Measures Taken During COVID-19 Pandemic for Patients with Cancer in China

In a paper published in JAMA Oncology, researchers discussed active and effective measures for the care of patients with cancer during the coronavirus disease 2019 (COVID-19) in China.

To reduce or avoid cross infection of COVID-19, many hospitals have begun implementing measures that limit the number of outpatient and inpatient admissions. However, forced delays or interruptions of routine cancer treatments could increase the risk of disease deterioration for patients with cancer.

“In China, approximately 4.3 million cases of cancer are diagnosed each year,” the authors wrote. “To alleviate the difficulties of patients with cancer in seeking medical aid and simultaneously avoid COVID-19-related nosocomial cross infection between patients and medical staff, several mandatory measures are being carried out in the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences during this period.”

First, hospitals have begun performing multiple on-site temperature tests at the entrances of the hospital, the outpatient clinic, and the wards. Additionally, the contact and travel histories regarding the epidemic area of all individuals are recorded.

Moreover, an appointment scheduling system has been made available for outpatients, allowing for both online appointment scheduling and on-site registration. The researchers indicated that this system substantially reduced the flow of people in the hospital. Online consultation programs for patients have also been developed and are opened on a daily basis in order to help instruct patients on cancer-related symptom management and treatment. 

For patients who are preparing to be admitted, hospitals are asking for symptoms potentially associated with COVID-19, such as fever and cough, to be routinely recorded. Admitted patients must also take essential personal protective measures laid out by facilities, such as wearing a mask and bringing their own disinfectant. Further, mandatory routine blood tests and high-resolution computed tomography scans of the lungs are performed upon admission, and COVID-19 virus nucleic acid tests are carried out for patients with suspected pneumonia on computed tomography imaging. 

For patients with cancer, some anticancer drugs conventionally administered through infusion were changed to orally administered drugs if possible, such as etoposide (Etopophos) and vinorelbine (Navelbine). Individuals undergoing adjuvant chemotherapy or maintenance chemotherapy had their infusion intervals appropriately prolonged, dependent on the condition of the individual patient. 

“Under the further attack of COVID-19 worldwide, more attention should be paid to patients with cancer as a special population,” the authors wrote. “Both the effective prevention of cross infection of COVID-19 and the rational arrangement of anticancer treatment are extremely important. The measures we are taking may be of great value to help guide patients with cancer smoothly and safely through the epidemic.”

From February 12, 2020, to March 2, 2020, the Department of Medical Oncology in the Cancer Hospital, Chinese Academy of Medical Sciences, received a total of 2944 patients for clinic consultation and treatment in the wards, including 2795 outpatients and 149 inpatients. Under the strict screening strategy, 27 patients showed radiologic manifestations of inflammatory changes or multiple-site exudative pneumonia in the lungs, 8 of whom were thought to possibly have COVID-19 infection.

Negative results from nucleic acid testing ultimately excluded COVID-19 infection in all of these patients. Notably though, the researchers suggested that 2 of these patients presented with recovered pneumonia after symptomatic treatment. 

However, with the implementation of the strict protective measures, as of March 3, 2020, the researchers indicated that not a single patient or staff member had been diagnosed with COVID-19 infection.

Reference:

Wang Z, Wang J, He J. Active and Effective Measures for the Care of Patients With Cancer During the COVID-19 Spread in China. JAMA Oncology. doi:10.1001/jamaoncol.2020.1198.