ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has severely affected cancer care and research by disrupting the prevention and treatment paths as well as the preclinical, clinical, and translational research ecosystem. In Italy, this has been particularly significant given the severity of the pandemic's impact and the intrinsic vulnerabilities of the national health system. However, whilst detrimental, disruption can also be constructive and may stimulate innovation and progress. The Italian Association of Medical Oncology (AIOM) has recognized the impact of COVID-19 on cancer care continuum and research and proposes the '2021 Matera statement' which aims at providing pragmatic guidance for policymakers and health care institutions to mitigate the impact of the global health crisis on Italian oncology and design the recovery plan for the post-pandemic scenario. The interventions are addressed both to the pillars (prevention, diagnosis, treatment, follow-up, health care professionals) and foundations of cancer care (communication and care relationship, system organization, resources, research, networking). The priorities to be implemented can be summarized in the MATERA acronym: Multidisciplinarity; Access to cancer care; Telemedicine and Territoriality; Equity, ethics, education; Research and resources; Alliance between stakeholders and patients.
Subject(s)
COVID-19 , Medical Oncology , Ecosystem , Humans , Neoplasms , PandemicsABSTRACT
Introduction: The SARS-CoV-2 spread has led to a revolution in the healthcare. Veneto Institute of Oncology has adopted contagion containment measures to guarantee a greater level of protection to cancer patients. The anti- COVID vaccination for cancer patients has been a priority for the national health system and the institute has implemented a vaccination campaign to ensure coverage for patients. A survey was developed to assess the impact of the COVID-19 pandemic on patients' perceptions about the measures taken to limit the risk of SARS-CoV-2 infections and their concern about their cancer care. A questionnaire on the degree of satisfaction with vaccination was administered after anti-COVID vaccination. Methods: The Survey was distributed to all patients who entered in hospital during analysis period and it was divided into 3 items: characteristics of patients, concerns about the pandemic on their cancer path, perception of the measures adopted by the institute to limit the spread of the infection. The vaccination questionnaire was distributed to a cohort of vaccinated patients and explored the degree of satisfaction with the vaccination campaign. Results: From May18th until June15th, 3238 questionnaires were completed. Most of the responders said they were concerned about SARS-CoV-2 pandemic while keeping the concern for oncological disease as a priority. All measures (triage for hospital access, restrictions for caregivers, use of personal protective equipment, sanitization of environments) have been appreciated by patients. Telemedicine was positively evaluated by the responders while, the absence of the caregiver during visit, does not seem to have determined discomfort in about two thirds of patients. From April26th until May14th 2021, 356 vaccination questionnaires were completed. 60% of responders were female;90% were on active cancer treatment and 33% of the patients reported adverse events related to the anti-COVID vaccination. Patients expressed a high degree of satisfaction with the vaccination campaign (99% were satisfied/very satisfied) Conclusions: This survey reported the point of view of cancer patients regarding the impact of the COVID-19 pandemic on the oncological activities of which they are protagonists and patients' perceptions of the anti-COVID vaccination campaign. We believe that the perspective of patients can be crucial to help the reorganization of the health system, especially in this period of medical emergency.
ABSTRACT
Background: No data have been published on the safety of Covid-19 vaccines in cancer patients (pts). Patients and methods: Pts undergoing anti-cancer treatment who were vaccinated with anti-SARS-CoV-2 Pfizer- BioNTech vaccine (Comirnatyc) at Istituto Oncologico Veneto - IOV, IRCCS, Padova, were instructed to report adverse drug reactions (ADRs) through the national pharmacovigilance platform (www.vigicovid.it) either directly or through the treating oncologist. ADRs were then retrieved from vigiCOVID. Results: From March 6th to May 9th 2021, a total of 5297 pts treated at Istituto Oncologico Veneto - IOV for either solid (87%) or onco-hematologic malignancies (13%) have been vaccinated with two 30 μg doses of BNT162b2 Pfizer-BioNTech vaccine. Overall 10.820 doses of vaccine have been administered, with 226 pts (1.8%) who received the first dose not completing the planned second dose because of either worsening of general conditions, admission to other hospital wards, occurrence of COVID-19, or death. Globally 207 pts (3.9%) refused vaccination. About 80% of pts were actively receiving oncological treatment, and 20% had completed it in the past 6 months, with half of the pts receiving cytotoxic chemotherapy, and the other half either immunotherapy, targeted therapy or a combination of targeted therapy and endocrine therapy. No specific timing regarding chemotherapy schedule was required, except pts were not vaccinated on the same day of chemotherapy, and vaccine was preferentially administered before chemotherapy start. Eight ADRs were reported. Seven were non-severe ADRs (fainting, hypertensive episode, hypotension;skeletal pain, muscle pain, fever, rhinitis;back pain, fatigue, fever;reddening at injection site, hot flashes;tongue pruritus;paresthesia, pruritus, skin rash;headache, myalgia, fever, rigidity), and resolved within 48 hours. The severe ADR was a central retinal artery thrombosis in a patient treated with gefitinib for EGFR-mutated non small cell lung cancer, causing blindness in the affected eye. Patient was treated with acetilsalicilic acid, with condition not resolved to date. Only 4 pts experienced hypersensitivity reactions, which were not serious and resolved in less than one hour. Conclusions: Though it is likely that frequent, minor ADRs such as pain at the injection site may be underreported, our data confirm safety of the Pfizer-BioNTech vaccine in the largest cohort of cancer pts reported to date.
