Results of a national survey exploring the perception and attitudes of italian physicians towards the management of checkpoint inhibitors in oncology during covid-19 outbreak

Background: The province of Cremona had one of the highest incidence of COVID-19 (COV-19) infection in Italy The pandemic determined a significant shrinkage of our healthcare resources with difficulty for many patients (pts) to be assisted in the hospital, especially for the risk of being infected Therefore, we created a homecare project for cancer pts with the aim of reducing hospitalizations, accesses to the oncology ward and emergency room Methods: The team was composed by oncologists and nurses from the Oncology Unit of Cremona Community Hospital, supported by a secretary with a dedicated telephone number The assistance was provided from Monday to Saturday, 9 AM-5 PM Cancer pts were eligible if presenting confirmed diagnosis or suggestive symptoms for COV-19 A telephonic triage was performed Cancer pts and their cohabitants were tested with at least 2 nasopharyngeal swabs (NPS) Blood test, medical examinations and vital parameters were performed We advised screened individuals to follow the quarantine procedures, providing them with an information leaflet We administered oral/infusional treatments, including antiviral drugs Results: From March 23rd to April 30th 2020, 71 cancer pts were assisted at home, with a total of 191 visits Of the 71 pts tested with NPS, 26 resulted COV-19 positive (COV-19+) 19 of COV-19+ pts had mild symptoms;7 pts with stable vital parameters and initial pneumonia were successfully treated at home with hydroxychloroquine, antivirals and NSAIDs 7 pts with severe symptoms were promptly hospitalized 4 of them died, 2 due to the infection, 2 to progression disease 52 cohabitants were screened with NPS, 28 lived with a COV-19+ cancer patient;in this subgroup, 16 resulted COV-19+ 15 of them were completely asymptomatic Conclusions: This project demonstrated the feasibility of an innovative model based on homecare assistance for COV-19+ cancer pts with mild symptoms This strategy, limiting the number of hospital accesses for COV-19+ pts, might be useful to contain the spread of the infection Further studies are needed to test this strategy in COV-19 negative cancer pts Moreover, our experience indicates a high probability of identifying asymptomatic positive individuals cohabiting with COVID+ pts NPS screening for asymptomatic subjects is not routinely performed in Italy There is a urgent need to extend the screening to this population