Infection Control of 2019 Novel Corona Virus Disease (COVID-19) in Cancer Patients undergoing Radiotherapy in Wuhan

  1. Conghua Xie
  2. Xiaoyong Wang
  3. Hui Liu
  4. Zhirong Bao
  5. Jing Yu
  6. Yahua Zhong
  7. Melvin L.K. Chua

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Abstract

Background

A pandemic of 2019 novel corona virus disease (COVID-19), which was first reported in Wuhan city, has affected more than 100,000 patients worldwide. Patients with cancer are at a higher risk of COVID-19, but currently, there is no guidance on the management of cancer patients during this outbreak. Here, we report the infection control measures and early outcomes of patients who received radiotherapy (RT) at a tertiary cancer centre in Wuhan.

Methods

We reviewed all patients who were treated at the Zhongnan Hospital of Wuhan University (ZHWU) from Jan 20 to Mar 6, 2020. This preceded the city lock-down date of Jan 23, 2020. Infection control measures were implemented, which included a clinical pathway for managing suspect COVID-19 cases, on-site screening, modifications to the RT facility, and protection of healthcare workers. Primary end-point was infection rate among patients and healthcare staff. Diagnosis of COVID-19 was based on the 5 th edition criteria.

Findings

209 patients completed RT during the study period. Median age was 55 y (IQR = 48-64). Thoracic, head and neck, and lower gastrointestinal and gynaecological cancer patients consisted the majority of patients. Treatment sites included thoracic (38.3%), head and neck (25.4%), and abdomen and pelvis (25.8%); 47.4%, 27.3%, and 25.4% of treatments were for adjuvant, radical, and palliative indications, respectively. 188 treatments/day were performed prior to the lock-down, in contrast to 12.4 treatments/day post-lock-down. Only one (0.48%) patient was diagnosed with COVID-19 during the study period. No healthcare worker was infected.

Interpretation

Herein, we show that in a susceptible population to COVID-19, strict infection control measures can curb human-to-human transmission, and ensure timely delivery of RT to cancer patients.

Funding

This study was funded by Health Commission of Hubei Province Scientific Research Project, WJ2019H002, Health Commission of Hubei Province Medical Leading Talent Project.

Research in context

Evidence before this study

The 2019 novel coronavirus disease (COVID-19) is now a global pandemic. Cancer patients are at risk of COVID-19 pneumonia, and thus infection control measures are crucial to mitigate their risk of infection. We searched PubMed and Medline for articles published up to Mar 12, 2020, using the following keywords: “COVID-19”, “SARS”, “SARS-CoV-2”, “infection control”, and “cancer”. No evidence exists that informs on the appropriate infection control measures for COVID-19.

Added value of this study

We report our single centre experience on the detailed infection control measures that were undertaken to minimise cross transmission between cancer patients undergoing radiotherapy, and between patients and healthcare workers. Measures entailing screening of suspect cases, re-organisation of the treatment facility, and protection of healthcare workers were described. With our infection control protocol, we recorded only one COVID-19 case among the 209 patients (0.48%) who were treated at our centre during the period of Jan 20 to Mar 6, 2020. No healthcare worker was affected.

Implications of all the available evidence

The effective infection control measures outlined in this study will help institutions worldwide affected by COVID-19 to formulate guidelines to mitigate nosocomial human-to-human transmission, especially among susceptible patients.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.03.21.20037051: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the institutional review board of ZHWU (2020039).
    Consent: As aggregated, anonymised patient data was used in this study, waiver of consent was approved by the ethics committee.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some limitations of this study deserve mention. First, it is apparent that the number of patients decreased substantially following the lock-down (a 10-fold drop in case-load; Figure 3). While it is unknown if such a meticulous protocol would be applicable in high-volume cancer centres from other parts of the world, reduction of case-load constitutes a key step of limiting human-to-human transmission of SARS-CoV-2, and thus, patients’ treatment ought to be prioritised accordingly. Finally, it is important to assess the impact on the long-term prognosis of these cancer patients, especially for those individuals who were unable to resume their treatment, which is the undesired consequence of a lock-down and robust infection control measures.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.03.21.20037051v1 on medRxiv