ABSTRACT
Background: Since the beginning of the COVID19 outbreak, the Veneto Oncology Network ROV licensed dedicated guidelines for cancer patients care during the pandemic, and developed a regional registry (ROVID) aimed at describing epidemiology and clinical course of SARS-CoV-2 infection in cancer patients. Preliminary data on 170 patients mainly diagnosed during the first pandemic wave have been published (Guarneri V, Eur J Cancer 2021). Here we report the data of additional 270 patients, comparing clinical data and outcomes between first (W1) and second (W2) pandemic waves. Methods: All patients with cancer diagnosis and documented SARS-CoV-2 infection are eligible. Data on diagnosis, comorbidities, anticancer treatments, details on SARS-CoV-infection including source of contagion, clinical presentation, hospitalization, treatments and fate of the infection are recorded. Results: 440 patients have been enrolled, 196 diagnosed during W1 (until September 2020) and 244 during W2. The most common cancer type was breast cancer (n = 116). Significant differences in clinical characteristics between W1 and W2 were the followings: ECOG PS 0 (34% vs 58%), presence of cardiac comorbidities (30% vs 13%), presence of any co-morbidities (81% vs 62%), smoking habits (23% vs 13%). Patients diagnosed in W1 were less likely on active anticancer therapy (54% vs 73%) at the time of SARS-CoV-2 infection. Distribution per stage, presence of lung metastases, disease setting (curative vs palliative), active treatment discontinuation due to infection were similar between W1 and W2. Patients diagnosed in W1 were more likely symptomatic for SARS-CoV-2 infection (80% vs 67%), and reported more frequently an inhospital contact as potential source of infection (44% vs 9%). Significantly more patients diagnosed in W1 were hospitalized (76% vs 25%). All-cause mortality rates were 30.6% for patients diagnosed in W1 vs 12% for patients diagnosed in W2 (p < 0.001). However, deaths due to SARS-CoV-2 infection were more frequent in patients diagnosed in W2 (86% vs 54%, odds ratio 3.22;95% CI 1.97-5.279). Conclusions: Differences in clinical characteristics between W1 and W2 reflect different pattern of virus circulation. The dramatic reduction of in-hospital contact as a source of infection reflects the efforts put in place to protect this vulnerable population from in-hospital exposure. The lower all-cause mortality rate observed in W2 is in line with the observed less frail population. However, the higher relative risk of death due to SARS-CoV-2 infection observed in W2 reinforces the need to adopt protective measures including vaccination in cancer patients, irrespectively of age, stage, and comorbidities.
ABSTRACT
Background: COVID-19 pandemic started in Italy with clusters identified in Northern Italy. Since the beginning, the Veneto region started a proactive approach, including testing for SARS-CoV-2 part of the asymptomatic population and healthcare providers. The Veneto Oncology Network ROV licensed a dedicated PDTA to ensure proper care minimizing the risk of infection in cancer patient (pts). At the same time, a regional registry (ROVID) has been set up, to describe epidemiology and clinical course of SARS-CoV-2 infection in cancer pts. Materials and methods: All pts with cancer diagnosis and documented SARS-CoV-2 infection are eligible. The following information are recorded: age, cancer diagnosis, stage, tumor biology, comorbidities, presence of COVID- 19 symptoms, anticancer treatment at the time infection (type, aim, line of therapy, discontinuation, recovery), other medical treatments, hospitalization, treatments for SARS-CoV-2 infection, fate of the infection. Results: 144 pts from 18 centers have been enrolled. Mean age at the time infection: 69 yrs (25 to 95 yrs). The 5 most common cancer types were breast cancer (n=26), colorectal, prostate, lung cancer (n=16 each), melanoma (n=10). Distribution by stage was as follows: I 19%, II 9%, III 13%, IV 59%. Lung metastases were documented in 15% of the cases. 77% of the pts had at least one comorbidity. COVID-19 symptoms were reported in 78% of the pts. Active anticancer therapy at the time of the infection was reported for 71 pts (chemotherapy n=37, targeted therapy n=14, hormonal therapy n=13, immunotherapy n=6). Treatment was discontinued because of infection in 44 case. 101 pts were hospitalized;45 received low flow oxygen support and 26 received non-invasive mechanical ventilation, high flow nasal cannula or endotracheal intubation. The fate of infection is available for 95 cases so far: 44 infection resolution with confirmed negative swab, 16 with clinical resolution discharged with positive swab, and 35 deaths. Among cases with fatal exitus, 22 were attributable to COVID-19. Conclusions: Data collection is still ongoing, including further follow up and results of serological tests, where available. The mortality rate reported in this study is in line with other registry of cancer patients, confirming the frailty of this population. These data reinforce the need to protect cancer patients from SARS-CoV2 infection.