Cancer treatment during the COVID19 pandemic at the clinic for radiotherapy and oncology, clinical hospital center rijeka

Introduction: Consequences of COVID19 disease have mostly affected the health care system worldwide, including Croatia. A particularly vulnerable group of oncology patients found themselves in a sensitive and dangerous situation. At the Clinic for Radiotherapy and Oncology of the Clinical Hospital Center Rijeka, we were guided by ESMO guidelines as well as the guidelines of the Croatian Oncology Society, which soon issued instructions for the organization of the oncology service and oncology treatment. Numerous papers and large studies cite different delays in oncology treatment as well as the inability to tumor diagnose in a timely manner. In this research, we will present some of our results and challenges in oncology treatment at our Clinic. Methods: Retrospectively, 55 patients with a diagnosis of malignant disease who had a positive PCR test for SARS-CoV-2 virus were detected from the database of the Clinical Hospital Center Rijeka. In time between March 2020 and February 2021, the same patients were oncologically treated or were in oncological follow-up. The date of a positive PCR test was taken as the first day of COVID19. Results: The median age of the patients was 64 years. The study group consisted of 35 women and 20 men. Most patients had stage IV disease (n=32). At the time of COVID19, 21 patients were receiving chemotherapy, 8 were on hormone therapy, 1 patient was ongoing radiochemotherapy and 1 ongoing radiotherapy, 4 were being treated with immunotherapy, 8 were ongoing biotherapy. Also, 13 patients were not in active treatment but in oncological follow-up. It is interesting to note that patients in chemotherapy treatment became positive on average 11 days after the application of the planned cycle. The primary cancer site of COVID19 patients followed current epidemiological trends, with the largest number of patients with breast cancer (n=19) and colon cancer (n=14). 16 patients state that their possible source of SARSCoV-2 virus infection is a health facility. If we analyze the severity of COVID19 disease, 43 patients had a mild or asymptomatic form of the disease, 6 patients had a developed moderate clinical picture and at some point needed oxygenation. In the analyzed group, we detected 4 patients who had a severe form of the disease, 3 of them died of COVID19 disease. 18 patients were hospitalized in one of the COVID depart ments of our Institution with an average hospitalization time of 8 days. We specifically analyzed the delay in oncology treatment. In 31 patients there was a delay of an average of 22 days. When we analyze the type of oncology therapy, the next cycle of chemotherapy was delayed by an average of 22 days, biological therapy by 28 days while the delay in immunotherapy was 20 days. Conclusion: Cancer therapies are of proven benefit, but in light of the serious consequences of potential concurrent SARS-CoV-2 infection, risk-to-benefit considerations are becoming increasingly important. A multidisciplinary approach as well as a personalized treatment plan seems more important than ever for successful oncology treatment during the COVID19 pandemic.