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19-11-2020 | COVID-19 | News

Serial COVID-19 screening could help guide continuation of anticancer therapy

Author:
Shreeya Nanda

medwireNews: Research from the United Arab Emirates suggests that serial screening for SARS-CoV-2 infection in asymptomatic patients with cancer could help guide the continuation of anticancer therapy.

Humaid Al-Shamsi (Burjeel Oncology-Burjeel Medical City, Abu Dhabi) and colleagues previously implemented “a pilot microbiologic screening program” in all asymptomatic cancer patients as “symptom-based screening may inadequately triage patients to safely resume anticancer therapy” in light of “the frequency of asymptomatic COVID-19, and presymptomatic transmission.”

The current report focuses on an expansion to the program involving serial nasopharyngeal swab testing for SARS-CoV-2 across treatment cycles, with the screening interval dependent on the type of therapy, specifically:

48 hours prior to each cycle of systemic chemotherapy or immunotherapy;weekly for daily radiotherapy or chemoradiotherapy; andmonthly for daily targeted or hormonal therapy.

“Anticancer therapy, besides hormonal therapy, was held until 2 consecutively negative PCR [polymerase chain reaction] results and clinical recovery or per physician discretion,” explain the investigators in a research letter published in JAMA Oncology.

Of the 109 patients with cancer (median age, 55 years), but no COVID-19 symptoms, who underwent 384 screening swabs across a median of two cycles, 29.4% developed SARS-CoV-2 infection. The majority (78.1%) were diagnosed while asymptomatic and the remaining 21.9% developed symptoms in the interval following a negative PCR result.

Emphasizing that “[m]ost infections were identified in the presymptomatic phase,” Al-Shamsi and co-authors note that “[i]n the absence of this microbiologic screening, such patients would have proceeded with anticancer therapy unaware of their COVID-19 infection, which may have increased their complication risk.”

The infection was mild for most (84.4%) patients, but 28.1% required hospitalization, as a result of COVID-19 in six cases and other reasons in three (for an adverse drug reaction, palliation, and rectal abscess). A total of 12.5% of patients needed intensive care and 12.5% died.

The surviving patients with COVID-19 resumed anticancer therapy after a median delay of 16 days. By contrast, the median delay was 4 days among individuals who did not acquire SARS-CoV-2 infection.

“Although limitations of this study included small sample size and no control group, implementation of microbiologic screening for SARS-CoV-2 among patients with cancer guided continuation of anticancer therapy,” say Al-Shamsi et al.

“As we work to provide safe uninterrupted oncologic care amidst the COVID-19 pandemic, microbiologic screening should be considered for patients with cancer receiving anticancer therapy,” they conclude.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

19 November 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

JAMA Oncol 2020; doi:10.1001/jamaoncol.2020.5745

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