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Beard KR, Borca F, Phan H, Brown E, Fenton PA, Stansby J, Defty J, Clark TW. Routine, molecular point-of-care testing for SARS-CoV-2 and other respiratory viruses within an acute oncology service improves patient care. J Infect 2023; 87:516-523. [PMID: 37802471 DOI: 10.1016/j.jinf.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES COVID-19 has caused significant challenges for infection prevention measures and patient flow in hospital admission pathways. We aimed to assess the impact of replacing laboratory PCR with molecular point-of-care testing (mPOCT) for respiratory viruses including SARS-CoV-2, within an Acute Oncology Service (AOS). METHODS This pre- and post-implementation study took place in the AOS of a large teaching hospital, in Southampton, UK. We collected data from two periods: November 25th, 2019 to November 24th, 2020, when respiratory virus testing utilised laboratory PCR, and December 1st, 2020 to May 31st, 2021 following the introduction of mPOCT. The primary outcome was the time to results. RESULTS 2189 patients were tested in the pre-implementation period and 1540 in the post implementation period. Median (IQR) time to results was 5.8 h (4.2-10.6) pre-implementation and 1.9 h (1.5-3.0) post-implementation (difference -3.6 h [95%CI to -3.8 to -3.5]; p < 0.0001). Median time spent in assessment areas was 6.0 h (4.1-7.9) pre-implementation and 5.5 h (3.8-7.4) post-implementation (p < 0.0001). 20 (0.9%) patients admitted via AOS assessment unit developed hospital-acquired respiratory virus infection pre-implementation versus 0 (0%) post-implementation (p = 0.031). CONCLUSIONS Routine mPOCT for respiratory viruses, including SARS-CoV-2, was associated with a reduced time to results, reduced time in assessment areas, and a reduction in the rates of hospital-acquired respiratory virus infection in an acute oncology assessment unit.
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Affiliation(s)
- Kate R Beard
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Florina Borca
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Clinical Informatics Research Unit, University of Southampton, Southampton, UK
| | - Hang Phan
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Clinical Informatics Research Unit, University of Southampton, Southampton, UK
| | - Emma Brown
- Macmillan Acute Oncology Service, Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul A Fenton
- Macmillan Acute Oncology Service, Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jessica Stansby
- Macmillan Acute Oncology Service, Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Defty
- Macmillan Acute Oncology Service, Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Health Sciences, University of Southampton, Southampton, UK
| | - Tristan W Clark
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK Trust, Southampton, UK
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2
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Sorey W, Krantz EM, Morris J, Klaassen J, Sweet A, Tverdek F, Escobar ZK, McCulloch DJ, Pergam SA, Liu C. Antiviral Prescribing Among Patients at an Ambulatory Cancer Center With Laboratory-Confirmed Influenza. Open Forum Infect Dis 2023; 10:ofad254. [PMID: 37250175 PMCID: PMC10220506 DOI: 10.1093/ofid/ofad254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023] Open
Abstract
Among 133 cancer outpatients diagnosed with influenza between 2016 and 2018, 110 (83%) were prescribed oseltamivir. Among 109 with a known symptom onset date, 53% presented for care and 31% were prescribed oseltamivir within 48 hours. Patient/provider education and rapid diagnostics are needed to improve early oseltamivir use among cancer patients with influenza.
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Affiliation(s)
- Woody Sorey
- Correspondence: Catherine Liu, MD, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109 (); or Woody Sorey, 6212 Phinney Ave N., Apt 3, Seattle, WA 98103 ()
| | | | | | - John Klaassen
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Ania Sweet
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Frank Tverdek
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Zahra K Escobar
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Denise J McCulloch
- School of Medicine, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Steven A Pergam
- School of Medicine, University of Washington, Seattle, Washington, USA
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Catherine Liu
- Correspondence: Catherine Liu, MD, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109 (); or Woody Sorey, 6212 Phinney Ave N., Apt 3, Seattle, WA 98103 ()
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3
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González-Montero J, Valenzuela G, Ahumada M, Barajas O, Villanueva L. Management of cancer patients during COVID-19 pandemic at developing countries. World J Clin Cases 2020; 8:3390-3404. [PMID: 32913846 PMCID: PMC7457113 DOI: 10.12998/wjcc.v8.i16.3390] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
Cancer patient care requires a multi-disciplinary approach and multiple medical and ethical considerations. Clinical care during a pandemic health crisis requires prioritising the use of resources for patients with a greater chance of survival, especially in developing countries. The coronavirus disease 2019 crisis has generated new challenges given that cancer patients are normally not prioritised for admission in critical care units. Nevertheless, the development of new cancer drugs and novel adjuvant/neoadjuvant protocols has dramatically improved the prognosis of cancer patients, resulting in a more complex decision-making when prioritising intensive care in pandemic times. In this context, it is essential to establish an effective and transparent communication between the oncology team, critical care, and emergency units to make the best decisions, considering the principles of justice and charity. Concurrently, cancer treatment protocols must be adapted to prioritise according to oncologic response and prognosis. Communication technologies are powerful tools to optimise cancer care during pandemics, and we must adapt quickly to this new scenario of clinical care and teaching. In this new challenging pandemic scenario, multi-disciplinary work and effective communication between clinics, technology, science, and ethics is the key to optimising clinical care of cancer patients.
