Italian survey on the clinical management of non-small cell lung cancer patients during the COVID-19 pandemic: A lesson for the second wave

Abstract

This study investigated the clinical management of non small cell lung cancer (NSCLC) patients during the first wave of coronavirus disease 2019 (COVID-19) outbreak in Italy. A 29-questions survey was sent to 95 Italian thoracic oncologists, with 77 % of them declaring significant changes in the outpatients management and treatment. The results of this survey pointed out a significant delay of lung cancer diagnosis along with a relevant reduction of patients' accrual within clinical trials. Telemedicine emerged as a valid support for patient-healthcare interactions. Therapeutic indications followed the guidelines for adjuvant chemotherapy and concurrent chemo-radiation. Clinical indications to first-line therapies were largely confirmed, while major changes regarded the selection of second line treatment options as well as the management of elderly population. This work may represent a valid source of information to improve the clinical management of NSCLC patients during second wave of COVID-19 pandemic.

Keywords: COVID-19; Lung cancer; Outpatient management; SARS‐CoV‐2; Survey.

Graphical abstract

Fig. 1

Schematic representation of the responses to the following survey’s questions: A Has the outpatient/Day Hospital organization for the management of NSCLC patients changed? B Where NSCLC patients underwent triage (body temperature measurement, questions about epidemiological status and clinical conditions)?. C Did the the number of consultations in patients with suspected NSCLC diagnosis vary?. D Did the number of consultations in patients with suspected NSCLC diagnosis coming from emergency department vary?. E Did the number of patients with newly diagnosed of NSCLC vary?. F Has multidisciplinary tumor boards for the discussion of NSCLC patients management been manteined?.

Fig. 2

Schematic representation of the responses to the following survey’s questions: A Has the indication to adjuvant treatment been modified for surgically resected NSCLC patients? B Has the indication to concurrent chemo-radiotherapy been modified for NSCLC patients with unresectable locally advanced disease?. C Has the indication to first-line chemotherapy been modified for patients with metastatic NSCLC?. D Has the indication to first-line chemo-immunotherapy been modified for patients with metastatic NSCLC?. E Has the indication to first-line single agent immunotherapy been modified for patients with metastatic NSCLC?. F Has the indication to first-line targeted therapies been modified for patients with metastatic NSCLC? G Has treatment indication to first line chemotherapy or immunotherapy been modified in elderly patients (over 75 years) with non-oncogene addicted metastatic NSCLC?. H Has treatment indication to manteinance therapy benn modifed for patients with metastatic NSCLC candidate to start/continue maintenance chemotherapy (pemetrexed). I Has treatment indication for metastatic NSCLC patients undergoing first line immunotherapy been modified?. L Has treatment indication to second line chemotherapy been modified fro metastatic NSCLC patients?. M Has treatment indication to second line immunotherapy been modified for metastatic NSCLC patients?. N Has the indication to interrupt active treatment and start best supportive care been modified in metastatic NSCLC patients?. O Has follow-up management for NSCLC patients been modified?. P Has NSCLC patients’ accrual in ongoing clinical trials been modified?.

Fig. 2

Schematic representation of the responses to the following survey’s questions: A Has the indication to adjuvant treatment been modified for surgically resected NSCLC patients? B Has the indication to concurrent chemo-radiotherapy been modified for NSCLC patients with unresectable locally advanced disease?. C Has the indication to first-line chemotherapy been modified for patients with metastatic NSCLC?. D Has the indication to first-line chemo-immunotherapy been modified for patients with metastatic NSCLC?. E Has the indication to first-line single agent immunotherapy been modified for patients with metastatic NSCLC?. F Has the indication to first-line targeted therapies been modified for patients with metastatic NSCLC? G Has treatment indication to first line chemotherapy or immunotherapy been modified in elderly patients (over 75 years) with non-oncogene addicted metastatic NSCLC?. H Has treatment indication to manteinance therapy benn modifed for patients with metastatic NSCLC candidate to start/continue maintenance chemotherapy (pemetrexed). I Has treatment indication for metastatic NSCLC patients undergoing first line immunotherapy been modified?. L Has treatment indication to second line chemotherapy been modified fro metastatic NSCLC patients?. M Has treatment indication to second line immunotherapy been modified for metastatic NSCLC patients?. N Has the indication to interrupt active treatment and start best supportive care been modified in metastatic NSCLC patients?. O Has follow-up management for NSCLC patients been modified?. P Has NSCLC patients’ accrual in ongoing clinical trials been modified?.

Fig. 3

Schematic representation of the responses to the following survey's questions: A In case of suspected COVID-19 infection in NSCLC patients, where the nasopharyngeal swab has been performed?. B How many NSCLC patients have been positive for COVID-19 infection in your Institution considering the period from the pandemic declaration to the following four weeks (March 11th-April 11th 2020)?.