The province of Cremona had one of the highest incidence of COVID-19 (COV-19). The pandemic determined a significant shrinkage of healthcare resources with difficulty for many patients (pts) to be assisted in the hospital, especially for the risk of being infected. We created a homecare project for cancer pts with the aim of reducing hospitalizations, accesses to the oncology ward and emergency room.
The team was composed by oncologists and nurses from the Oncology Unit of Cremona Hospital, supported by a secretary with a dedicated phone number. The assistance was provided from Mon to Sat, 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.
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, 28 lived with a COV-19+ cancer patient; in this subgroup, 16 resulted COV-19+.15 of them were asymptomatic.
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. NPS screening for asymptomatic subjects is not routinely performed. There is a urgent need to extend the procedure to this population.
Clinical trial identification
Legal entity responsible for the study
MEDEA ODV, Uniti per la Provincia di Cremona.
All authors have declared no conflicts of interest.