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Affiliation(s)
- Jaime González-Montero
- Basic and Clinical Oncology Department, Faculty of Medicine, University of Chile, Santiago 70058, Chile
| | - Guillermo Valenzuela
- Basic and Clinical Oncology Department, Faculty of Medicine, University of Chile, Santiago 70058, Chile
| | - Mónica Ahumada
- Basic and Clinical Oncology Department, Faculty of Medicine, University of Chile, Santiago 70058, Chile
- Basic and Clinical Oncology Department, Hospital Clinico Universidad de Chile and Clínica Dávila, Chile
| | - Olga Barajas
- Basic and Clinical Oncology Department, Faculty of Medicine, University of Chile, Santiago 70058, Chile
- Basic and Clinical Oncology Department, Hospital Clinico Universidad de Chile and Fundación Arturo López-Pérez, Chile
| | - Luis Villanueva
- Oncology Department, Hospital Clínico Universidad de Chile and Fundación Arturo López-Perez, Chile
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El Ramahi R, Freifeld A. Epidemiology, Diagnosis, Treatment, and Prevention of Influenza Infection in Oncology Patients. J Oncol Pract 2020; 15:177-184. [PMID: 30970229 DOI: 10.1200/jop.18.00567] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Influenza infection causes increased morbidity and higher mortality in patients receiving treatment of underlying cancer, particularly in those with hematological malignancy or patients who have undergone hematopoietic stem-cell transplantation. The illness is characterized by seasonality and nonspecific clinical manifestations of upper respiratory infection at a time when other respiratory illnesses are common in the community, making the diagnosis challenging. However, accurate and timely diagnosis by new molecular techniques is crucial in the management of immunocompromised patients, because delays in initiating appropriate therapy can have devastating consequences. Emergence of viral resistance to currently used antiviral agents is of concern, particularly in immunocompromised hosts, and warrants continued monitoring and surveillance. Early and effective treatment improves outcomes, but optimal therapeutic strategies in patients with cancer are not well defined. Health care and research efforts should focus on defining treatment guidelines in patients with cancer and attempt to improve on current vaccination strategies.
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姚 艳, 路 明, 刘 燕, 曹 宝. [The Effects and Management of Viral Pneumonia on Lung Cancer Patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:255-260. [PMID: 32213266 PMCID: PMC7210092 DOI: 10.3779/j.issn.1009-3419.2020.102.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 01/08/2023]
Abstract
The worldwide epidemic of three coronaviruses and one influenza virus in 21st century have seriously threatened human health. Infection with these viruses can cause respiratory symptoms. The patients with lung cancer are more susceptible to viral infection and have a worse prognosis due to the advanced age and the systemic immunosuppressive state caused by malignancy itself and the anticancer treatments. In addition, without sufficient clinical awareness, a missed diagnosis of viral pneumonia may occur due to the fever and respiratory symptoms caused by lung cancer and its secondary diseases. Furthermore, control measures against viral outbreaks may interfere with routine diagnosis and treatment of lung cancer patients. Therefore, scientific protection and individualized management of lung cancer patients are particularly important during virus epidemic prevention and control. Here, we systematically reviewed the epidemiological and clinical characteristics of viral pneumonia, its impact on patients with lung cancer and the differential diagnosis of lung cancer-related respiratory manifestations, aiming to provide guidance for the individual management of lung cancer patients during the prevention and control of viral pneumonia epidemic.
