Impact of reverse transcriptase real-time polymerase chain reaction-cycle threshold values on SARS-CoV-2-positive cancer patients undergoing treatment

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) pandemic, being a novel viral infection, has resulted in disruption of health services, including cancer patient's care and treatment. Hence, there was a need for testing and lateral integration of services for cancer patients with COVID-19. Materials and Methods: A total of 1178 samples were collected from cancer patients for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing before undergoing treatment in a tertiary care cancer center. The realtime reverse transcriptase polymerase chain reaction (RTPCR) was done using the E gene for screening, and for the confirmation, any of the three reactions using RdRp, ORF1bnsp14 and RNasePas were run as internal control. Results: Out of the 1178 samples tested, 211 (17.91%) were positive, and of these patients, 863 (73.25%) were men and 342 (29%) were women. Among the 863 men with cancer, 133 (15.41%) were real-time reverse transcriptase PCR (RT-PCR) positive. Of the 342 women with cancer, 78 (22.80%) were positive. Of the 144 SARS-CoV-2-positive cancer patients with cycle threshold (Ct) <25, 112 (84.2%) were asymptomatic and 32 (41.0%) were symptomatic. Sixty-seven patients showed positive results with a Ct >25. Out of them, 21 (31.3%) were asymptomatic and 46 (68.65%) were symptomatic cancer patients (P < 0.001). Of 144 patients with Ct <25, only 4 (2.8%) patients tested negative within 7-9 days, whereas the rest of the 140 (97.22%) became negative in >9 and up to 28 days. In the 67 cancer patients with Ct >25, within 7-9 days, 50 (74.6%) became RT-PCR negative and the remaining 17 patients mostly >60 years age group became RT-PCR negative in >9-28 days. Conclusions: Ct value of qualitative SARS-CoV-2 reverse transcriptase RT-PCR should be an important tool for an oncologist in designing and implementing patient management guidelines for SARS-CoV-2-positive cancer patients without or with symptoms for COVID-19.