1. Froelich, Warren

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Cancer patients experienced a 19 percent rate of hospital-acquired or nosocomial COVID-19 infections that was "strongly and independently associated with death," according to research conducted from March 3 to May 28, 2020, involving nine Canadian medical centers. The study, presented during a virtual COVID-19 and Cancer conference held online July 20-22 by the American Association for Cancer Research, underscores a need to treat cancer patients in COVID-19 free zones.

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"This is the first report that describes a high rate of hospital- acquired COVID-19 in patients with cancer at a rate of 19 percent," said Arielle Elkrief, MD, an oncology fellow at McGill University Health Centre in Montreal.


"Our study reinforces the importance of adherence to stringent infection control guidelines in order to protect patients such as those with cancer," she added. "This is important because patients with cancer have high contact with the health care system due to frequent treatments, surveillance visits, and hospitalizations for cancer-related complications."


According to recent analyses, cancer patients have a higher mortality from COVID-19 compared to the general population. While it's also been shown that the incidence of nosocomial COVID-19 transmissions in the general population ranges from 7 percent to 20 percent, the impact of hospital-acquired COVID-19 infections in patients with cancer has remained unknown. The goal of this study was to determine the incidence and impact of nosocomial COVID-19 infections in patients with cancer across two Canadian provinces-Quebec and British Columbia.


"It's important to know that Quebec was one of the most heavily affected areas of North America at the time of the study," Elkrief said.


The definition of nosocomial infection for this study was taken from the National Quebec definition. A suspected case is defined by a clinical picture of respiratory infection greater than 5 days following admission to a non-COVID-19 unit; a confirmed case is defined as a patient with a clinical picture of a respiratory infection beyond the maximum incubation period of 14 days or when a direct epidemiological link with a COVID-19 case in a health care setting was identified regardless of incubation period.


Though three pediatric patients were included in the study, most of the patients were older adults between the ages of 70 and 90 years, with a median age of 73. Breast, prostate, and lymphoma cancers were the most common types of tumors, with most patients on active anti-cancer therapy versus no active anti-cancer therapy.


As outlined by Elkrief, some 253 cancer patients from nine medical centers in Quebec and British Columbia were identified with laboratory-confirmed or presumed diagnosis of COVID-19 between March 3 and May 23, 2020, with 47 of these patients identified as fitting the definition for nosocomial infections, or about 19 percent.


Mortality rate for the entire 253 cancer patient cohort was 28 percent. Patients with hospital-acquired COVID-19 infections had a 47 percent mortality rate compared to 23 percent in the community-acquired group; 39 percent of patients in the community-acquired group were outpatient and fully recovered compared to 26 percent in the hospital-acquired group.


The median overall survival for cancer patients in the hospital-acquired group was 27 days, compared to 71 days in the community-acquired group. No differences were found in secondary outcomes, including oxygen requirements, ICU admissions, need for mechanical ventilation, or length of stay.


Elkrief and colleagues then performed a multi-variant analysis and found that nosocomial COVID-19 infection "was strongly and independently associated with death" among cancer patients. Other risk factors for negative prognosis included age, poor ECOG status, and advanced stage of cancer. Patients above age 80 years experienced a higher incidence of adverse outcomes, as did patients with poor ECOG scores and advanced stage of cancer.


Elkrief concluded her talk by identifying stringent controls that hospitals need to take to protect cancer patients from COVID-19 nosocomial infections.


In ambulatory clinics, she said an example is decreasing in-person visits by increasing some medical conversations through telecommunications. For persons who need in-person visits, screening for symptoms or PCR testing, when resources permit, can be adequate solutions. Similar principles apply to chemotherapy, she said.


"It is important for staff not to cross-contaminate between COVID and COVID-free zones, and for dedicated personnel and equipment to be maintained and separate between these two areas," Elkrief added. "Adequate protective personal equipment and strict hand hygiene protocols are also of utmost importance.


"The threat of COVID-19 is not behind us, and so we must continue to enforce these strategies to protect our patients."


Warren Froelich is a contributing writer.


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