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.
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JAMA Oncol 2020; doi:10.1001/jamaoncol.2020.5745