Team huddle, education and infection screening as effective tools in continuing cancer care delivery during the peak of COVID19 pandemic in 2020 in the Bronx, NY: Experience from a public teaching hospital

ABSTRACT

Background: COVID-19 pandemic has affected healthcare delivery, particularly in the hard-hit areas. During the peak of COVID-19 pandemic crisis in the New York city, our outpatient oncology infusion center, located within a public teaching hospital in the South Bronx remained active. We implemented twice daily team huddle, staff and patient education, and infection screening tools and modified treatment plans based on social, personal and disease related factors. We evaluate the effectiveness of the above strategies in timely delivery of critical oncological care. Methods: Patients treated from the March 1, 2020 to the May 8, 2020 were included. De-identified data from medical charts were analyzed using IBM SPSS Version 27.0. Bivariate logistic regression analysis was applied to identify factors associated with COVID-19. Results: In total, 170 patients were treated in 576 visits. Median age was 60.7 years, 44% Hispanic and 41% Black, median Charlson Comorbidity index (CCI) was 6.6. Fifty percent received cytotoxic chemotherapy, 44% targeted therapies and the remaining received immune-checkpoint inhibitors. Of the 170 patients, six developed severe COVID-19 requiring hospitalization. Their median age was 63 years with average of 10.5 days from infusion center visit to COVID-19 and median CCI score was 9, higher than the rest of the cohort. Two patients died, 3 made complete recovery, 1 enrolled in hospice. Two patients contracted mild COVID-19 managed in the outpatient setting. Diabetes mellitus was associated with severe COVID-19 [OR 25.9 (95%CI 1.3-519, p=0.03)]. Age, gender, type of cancer and oncological treatment, smoking, CCI, growth factor support, nursing home residence, statin use were not associated with risk of developing severe COVID-19 Conclusions: Cancer treatment in the outpatient setting using an approach focused on careful patient selection, infection prevention strategies and strong team communication is feasible and allows for continuity of critical oncological care. Receipt of cancer directed therapy was not associated with higher risk for infection compared to risks associated with communitybased transmission. In communities with high community-based transmission, careful selection of patients for oncological based treatment is paramount.