Transformation of Cancer Care during and after the COVID Pandemic, a point of no return. The Experience of Italy.

Policymakers everywhere struggle to introduce therapeutic innovation while controlling costs, a particular challenge for the universal Italian National Healthcare System (SSN), which spends only 8.8% of GDP to care for one of the world's oldest populations. Oncology provides a telling example, where innovation has dramatically improved care and survival, transforming cancer into a chronic condition. However, innovation has also increased therapy duration, adverse event management, and service demand. The SSN risks collapse unless centralized cancer planning changes gear, particularly with Covid-19 causing treatment delays, worsening patient prognosis and straining capacity. In view of the 750 billion Euro "Next Generation EU", released by the European Union to relieve Member States hit by the pandemic, the SSN tapped a multidisciplinary research team to identify key strategies for equitable uptake of innovations in treatment and delivery, with emphasis on data-driven technological and managerial advancements - and lessons from Covid-19.

Short-term mortality among cancer patients with suspected or ascertained covid infection

Background: SARS-2 (COVID-19) infection is recent. Mortality among cancer patients affected by Covid-19 is unknown. Patients and methods: Since February till to May 2020, we observed cancer patients with ascertained or suspected Covid infection (all symptomatic, or admitted in hospital due to undetermined pneumonia infection). Patients were classified in three subpopulations: a) patients resulted as Covid positive at the first pharyngeal swab;b) patients positive at swab other than first (ie, the second or third one);c) patients with a clinical scenario compatible with Covid infection but with negative swab, or never tested before death We reviewed clinical trajectory and rate of deaths classified as Covid-linked. Results: We observed 27 possible Covid cases among cancer patients. Sex: 12 M/15 F. Type of cancer: lung in 9, colon in 6, breast in 4, others in 8. The patients were in diagnostic phase (5), under adjuvant treatment (2), on advanced disease therapy (16), in advanced disease not under active treatment (4). Out of 27 patients, 14 resulted as Covid positive at the first pharyngeal swab (group a);3 were positive at swab other than first (ie, the second or third one)(group b);10 patients with a clinical scenario compatible with Covid infection but with at least one negative swab (9) or never tested (1) (group c). On 20th May 2020,12 patients are alive, and 15 patients are dead: 9 with ascertained Covid (positive pharyngeal swab) and 6 without Covid confirmation. In the three subpopulations: a) Seven patients died and 4 patients are alive with negativized swab. b) All 3 patients are alive with negativized swab. c) Out of 10 patients with a clinical scenario compatible with Covid infection but not ascertained infection, 7 patients died within the observation time (death attributed to probable Covid infection even in absence of positive swab) and 3 are under observation. Conclusions: Preliminary data show a high mortality rate (15 out of 27;55.5%) among cancer patients with ascertained Covid infection but also in cancer patients with suspected infection and severe symptoms.