Delivery of systemic anti-cancer therapy during the COVID-19 pandemic

ABSTRACT

Background: The delivery of systemic anticancer therapy during the COVID-19 pandemic is extremely challenging. Increased hospital visits and active anticancer therapy have been described as risk factors for developing more severe infection. In order to balance the benefits of continuing anticancer therapy with these risks, we undertook a series of system changes in the delivery of cancer care. We examined the rate of COVID-19 infection in patients attending for systemic anticancer treatments and the impact of COVID-19 on therapy delivered at our oncology dayward. Methods: Patients who attended our dayward over a 4 month period were included. Data were obtained from electronic patient records and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 infection at two separate timepoints the day prior to their visit via telephone, and using a symptom questionnaire given in a preassessment area on arrival at the hospital. This area was established so that patients didn't have to transit through the main hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab was arranged. Results: A total of 456 patients attended from January 1st to April 30th. During this time there were 2369 patient visits to the oncology dayward and 1953 intravenous therapies administered. 416 (18%) visits did not lead to treatments, 114 (27%) of which were scheduled non-treatment visits. 194 (47%) treatments were held due to disease-related illness and 108 (26%) treatments were held due to treatment-related complications. 19 patients were identified as having COVID-19 symptoms via telephone screening. 34 patients were symptomatic on arrival at our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. Overall, 53 treatments were held due to the screening process. Conclusions: With the introduction of a new patient screening pathway, there have been few treatment disruptions due to the COVID-19 pandemic. The overall rate of symptomatic COVID-19 infection appears low in those who continue on active treatments with regular hospital visits. With careful systematic changes, it is feasible to continue to safely deliver systemic anticancer therapy during the COVID-19 pandemic. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure All authors have declared no conflicts of interest.