Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK.
Hospital Clinic de Barcelona, Barcelona, Spain.
Support Care Cancer. 2021 Feb;29(2):1129-1138. doi: 10.1007/s00520-020-05906-y. Epub 2020 Nov 23.
Patients with cancer are at higher risk of more severe COVID-19 infection and have more associated complications. The position paper describes the management of cancer patients, especially those receiving anticancer treatment, during the COVID-19 pandemic. Dyspnea is a common emergency presentation in patients with cancer with a wide range of differential diagnoses, including pulmonary embolism, pleural disease, lymphangitis, and infection, of which SARS-CoV-2 is now a pathogen to be considered. Screening interviews to determine whether patients may be infected with COVID-19 are imperative to prevent the spread of infection, especially within healthcare facilities. Cancer patients testing positive with no or minimal symptoms may be monitored from home. Telemedicine is an option to aid in following patients without potential exposure. Management of complications of systemic anticancer treatment, such as febrile neutropenia (FN), is of particular importance during the COVID-19 pandemic where clinicians aim to minimize patients' risk of infection and need for hospital visits. Outpatient management of patients with low-risk FN is a safe and effective strategy. Although the MASCC score has not been validated in patients with suspected or confirmed SARS-CoV-2, it has nevertheless performed well in patients with a range of infective illnesses and, accordingly, it is reasonable to expect efficacy in the clinical setting of COVID-19. Risk stratification of patients presenting with FN is a vital tenet of the evolving sepsis and pandemic strategy, necessitating access to locally formulated services based on MASCC and other national and international guidelines. Innovative oncology services will need to utilize telemedicine, hospital at home, and ambulatory care services approaches not only to limit the number of hospital visits but also to anticipate the complications of the anticancer treatments.
癌症患者感染 COVID-19 的风险更高，且相关并发症更多。本文主要描述了 COVID-19 大流行期间癌症患者（尤其是正在接受抗肿瘤治疗的患者）的管理。呼吸困难是癌症患者常见的紧急表现，其鉴别诊断范围广泛，包括肺栓塞、胸膜疾病、淋巴管炎和感染等，而 SARS-CoV-2 是目前需要考虑的病原体。对患者进行筛查访谈，以确定其是否可能感染 COVID-19，这对于防止感染传播至关重要，尤其是在医疗机构内。对于无症状或症状轻微的癌症患者检测呈阳性，可在家中进行监测。远程医疗是一种帮助患者就医而避免潜在暴露的选择。在 COVID-19 大流行期间，管理全身性抗肿瘤治疗的并发症（如发热性中性粒细胞减少症）尤为重要，因为临床医生的目标是尽量降低患者感染风险和减少医院就诊的需求。对于低危 FN 患者，采用门诊管理是一种安全有效的策略。尽管 MASCC 评分尚未在疑似或确诊 SARS-CoV-2 患者中得到验证，但它在各种感染性疾病患者中表现良好，因此，预计其在 COVID-19 的临床环境中也具有疗效。对于 FN 患者，进行风险分层是脓毒症和大流行策略的重要原则，需要根据 MASCC 和其他国家及国际指南制定的当地服务来满足需求。创新性的肿瘤学服务将需要利用远程医疗、居家式医院和门诊护理服务方法，不仅要限制医院就诊次数，还要预测抗肿瘤治疗的并发症。
