The safety and management of cancer patients in the current SARS-CoV-2 outbreak is an important clinical concern. Most cancer clinics have established or are in the living process of adapting already established contingency plans. It is well known that patients with cancer are more susceptible to infections because of the immunosuppression. First reports from China indicate that developing severe events in COVID-19 disease is statistically significantly higher in patients with cancer. While the situation is evolving worldwide, there are still no articles published in peer-reviewed journals on the situation in European countries.
The COVID-19 disease situation is particularly pressing in Italy. An editorial article on managing COVID-19 in cancer clinic and considerations on how to avoid distraction effects, published on 13 March 2020 in the Annals of Oncology, highlight challenges posed to the Aviano Cancer Centre, which is a National Cancer Institute that attracts patients with cancer from all over Italy.
The National Cancer Institute (Centro di Riferimento Oncologico) is located in Aviano, in western Friuli within the province of Pordenone. Its mission is to improve public health by advancing medical knowledge, providing outstanding specialty medical care, and preparing tomorrow’s physicians, scientists and other health professionals in the field of oncology. It is a public, non-profit institute operating under the authority of the Italian Health Ministry for the clinical and experimental research functions and shared in the governance by the Friuli Venezia Giulia region as for patient care.
The latest situation, described in the article published in the Annals of Oncology, features tents built in front of each hospital entrance. These tents serve as triage areas. Nurses and doctors work around the clock, evaluating the personal and medical history of each incoming patient, visitor and guest.
Dedicated staff in protected areas evaluate patients who present with respiratory symptoms or fever. The COVID-19 test is performed in suspected cases according to national health system recommendations.
Visits to inpatients have been limited to one guest per day and forbidden in the haematology division. Outpatients are allowed with only one companion and limited to underage or non-self-sufficient patients.
Patients with a scheduled follow-up visit who report suspected symptoms are encouraged to contact their physician to reschedule their visit.
For all medical and para-medical staff, multidisciplinary boards have been limited to one specialist per board. Morning meetings and journal clubs have been suspended, but allowed via teleconference.
The library service has been closed until further notice. The visitor’s canteen is closed as well.
Medical students’ trainee programmes have been postponed.
However, the above mentioned restrictions did not affect provision of chemotherapy or other forms and programmes of systemic treatment or surgery.
Follow-up visits were suspended for two weeks pending decisions related to the evolution of the epidemic.
The remaining part of the article describes threats posed by COVID-19 infection in terms of provision of cancer care and impacts on different domains.
Reference
Cortiula F, Pettke A, Bartoletti M, et al. Managing COVID-19 in the oncology clinic and avoiding the distraction effect. Annals of Oncology; Published online 13 March 2020. DOI: https://doi.org/10.1016/j.annonc.2020.03.286