Abstract
Purpose: Cancer treatment during the COVID-19 pandemic represents a challenge. Hospital visits to receive treatment and interaction with health care workers (HCW) represent potential contagious events. We aimed to determine SARS-CoV-2 infection rate among patients with cancer and HCW of a chemoradiotherapy unit localized in a center designated as a COVID-19 priority facility in Mexico City. We also determined the diagnostic performance of a clinical questionnaire (CQ) as a screening tool and anti-SARS-CoV-2 antibody seroconversion rate.
Methods: HCW and patients with solid tumors attending the chemoradiotherapy unit signed informed consent. To determine SARS-CoV-2 infection rate prospectively, a nasopharyngeal swab for SARS-CoV-2 real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) was performed every 2 weeks in asymptomatics. An electronic CQ interrogating COVID-19-related symptoms was sent daily. Anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies were measured at baseline and at the end of the study period.
Results: From June to September 2020, we included 130 asymptomatic participants, 44.6% HCW and 55.4% patients with cancer. During a median follow-up of 85 days, 634 nasopharyngeal swabs were performed. Average SARS-CoV-2 monthly incidence was 4.6% (3.15%-7.47%), and cumulative infection rate was 13.8% (18 of 130). Cases were mostly asymptomatic (66%), and no hospitalizations or deaths were recorded. The CQ as a screening tool provided a sensitivity of 27.7%, a positive predictive value of 26.3%, and a positive likelihood ratio of 12. SARS-CoV-2 IgG seroconversion rate was 27.7% among those with a positive RT-PCR.
Conclusion: Patients with cancer on treatment can have uncomplicated COVID-19 outcomes. Biweekly RT-qPCR testing detects asymptomatic infections, prevents transmission, and should be implemented in units to increase patient safety. CQ increase RT-qPCR diagnostic yield and may prioritize testing in resource-deprived settings. Post-infection IgG seroconversion is unreliable.
【초록키워드】 COVID-19, Treatment, SARS-CoV-2, IgG, Health care, Hospitalization, antibody, SARS-COV-2 infection, COVID-19 pandemic, health care workers, Cancer, diagnostic, Transmission, patient safety, Predictive value, asymptomatic infections, outcomes, Nasopharyngeal swab, polymerase chain reaction, sensitivity, RT-qPCR, Immunoglobulin G, Seroconversion, Positive predictive value, Reverse transcriptase polymerase chain reaction, Asymptomatic, Immunoglobulin, anti-SARS-CoV-2 antibody, nasopharyngeal swabs, Patient, death, Health care worker, Informed consent, Follow-up, infection rate, incidence, Quantitative, cancer treatment, SARS-CoV-2 IgG, positive RT-PCR, Interaction, solid tumors, tumors, HCW, reverse transcriptase, Chain Reaction, Mexico City, Patients with cancer, Participants, study period, solid tumor, center, seroconversion rate, likelihood ratio, cumulative, positive, contagious, COVID-19-related symptoms, transcriptase, clinical questionnaire, Prevent, anti-SARS-CoV-2 immunoglobulin, polymerase chain, chemoradiotherapy, performed, detect, events, provided, was performed, median, determine, were measured, receive, were recorded, baseline, Biweekly, COVID-19-related symptom, 【제목키워드】 SARS-CoV-2, Prospective, worker, unit, Rate,