patients (74%) scheduled in March followed a 28-day dosing schedule (q28), 13.04% q21, for the remainder the control was less frequently. Moreover, we also recorded subsequent visits, until May 2020. We divided the visits into 3 groups: the first group includes visits scheduled only in March, the second in April (> 90%) and the third in May (> 90%). Results At the first scheduled visit during the lockdown, 1 patient did not come, in 2 cases the caregiver came, 3 patients have postponed the visit, 10 were managed by phone, 53 by phone and e-mail, 46 came to visit. In the first and third phase, patients received the drug or prescription mainly directly in the clinic (40.17% and 47.94% respectively), in contrast, in the second phase, shipping by courier was preferred (37.5%). We noticed a correlation between the basal ECOG performance status (PS), assessed before the pandemic spread, and the modality of the visit (p< .001). Most patients (55.75%) with PS ECOG 0 carried out the first visit in the lockdown phase electronically (e-mail and telephone contact). However, no statistically significant correlation emerged between the Charlson comorbidity index and the method of carrying out the visit (p 0.998). Comparing the baseline PS and that recorded at the last visit, a statistically significant deterioration emerged (p < .001). Considering the baseline ECOG PS 0, at the third visit 52.94% of the evaluable patients maintained the PS. In 18 patients the data is missing. Conclusions: Telemedicine seems to be feasible in some contexts. The challenge is to select the right patient in the right moment. PS could be a screening tool but other factors should be investigated such as availability of appropriate technology for telemedicine.
ABSTRACT
Background: Pandemic SARS-CoV2 infection was characterized by a severe respiratory syndrome whit a worst course in elderly with comorbidity. Oncology patients (pts) may be at risk for an unfavorable course of infection (1). For this, oncologists had to choose how maintaining therapeutic benefit, minimizing risk of treatments (txs). Oncologist associations had recommended to reduce risk but encouraging continuation of txs. Indeed, one of the risks for oncological pts was inability to receive necessary medical service (2). In this study we reported our experience. Methods: We analyzed pts with solid tumors which received 1 cycle of therapy from 9 to 30 March 2020 at Medical Oncology Unit of Azienda Ospedaliero Universitaria Careggi. We subsequently followed pts over time to evaluate delays in subsequent cycles, and its cause (COVID19 or not related). Results: We analyzed 118 pts (27% affected by lung cancer), divided in age groups (172 were over 50, 96 over 70 and 16 over 80), setting (86% metastatic disease, 8% adjuvant and 7% neoadjuvant/perioperative and type of txs (32% immunotherapy). There were 26 delay in second cycles, 24 in third and only 2 in fourth. In 18 cases delay was scheduled to minimize risk of COVID19 contagion. Expected neutropenia risk did not significantly influenced delay, while age influenced in pts over 60 (13,3% of delay in 80-90 group, 13,3% in 70-79, 17,3% 60-69 and 5,3% in 50-59). Adjuvant txs showed greater delays than metastatic and neoadjuvant /perioperative. 14% of immunotherapies (no difference in lung cancer vs others) was delayed vs 16% of other txs. Conclusions: The SAR-CoV2 pandemic infection obligated oncologists to establish the risk/benefit ratio of a delay in txs, in absence of data. In our experience, the age> 60 and adjuvant setting have more often delayed txs, while type of therapy and the risk of neutropenia have had less impact. In contrast to cancer society's recommendations, there have been no greater delays in immunotherapy in lung cancer than in other diseases. The delay was more frequent in the first phase of the pandemic, probably due to the progressive reorganization of the cancer department.