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Affiliation(s)
- 艳红 姚
- 100191 北京,北京大学第三医院肿瘤化疗与放射病科Department of Medical Oncology and Radiation Sickness Peking University Third Hospital, Beijing 100191, China
| | - 明 路
- 100191 北京,北京大学第三医院呼吸与危重症医学科Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - 燕娥 刘
- 100191 北京,北京大学第三医院肿瘤化疗与放射病科Department of Medical Oncology and Radiation Sickness Peking University Third Hospital, Beijing 100191, China
| | - 宝山 曹
- 100191 北京,北京大学第三医院肿瘤化疗与放射病科Department of Medical Oncology and Radiation Sickness Peking University Third Hospital, Beijing 100191, China
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Ángeles-Sistac D, Martin-Onraet A, Cornejo-Juárez P, Volkow P, Pérez-Jimenez C, Vilar-Compte D. Influenza in patients with cancer after 2009 pandemic AH1N1: An 8-year follow-up study in Mexico. Influenza Other Respir Viruses 2019; 14:196-203. [PMID: 31747133 PMCID: PMC7040981 DOI: 10.1111/irv.12704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 08/09/2019] [Accepted: 10/21/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Immunosupressed patients are at high risk of influenza-related complications. Influenza AH1N1 has been hypothesized to induce worse outcomes in patients with malignancies, but after the A(H1N1)pdm09 few publications have analyzed the presentation and complications related to influenza afterward. OBJECTIVES We aimed to describe the characteristics, risk factors, and outcomes of influenza in an oncologic center after the 2009 pandemic and to compare our case distribution to the National community acquired influenza databases in Mexico and the United States. METHODS We reviewed the cases of confirmed influenza in patients with cancer from an oncological center in Mexico from April 2009 to April 2017. Data on severity and influenza type, malignancy, comorbidities, and outcomes were recorded. We correlated data between the Centers for Disease Control and Prevention (CDC) in the United States and SISVEFLU (Influenza Surveillance Program) in Mexico. RESULTS One hundred eighty-eight patients were included; 75 (39.9%) had a solid neoplasm and 113 (60.1%) had hematologic malignancies. AH1N1 was the most frequent influenza type (54.2%). Patients with hematologic malignancies had more pneumonia (55% vs 25%, P < .001), needed more hospitalizations (75% vs 39% P < .001), had higher all-cause mortality at 30 days (20% vs 9% P = .048) and influenza-associated mortality (17% vs 7% P = .041). Thirty (16%) patients died within 30 days, and 24 (12.7%) were related to influenza. Influenza type was not associated with worse outcomes. Yearly occurrence of influenza reported by the CDC and SISVEFLU showed a significant correlation (ρ = 0.823, P = .006). CONCLUSIONS AH1N1 was the dominant serotype. Patients with hematologic malignancies had more severe influenza and presented worse outcomes. Annual SISVEFLU and CDC surveillance information showed a similar distribution of cases along time but influenza serotypes did not match for all seasons.
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Affiliation(s)
- Diego Ángeles-Sistac
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Patricia Volkow
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Carolina Pérez-Jimenez
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
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7
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Are Community Acquired Respiratory Viral Infections an Underestimated Burden in Hematology Patients? Microorganisms 2019; 7:microorganisms7110521. [PMID: 31684063 PMCID: PMC6920795 DOI: 10.3390/microorganisms7110521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/25/2022] Open
Abstract
Despite a plethora of studies demonstrating significant morbidity and mortality due to community-acquired respiratory viral (CRV) infections in intensively treated hematology patients, and despite the availability of evidence-based guidelines for the diagnosis and management of respiratory viral infections in this setting, there is no uniform inclusion of respiratory viral infection management in the clinical hematology routine. Nevertheless, timely diagnosis and systematic management of CRV infections in intensively treated hematology patients has a demonstrated potential to significantly improve outcome. We have briefly summarized the recently published data on CRV infection epidemiology, as well as guidelines on the diagnosis and management of CRV infections in patients intensively treated for hematological malignancies. We have also assessed available treatment options, as well as mentioned novel agents currently in development.
