COVID-19 Testing in Patients with Cancer: Does One Size Fit All?

Abstract

The COVID-19 global pandemic has drastically impacted cancer care, posing challenges in treatment and diagnosis. There is increasing evidence that cancer patients, particularly those who have advanced age, significant comorbidities, metastatic disease, and/or are receiving active immunosuppressive therapy may be at higher risk of COVID-19 severe complications. Controlling viral spread from asymptomatic carriers in cancer centers is paramount, and appropriate screening methods need to be established. Universal testing of asymptomatic cancer patients may be key to ensure safe continuation of treatment and appropriate hospitalized patients cohorting during the pandemic. Here we perform a comprehensive review of the available evidence regarding SARS-CoV-2 testing in asymptomatic cancer patients, and describe the approach adopted at Princess Margaret Cancer Centre (Toronto, Canada) as a core component of COVID-19 control.

Optimization of Patient Management During the COVID-19 Pandemic: Chest CT Scan and PCR as Gatekeepers of the Radiation Therapy Workflow

“…These screening strategies have the most potential and maximum benefit during the peak of COVID-19 cases and adjustments need to be made according to the evolution of the pandemic and the pre-test probability of COVID-19 in a particular area, as low prevalence of COVID-19 leads to a low PPV, especially for chest CT (20). For instance, while systematic baseline RT-PCR testing is recommended in Canada by the Ontario provincial Ministry of Health guidelines for cancer patients undergoing immunosuppressive cancer treatment, including radiation therapy, high priority testing criteria for asymptomatic patients in the event of testing limitations were defined, included age ≥ 60 years, performance status ≥ 2, comorbid conditions or impaired immunity, significant smoking history and lung tissue in the radiation treatment volume (43).…”

COVID-19 in Children with Cancer: A single Low-Middle income center experience

“…Universal testing of asymptomatic cancer patients may help safe continuation of treatment. (16) As regards the treatment, all the patients received supportive care in addition to antivirals or antibiotics guided by radiological findings and symptom progression (according to Children's hospital and MOH guidelines). With the large diversity of therapeutic options, (17) whether a different treatment approaches in children with cancer on chemotherapy is not adopted.…”

Cancerona: Challenges of Cancer Management in Times of COVID-19 Pandemic

“…These antibodies are detected even if the RT-PCR results were negative. Nonetheless, it has not been encouraged to rely solely on serological testing to diagnose SARS-CoV-2 because even though antibodies are detected in the serum, their generation, long-term immunity, and possible cross-reactivity with other coronavirus strains are not yet properly understood [34].…”

“…Standard testing in some areas are reserved for symptomatic patients and people with possible exposure to COVID-19, thus undermining the true number of SARS-CoV-2 carriers. Since asymptomatic patients are capable of transmitting the virus, this testing approach might fail to properly protect vulnerable populations such as cancer patients [34]. To minimize infection rates in cancer patients, leading centers have encouraged testing for SARS-CoV-2 before initiating antineoplastic treatments including systemic treatments, radiation therapies, and surgeries [34].…”