Operationalizing a prioritized COVID-19testing strategy at a Canadian tertiary care cancer center
Authors: April A. Hildebrand, Desiree Hao, Safiya Karim, Winson Y. Cheung, Don Morris, Daniel Y. C. Heng
Journal: Clinical Cancer Research (2020)

Background: Available data suggest that cancer patients who contract COVID-19 may have worse outcomes, including a higher mortality compared to noncancer patients  In an effort to inform and guide our clinicians in theongoing management of cancer patients during the COVID-19 pandemic, CancerControl Alberta (CCA)implemented targeted fast-track testing for symptomatic, immunocompromised cancer patients in the ambulatorysetting  We report the results of the first 7 weeks of testing at the Tom Baker Cancer Centre (TBCC), acomprehensive tertiary cancer center serving southern Alberta (population approximately 2 million)  Methods: Referral for prioritized COVID-19 testing (results within 24 hours) was intended for ambulatory cancerpatients who were identified to have symptoms consistent with an influenza-like illness and confirmed to meet atleast one of the following criteria: stem cell transplant recipient, hematologic malignancy, cancer diagnosis receiving>0 5 mg/kg/day of prednisone or equivalent, patients on immunotherapy treatment, patients on active chemotherapy within the last 3 weeks, neutropenia (ANC <500), lung cancer, chronic lung disease (e g , COPD), or patientsreceiving curative radiation  Testing occurred on site at the TBCC at a designated drive-through testing area wherestaff, using PPE, tested patients who remained in their cars  The assay for COVID-19 was nucleic acid-based test, and patients were also tested for a standard respiratory virus panel  Patients received either a nasopharyngeal orthroat swab, for hematologic and solid tumors diagnoses, respectively  Descriptive analyses were performed  Results: Between April 15th and June 1st, 2020, 80 patients received prioritized testing at the Tom Baker CancerCentre  Patients who were tested for COVID-19 had the following characteristics: median age of 60 5 years (range19, 85) and 31% were male  The majority of tested patients (80%) met the criteria as outlined to prioritize testing Patients with the following tumor types comprised over 80% of those tested: breast (n=22), hematologic (n=16), lung(n=9), gynecologic (n=9), and GI (n=9)  The average time from screening to testing was 26 5 hours, and theaverage time from test to result was 12 8 hours  At the time of reporting, only one breast cancer patient, who justfinished chemotherapy, tested positive via the fast-track testing process;this patient received repeat clearancetesting, undergoing a total of 6 tests over one month before achieving 2 negative tests  Conclusions: Our experience demonstrates that prioritized testing for COVID-19 among those who are potentiallythe most susceptible, namely immunocompromised cancer patients, is feasible  Very few (1%) positive cases ofCOVID-19 were identified, among 80 patients tested in the first 47 days of operationalizing the fast-track testingprocess  Expedited testing should be considered as an ongoing strategy to provide guidance to clinicians inmanaging cancer patients during the COVID-19 pandemic