Alternative pathways for assessment of acute medical oncology visits resulted in decreased length of hospital stay and frequency of emergency department (ED) visits during the COVID-19 pandemic, according to results from a study conducted in Ireland and presented at the European Society of Medical Oncology (ESMO) Virtual Congress 2020.
The first confirmed case of community-acquired SARS-CoV-2 infection in Ireland was reported on March 5, 2020, and a lockdown was instated on March 27, 2020. The purpose of this study was to characterize the unscheduled acute medical oncology visits that occurred at the Cork University Hospital during February 1 to April 30, 2020, of the pandemic.
The audit of unscheduled medical oncology visits evaluated presenting time, location, complaint, SARS-CoV-2 status, and average length of hospital stay (aLOS). The data were characterized into 3 phases: phase 1 included visits that occurred prior to the first confirmed case of SARS-CoV-2 in Ireland; phase 2 was from the time of the first confirmed case to the lockdown implementation; and phase 3 was a 4-week period after the lockdown was implemented.
At baseline, the most common cancer types were of the breast and gastrointestinal tract and 57% of patients were receiving systemic anticancer treatment. One patient tested positive for SARS-CoV-2 infection.
Overall, there were 162 unscheduled medical oncology visits, with 41% occurring during the first phase of the study, 23% during the second phase, and 36% during the third phase. The most common complaints at presentation were pain (21%), pyrexia (17%), and dyspnea (14%).
During the first phase of the study, 78% of unscheduled visits presented to the ED. This decreased to 54% in the second phase of the study, after the first confirmed SARS-CoV-2 case in Ireland, and then to 47% during the third phase, after the lockdown was implemented.
In contrast, the number of visits to a separate medical oncology assessment facility increased during the study, with 6 during phase 1, 10 during phase 2, and 16 during phase 3. In addition, a separate hospital for potential SARS-CoV-2 cases was visited by 0 patients during phase 1, and 4 patients each during phase 2 and phase 3 of the study.
The aLOS was 15 days during the first phase of the study, which decreased to 5 days during phase 2 and 3 days during phase 3. Admission to the hospital was related to cancer among 51% of patients, due to a treatment-related toxicity in 10%, and non–cancer related in 39%. Non–cancer related reasons were not specified.
The authors concluded that “processes which facilitate urgent assessment of oncology patients in specialized units avoid ED attendance and accelerate discharge planning in the care of cancer patients in the face of a pandemic and beyond.”
Ni Choinin A, Allen M, Milewski L, et al. Lessons from a pandemic: An audit of acute medical oncology admissions during SARS-CoV-2 outbreak. Presented at: European Society of Medical Oncology (ESMO) Virtual Congress 2020; September 19-21, 2020. Abstract 1751P.