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Vilar-Compte D, Shah DP, Vanichanan J, Cornejo-Juarez P, Garcia-Horton A, Volkow P, Chemaly RF. Influenza in patients with hematological malignancies: Experience at two comprehensive cancer centers. J Med Virol 2017; 90:50-60. [PMID: 28851056 DOI: 10.1002/jmv.24930] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/20/2017] [Indexed: 12/15/2022]
Abstract
The burden of influenza infections in patients with hematological malignancies (HMs) is not well defined. We describe the clinical presentation and associated outcomes of influenza at two comprehensive cancer centers (center 1 in the United States and center 2 in Mexico). Clinical and laboratory data on patients with HMs and influenza infection diagnosed from April 2009 to May 2014 at the two centers were reviewed retrospectively. A total of 190 patients were included, the majority were male (63%) with a median age of 49 years (range, 1-88 years), and had active or refractory HMs (76%). Compared to center 1, patients in center 2 were significantly sicker (active cancer, decreased albumin levels, elevated creatinine levels, or hypoxia at influenza diagnosis) and experienced higher lower respiratory tract infection (LRI) rate (42% vs 7%; P < 0.001). In multivariable logistic regression analysis (odds ratio, 95% confidence interval), leukemia, (3.09, 1.23-7.70), decreased albumin level (3.78, 1.55-9.20), hypoxia at diagnosis (14.98, 3.30-67.90), respiratory co-infection (5.87, 1.65-20.86), and corticosteroid use (2.71, 1.03-7.15) were significantly associated with LRI; and elevated creatinine level (3.33, 1.05-10.56), hypoxia at diagnosis (5.87, 1.12-30.77), and respiratory co-infection (6.30, 1.55-25.67) were significantly associated with 60 day mortality in both centers. HM patients with influenza are at high risk for serious complications such as LRI and death, especially if they are immunosuppressed. Patients with respiratory symptoms should seek prompt medical care during influenza season.
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Affiliation(s)
- Diana Vilar-Compte
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Dimpy P Shah
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Cancer Center, Houston, Texas
| | - Jakapat Vanichanan
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Cancer Center, Houston, Texas
| | | | - Alejandro Garcia-Horton
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico.,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Patricia Volkow
- Department of Infectious Diseases, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Cancer Center, Houston, Texas
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Rao S, Torok MR, Bagdure D, Cunningham MA, Williams JTB, Curtis DJ, Wilson K, Dominguez SR. A comparison of H1N1 influenza among pediatric inpatients in the pandemic and post pandemic era. J Clin Virol 2015; 71:44-50. [PMID: 26370314 DOI: 10.1016/j.jcv.2015.07.308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/24/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The novel influenza A H1N1 (A[H1N1]pdm09) strain emerged in 2009, contributing to significant morbidity and mortality. It is not known whether illness associated with A(H1N1) pdm09 in the post-pandemic era exhibits a similar disease profile. OBJECTIVE The objectives of this study were to compare the burden of disease of A(H1N1) pdm09 influenza from the 2009 pandemic year to the post-pandemic years (2010-2014), and to explore potential reasons for any differences. STUDY DESIGN We conducted a retrospective cohort study of inpatients admitted to Children's Hospital Colorado with a positive respiratory specimen for influenza from May-December, 2009 and December, 2010-April, 2014. Univariate and multivariate analyses were conducted to compare the demographics and clinical characteristics of patients with H1N1 during the two periods. RESULTS There were 388 inpatients with influenza A(H1N1) pdm09 in 2009, and 117 during the post-pandemic years. Ninety-four percent of all H1N1 during the post-pandemic era was observed during the 2013-2014 influenza season. Patients with A(H1N1) pdm09 during the post-pandemic year were less likely to have an underlying medical condition (P<0.01). Patients admitted to the ICU during the post-pandemic year had a lower median age (5 vs 8 years, P=0.01) and a lower proportion of patients were intubated, had mental status changes, and ARDS compared with the pandemic years, (P<0.01 for all), with decreased mortality (P=0.02). CONCLUSION Patients with influenza A(H1N1) pdm09 during the post-pandemic years appeared to have less severe disease than patients with A(H1N1) pdm09 during the pandemic year. The reasons for this difference are likely multifactorial.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics (Hospital Medicine and Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Michelle R Torok
- University of Colorado School of Medicine, Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Dayanand Bagdure
- Department of Pediatrics, University of Maryland School of Medicine, MD, USA
| | - Maureen A Cunningham
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Joshua T B Williams
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Donna J Curtis
- Department of Pediatrics (Infectious Diseases), University of Colorado School Of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Karen Wilson
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Samuel R Dominguez
- Department of Pediatrics (Infectious Diseases), University of Colorado School Of Medicine and Children's Hospital Colorado, Aurora, CO, USA
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