Medical Oncology Unit, IRCCS Foundation Ca' Granda Maggiore Hospital Policlinic, Milan, Italy.
Department of Medicine, University of Udine, Udine, Italy.
Cancer. 2021 Apr 1;127(7):1091-1101. doi: 10.1002/cncr.33366. Epub 2020 Dec 3.
Patients with cancer are considered at high risk for the novel respiratory illness coronavirus disease 2019 (COVID-19). General measures to keep COVID-19-free cancer divisions have been adopted worldwide. The objective of this study was to evaluate the efficacy of triage to identify COVID-19 among patients with cancer.
From March 20 to April 17, 2020, data were collected from patients who were treated or followed at the authors' institution in a prospective clinical trial. The primary endpoint was to estimate the cumulative incidence of COVID-19-positive patients who were identified using a triage process through the aid of medical and patient questionnaires. Based on a diagnostic algorithm, patients with suspect symptoms underwent an infectious disease specialist's evaluation and a COVID-19 swab. Serologic tests were proposed for patients who had symptoms or altered laboratory tests that did not fall into the diagnostic algorithm but were suspicious for COVID-19.
Overall, 562 patients were enrolled. Six patients (1%) were diagnosed with COVID-19, of whom 4 (67%) had the disease detected through telehealth triage, and 2 patients (33%) without suspect symptoms at triage had the disease detected later. Seventy-one patients (13%) had suspect symptoms and/or altered laboratory tests that were not included in the diagnostic algorithm and, of these, 47 patients (73%) underwent testing for severe acute respiratory syndrome coronavirus 2 antibody: 6 (13%) were positive for IgG (n = 5) or for both IgM and IgG (n = 1), and antibody tests were negative in the remaining 41 patients.
The triage process had a positive effect on the detection of COVID-19 in patients with cancer. Telehealth triage was helpful in detecting suspect patients and to keep a COVID-19-free cancer center. The overall incidence of COVID-19 diagnosis (1%) and antibody positivity (13%) in patients with suspect symptoms was similar to that observed in the general population.
患有癌症的患者被认为有感染新型呼吸道疾病 2019 冠状病毒病（COVID-19）的高风险。全球范围内已采取一般措施来保持 COVID-19 阴性的癌症病房。本研究的目的是评估分诊以识别癌症患者中的 COVID-19 的效果。
2020 年 3 月 20 日至 4 月 17 日，从作者所在机构接受治疗或随访的患者中收集数据，进行一项前瞻性临床试验。主要终点是通过医疗和患者问卷协助分诊流程，估计 COVID-19 阳性患者的累积发病率。根据诊断算法，有疑似症状的患者由传染病专家进行评估并进行 COVID-19 拭子检查。对于有症状或改变实验室检查但不符合诊断算法且疑似 COVID-19 的患者，建议进行血清学检测。
共有 562 名患者入组。6 名患者（1%）被诊断为 COVID-19，其中 4 名（67%）通过远程医疗分诊发现该疾病，而 2 名在分诊时无可疑症状的患者后来被发现患有该疾病。71 名患者（13%）有疑似症状和/或未包含在诊断算法中的改变实验室检查，其中 47 名患者（73%）进行了严重急性呼吸综合征冠状病毒 2 抗体检测：6 名（13%）IgG 阳性（n=5）或 IgM 和 IgG 均阳性（n=1），其余 41 名患者抗体检测结果为阴性。
分诊流程对癌症患者中 COVID-19 的检测有积极影响。远程医疗分诊有助于发现可疑患者，并保持 COVID-19 阴性的癌症中心。有疑似症状的患者的 COVID-19 诊断总发生率（1%）和抗体阳性率（13%）与一般人群观察到的相似。
