Organisational challenges, volumes of oncological activity and patients' perception during the severe acute respiratory syndrome coronavirus 2 epidemic

Serena Zuliani; Ilaria Zampiva; Daniela Tregnago; Miriam Casali; Alessandro Cavaliere; Arianna Fumagalli; Sara Merler; Silvia Teresa Riva; Alice Rossi; Francesca Zacchi; Elisa Zaninotto; Alessandra Auriemma; Michele Pavarana; Caterina Soldà; Lavinia Benini; Michele Borghesani; Alberto Caldart; Simona Casalino; Marina Gaule; Dzenete Kadrija; Marta Mongillo; Camilla Pesoni; Pamela Biondani; Sara Cingarlini; Elena Fiorio; Davide Melisi; Veronica Parolin; Luca Tondulli; Lorenzo Belluomini; Camilla Zecchetto; Barbara Avesani; Assunta Biasi; Chiara Bovo; Elena Dazzani; Alessandra Dodi; Sara Gelmini; Luigi Carmine Leta; Giuliana Lo Cascio; Fiorella Lombardo; Eleonora Lucin; Ilaria Asja Martinelli; Luisa Messineo; Viola Moscarda; Sarah Pafumi; Anna Reni; Giulia Sartori; Ilaria Mariangela Scaglione; Yiftach Shoval; Marco Sposito; Evelina Tacconelli; Ilaria Trestini; Valentina Zambonin; Sara Zanelli; Sara Pilotto; Michele Milella

doi:10.1016/j.ejca.2020.05.029

Organisational challenges, volumes of oncological activity and patients' perception during the severe acute respiratory syndrome coronavirus 2 epidemic

Eur J Cancer. 2020 Aug:135:159-169. doi: 10.1016/j.ejca.2020.05.029. Epub 2020 Jun 11.

Authors

Serena Zuliani¹, Ilaria Zampiva², Daniela Tregnago³, Miriam Casali⁴, Alessandro Cavaliere⁵, Arianna Fumagalli⁶, Sara Merler⁷, Silvia Teresa Riva⁸, Alice Rossi⁹, Francesca Zacchi¹⁰, Elisa Zaninotto¹¹, Alessandra Auriemma¹², Michele Pavarana¹³, Caterina Soldà¹⁴, Lavinia Benini¹⁵, Michele Borghesani¹⁶, Alberto Caldart¹⁷, Simona Casalino¹⁸, Marina Gaule¹⁹, Dzenete Kadrija²⁰, Marta Mongillo²¹, Camilla Pesoni²², Pamela Biondani²³, Sara Cingarlini²⁴, Elena Fiorio²⁵, Davide Melisi²⁶, Veronica Parolin²⁷, Luca Tondulli²⁸, Lorenzo Belluomini²⁹, Camilla Zecchetto³⁰, Barbara Avesani³¹, Assunta Biasi³², Chiara Bovo³³, Elena Dazzani³⁴, Alessandra Dodi³⁵, Sara Gelmini³⁶, Luigi Carmine Leta³⁷, Giuliana Lo Cascio³⁸, Fiorella Lombardo³⁹, Eleonora Lucin⁴⁰, Ilaria Asja Martinelli⁴¹, Luisa Messineo⁴², Viola Moscarda⁴³, Sarah Pafumi⁴⁴, Anna Reni⁴⁵, Giulia Sartori⁴⁶, Ilaria Mariangela Scaglione⁴⁷, Yiftach Shoval⁴⁸, Marco Sposito⁴⁹, Evelina Tacconelli⁵⁰, Ilaria Trestini⁵¹, Valentina Zambonin⁵², Sara Zanelli⁵³, Sara Pilotto⁵⁴, Michele Milella⁵⁵

Affiliations

¹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
² Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁵ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁶ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁷ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁸ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹⁰ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹¹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹² Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹³ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹⁴ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹⁵ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹⁶ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹⁷ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹⁸ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
¹⁹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²⁰ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²¹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²² Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²³ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²⁴ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²⁵ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²⁶ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²⁷ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²⁸ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
²⁹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³⁰ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³¹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³² Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³³ Medical Direction, Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³⁴ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³⁵ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³⁶ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³⁷ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³⁸ Microbiology and Virology Unit, Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
³⁹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴⁰ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴¹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴² Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴³ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴⁴ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴⁵ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴⁶ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴⁷ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴⁸ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁴⁹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁵⁰ Section of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁵¹ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁵² Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁵³ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁵⁴ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].
⁵⁵ Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy. Electronic address: [email protected].

Abstract

Background: On February 23rd, the 1st case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed at the University Hospital Trust of Verona, Italy. On March 13th, the Oncology Section was converted into a 22-inpatient bed coronavirus disease (COVID) Unit, and we reshaped our organisation to face the SARS-CoV-2 epidemic, while maintaining oncological activities.

Methods: We tracked down (i) volumes of oncological activities (January 1st - March 31st, 2020 versus the same period of 2019), (ii) patients' and caregivers' perception and (iii) SARS-CoV-2 infection rate in oncology health professionals and SARS-CoV-2 infection-related hospital admissions of "active"' oncological patients.

Results: As compared with the same trimester in 2019, the overall reduction in total numbers of inpatient admissions, chemotherapy administrations and specialist visits in January-March 2020 was 8%, 6% and 3%, respectively; based on the weekly average of daily accesses, reduction in some of the oncological activities became statistically significant from week 11. The overall acceptance of adopted measures, as measured by targeted questionnaires administered to a sample of 241 outpatients, was high (>70%). Overall, 8 of 85 oncology health professionals tested positive for SARS-CoV-2 infection (all but one employed in the COVID Unit, no hospital admissions and no treatment required); among 471 patients admitted for SARS-CoV-2 infection, 7 had an "active"' oncological disease (2 died of infection-related complications).

Conclusions: A slight, but statistically significant reduction in oncology activity was registered during the SARS-CoV-2 epidemic peak in Verona, Italy. Organisational and protective measures adopted appear to have contributed to keep infections in both oncological patients and health professionals to a minimum.

Keywords: Oncological activity; Patients' perception; Risk containing measures; SARS-CoV-2.

MeSH terms

Betacoronavirus / pathogenicity*
COVID-19
COVID-19 Testing
Clinical Laboratory Techniques / standards
Coronavirus Infections / diagnosis
Coronavirus Infections / epidemiology
Coronavirus Infections / prevention & control*
Coronavirus Infections / transmission
Coronavirus Infections / virology
Female
Health Knowledge, Attitudes, Practice
Health Personnel / psychology
Humans
Infection Control / organization & administration*
Infection Control / standards
Infectious Disease Transmission, Patient-to-Professional / prevention & control
Infectious Disease Transmission, Professional-to-Patient / prevention & control
Italy / epidemiology
Male
Mass Screening / standards
Medical Oncology / methods
Medical Oncology / organization & administration*
Neoplasms / psychology
Neoplasms / therapy*
Pandemics / prevention & control*
Patient Admission / standards
Pneumonia, Viral / epidemiology
Pneumonia, Viral / prevention & control*
Pneumonia, Viral / transmission
Pneumonia, Viral / virology
Psychosocial Support Systems
Retrospective Studies
Risk Factors
SARS-CoV-2