COVID-19 triage useful for patients with cancer
medwireNews: Using a triage algorithm can aid the detection of COVID-19 in people with cancer and thus help to keep cancer centers COVID-free, Italian researchers report in Cancer.
Francesco Grossi and colleagues, from the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, explain that “fever and/or respiratory symptoms can be very common findings in patients with cancer, and the interpretation of such symptoms in these patients can be challenging because they are potentially attributed to the seasonal flu, COVID-19, or may simply relate to the underlying disease and/or ongoing systemic treatment.”
In the current study, Grossi and team aimed to evaluate the efficacy of triage to identify COVID‐19 among 562 patients (median age 69 years) with cancer treated at their institution between 20 March and 17 April 2020.
Of these, 34% had telehealth visits, 19% had outpatient ambulatory visits, and 47% had day hospital visits including outpatient on-treatment visits. The most common cancer diagnoses were breast (37%), thoracic (25%), and gastrointestinal (18%), and 61% were receiving active anticancer treatment.
Patients were triaged using two questionnaires, one administered by clinicians in direct patient interviews that assessed fever and/or COVID-19–like respiratory and nonrespiratory symptoms, and one completed by patients that included smoking history, medication use, comorbidity, fever and/or respiratory symptoms in close contacts, and travel to high-risk areas within the past 15 days.
Individuals with dyspnea and/or cough or a body temperature of at least 37.5ºC were then assessed by an infectious disease specialist and underwent chest imaging and received a SARS-CoV-2 swab if clinically indicated.
Patients who did not meet these criteria but had other symptoms or altered laboratory tests that were suspicious for COVID‐19 underwent serologic testing with rapid test devices.
The researchers report that, after excluding 70 patients with pre-existing symptoms, 68 (49%) patients had new-onset or worsening COVID-19–like respiratory symptoms (25%), nonrespiratory symptoms (34%), or both (41%).
In addition, 12 (2%) patients had C-reactive protein levels more than 10 times the upper limit of normal, either alone (n=6) or in combination with COVID-19–like symptoms (n=6).
Overall, six (1%) patients were diagnosed with COVID‐19, of whom four had the disease detected through telehealth triage. The remaining two patients did not have suspicious symptoms at triage but had the disease detected 20–30 days later.
SARS-CoV-2 rapid antibody tests were performed in 47 (63%) of the 74 patients who had new-onset symptoms and/or altered laboratory tests. Of these, six (13%) were positive.
By comparison, the positivity rate was 11% among 47 patients who were asymptomatic for COVID-19.
Grossi and team believe their findings show that “the triage process had a positive impact on the detection of COVID-19 in patients with cancer.”
They say: “The overall incidence of COVID-19 diagnosis and antibody positivity in patients with suspect symptoms was similar to that observed in asymptomatic patients.”
The team therefore believes that these data “suggest that most oncology activities can be safely performed during the pandemic.”
The authors conclude that “[s]imple containment measures to reduce hospital access can be pursued without compromising cancer care delivery.”
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