Not All Cancer Outpatients Require COVID-19 Testing

By Reuters Staff

August 25, 2020

NEW YORK (Reuters Health) - COVID-19 testing is not recommended for most asymptomatic cancer outpatients, and antineoplastic treatment can be resumed after resolution of fever or the passage of time in patients who have tested positive, according to an expert task force.

In the current pandemic, clinicians must weigh the benefits of initiating or resuming antineoplastic therapy against the risk of worsening outcomes related to COVID-19.

Dr. Diane Reidy-Lagunes from Memorial Sloan Kettering Cancer Center, New York and colleagues considered whether SARS-CoV-2 testing is appropriate prior to antineoplastic therapy for an asymptomatic patient and when it is safe to reinitiate therapy in a patient who has tested positive for SARS-CoV-2.

Based on the available data and on their expertise in this setting, the panel recommended SARS-CoV-2 RNA testing of asymptomatic patients without a history of COVID-19 only for those with hematologic malignancies prior to the initiation of outpatient antineoplastic therapy.

For patients with solid tumors, including lung cancer, routine pretreatment SARS-CoV-2 RNA testing was not recommended, according to the online report in Journal of the National Cancer Institute.

Previously symptomatic patients with COVID-19 can resume antineoplastic therapy when COVID-19-related fevers have resolved for at least 7 days without use of fever-reducing medications, there has been a substantial improvement in respiratory symptoms, and at least 14 days have elapsed since the onset of symptoms and/or initial positive SARS-CoV-2 test, whichever came earlier.

In previously asymptomatic patients who tested positive for SARS-CoV-2, resumption of antineoplastic therapy can be considered when at least 14 days have elapsed since the initial positive test if no symptoms have emerged during this time.

Patients who experienced more severe symptoms due to COVID-19, older patients, and patients with certain malignancies (lung cancer and hematologic malignancies, for example) might require additional time to recover prior to resumption of antineoplastic treatment.

"While we recognize that these guidelines are based on the current limited data and the opinions of their authors, we hope that they will be of use to physicians treating patients with cancer in other institutions," the authors conclude.

Dr. Reidy-Lagunes did not respond to a request for comments.

SOURCE: Journal of the National Cancer Institute, online August 14, 2020.