The Impact of Routine Molecular Screening for SARS-CoV-2 in Patients Receiving Anti-Cancer Therapy: An Interim Analysis of the Observational COICA Study.

Introduction Cancer aggravates COVID-19 prognosis. Nosocomial transmission of SARS-CoV-2 is particularly frequent in cancer patients, who need to attend hospitals regularly. Since March, 2020, all cancer patients having access to the Oncology Unit at the "Andrea Tortora" Hospital (Pagani, Salerno - referred to as "the Hospital") as inpatients or outpatients receiving intravenous therapy have been screened for SARS-CoV-2 using RT-PCR nasal swab. The ongoing COICA (COVID-19 Infection in Cancer Patients) study is an ambispective, multicenter, observational study designed to assess the prognosis of SARS-CoV-2 infection in cancer patients. The aim of the study presented here was to explore potential differences in COVID-19 related outcomes among screening-detected vs. non-screening detected SARS-CoV-2 infected patients. Methods The COICA study enrolled cancer patients who had received any anti-cancer systemic therapy within 3 months since the day they tested positive for SARS-CoV-2 on RT-PCR. The target accrual is 128 patients, and the study was approved by the competent Ethics Committee. Only the sub-group of patients enrolled at the Hospital was considered in this unplanned interim analysis. Logistic regression analysis was used to evaluate the association of screening-based vs. non screening based diagnosis. Results Since March, 15 2020 until August, 15 2021, a total of 931 outpatients and 230 inpatients were repeatedly screened for SARS-CoV-2 using RT-PCR nasal swab at the Hospital. Among these, 71 asymptomatic patients were positive on routine screening and five patients were positive for SARS-CoV-2 outside the institutional screening. Seven patients died because of COVID-19. At univariate analysis, non-screening vs. screening detected SARS-CoV-2 infection was associated with significantly higher odds of O2 Therapy (OR= 16.2; 95% CI =2.2 to 117.1; p =0.006),hospital admission (OR=31.5; 95% CI=3.1 to 317.8; p=0.003 ), admission to ICU (OR=23.0; 95% CI = 2.4 to 223.8; p= 0.007) and Death (OR=8.8; 95%CI= 1.2 to 65.5; p =0.034). Conclusion Routine screening with RT-PCR may represent a feasible and effective strategy in reducing viral circulation and possibly COVID-19 mortality in patients with active cancer having repeated access to hospital facilities.