Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper.
Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper.
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DOI：
10.1007/s00520-020-05906-y
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Rapoport B
中科院分区：
文献类型：
--
作者：
Cooksley T;Font C;Scotte F;Escalante C;Johnson L;Anderson R;Rapoport B
癌症患者感染更严重COVID-19的风险更高，相关并发症也更多。该意见书描述了在COVID-19大流行期间对癌症患者（尤其是接受抗癌治疗的患者）的管理。呼吸困难是癌症患者常见的急诊表现，具有广泛的鉴别诊断，包括肺栓塞、胸膜疾病、淋巴管炎和感染，其中SARS-CoV-2现在是要考虑的病原体。筛查面谈以确定患者是否可能感染COVID-19对于防止感染传播至关重要，特别是在医疗机构内。癌症患者检测呈阳性，没有或最小的症状，可以从家里监测。远程医疗是一种在没有潜在暴露的情况下帮助跟踪患者的选择。在COVID-19大流行期间，管理全身性抗癌治疗的并发症（如发热性中性粒细胞减少症（FN））尤为重要，临床医生旨在最大限度地降低患者的感染风险和住院治疗需求。低风险FN患者的门诊管理是一种安全有效的策略。尽管MASCC评分尚未在疑似或确诊的SARS-CoV-2患者中得到验证，但它在一系列感染性疾病患者中表现良好，因此，在COVID-19临床环境中预期疗效是合理的。FN患者的风险分层是不断发展的脓毒症和大流行战略的重要原则，需要获得基于MASCC和其他国家和国际指南的当地制定的服务。创新的肿瘤学服务将需要利用远程医疗、在家医院和门诊护理服务方法，不仅要限制医院就诊的次数，还要预测抗癌治疗的并发症。
Patients with cancer are at higher risk of more severe COVID-19 infection and have more associated complications. The position paper describes the management of cancer patients, especially those receiving anticancer treatment, during the COVID-19 pandemic. Dyspnea is a common emergency presentation in patients with cancer with a wide range of differential diagnoses, including pulmonary embolism, pleural disease, lymphangitis, and infection, of which SARS-CoV-2 is now a pathogen to be considered. Screening interviews to determine whether patients may be infected with COVID-19 are imperative to prevent the spread of infection, especially within healthcare facilities. Cancer patients testing positive with no or minimal symptoms may be monitored from home. Telemedicine is an option to aid in following patients without potential exposure. Management of complications of systemic anticancer treatment, such as febrile neutropenia (FN), is of particular importance during the COVID-19 pandemic where clinicians aim to minimize patients’ risk of infection and need for hospital visits. Outpatient management of patients with low-risk FN is a safe and effective strategy. Although the MASCC score has not been validated in patients with suspected or confirmed SARS-CoV-2, it has nevertheless performed well in patients with a range of infective illnesses and, accordingly, it is reasonable to expect efficacy in the clinical setting of COVID-19. Risk stratification of patients presenting with FN is a vital tenet of the evolving sepsis and pandemic strategy, necessitating access to locally formulated services based on MASCC and other national and international guidelines. Innovative oncology services will need to utilize telemedicine, hospital at home, and ambulatory care services approaches not only to limit the number of hospital visits but also to anticipate the complications of the anticancer treatments.
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