Incidence of influenza-like illness (ILI) in cancer patients during covid-19: The oncovid prospective observational study

ABSTRACT

Background: There are limited data on cancer patients (pts) and the novel coronavirus (SARS-CoV2) respiratory disease (COVID19). Fever and/or respiratory symptoms (influenza-like illness, ILI) is a common finding in cancer pts. We aim to evaluate the frequency of ILI in cancer pts during the pandemic and to identify high-risk subjects to test for COVID19. Materials and methods: From March 20th to April 17th 2020 we collected data of cancer pts in a prospective clinical trial approved by the local ethics committee. The primary endpoint was to estimate the cumulative incidence of ILI in the study population. The secondary endpoint was to estimate which proportion of pts with ILI had COVID19 diagnosis. A triage procedure with questionnaires was performed in pts accessing the hospital, with laboratory tests (complete blood count, C-reactive protein) in pts on active treatment. Non-urgent visits were converted into telehealth visits and triage pts with symptoms were addressed to general practitioners. Based on a diagnostic algorithm, pts with ILI symptoms underwent an infectious disease specialist's evaluation and SARS-CoV2 swab. The LepuMedical SARS-CoV2 immunoassay technique was used in pts with suspect symptoms or altered laboratory tests, not falling into the diagnostic algorithm. Results: Overall, 562 pts were enrolled 13 (2%) pts had a positive SARS-CoV2 swab, none of which performed on the basis of triage procedures or questionnaires, rather detected through telephone communications and triage;52 (9%) pts reported suspect symptoms and/or laboratory tests. Forty-five (8%) SARS-CoV2 swab positive, or with suspect symptoms and/or laboratory tests pts underwent SARS-CoV2 antibody tests;20 (3%) pts were excluded for poor clinical conditions (n=10), death (n=4), or pts' refusal (n=6). Four out of 41 (10%) suspect pts had IgG+ (n=3), or IgM+/IgG+ (n=1);4 out of 4 COVID-19 positive pts had IgG+ (100%). Antibody tests were negative in the remaining 37 pts. Conclusions: In our experience, triage procedures and questionnaires were not helpful in detecting COVID19 in cancer pts. The incidence of both COVID19 diagnosis (2%), and SARS-CoV2 antibody positivity in pts tested on the basis of suspect symptoms (<1%), were similar to those observed in the general population.