Under the coronavirus disease 2019 (COVID-19) pandemic circumstance, how to administrate cancer patients with fever during radiotherapy.

Under the current pandemic of the coronavirus disease 2019 (COVID-19), cancer patients are considered to be one of the high-risk infected population [1]. As a radiation oncology center in general hospital, the influence of fever patients during the treatment are largely unknown. So we retrospectively studied the clinical characteristics of febrile patients who received radiation therapy during the period of covid-19 infection, from Peking Union Medical College Hospital of China, analyzed the clinical characteristics and risk factors of febrile patients, concluded screening and treatment procedure of cancer patients with fever, and the management experience of patients receiving radiotherapy during the period of covid-19 epidemic is shared. We believe our approach could provide a good reference for other similar radiotherapy centers.

In this retrospective analysis, we collected the period from January 22, 2020 to April 30, 2020. A total of 770 cancer patients were treated in the radiotherapy center of Peking Union Medical College Hospital. When these cases encountered fever during the treatment, close follow-up screen and treatment were processed strictly to ensure the zero infection for all these patients [2].

The clinical characteristics clinical data of patients with fever during radiotherapy in the center

27 cases of fever occurred in 770 patients treated in our center under the outbreak of COVID-19 were monitored. Among them, 16 patients (59.3%) were women, with an average age of 62.15 years (32–90), 18 patients (66.7%) aged over 60, 7 patients (26%) with lung cancer, 11 patients (40.7%) under IV stage, and 15 patients (55.6%) had co-morbidities diseases. There were 15 patients (55.6%) combined synchronous chemotherapy, 14 patients (51.9%) of leukocyte abnormality, 17 patients (63%) of low lymphopaenia, 15 cases (55.6%) of hypoalbuminemia.

The screen process of patient with fever during radiotherapy in the center

All fever patients were screened by fever clinic with COVID 2019 nucleic acid, COVID 2019 antibody and chest CT examination. For these fever patients the treatment of radiotherapy should be suspended until COVID 2019 nucleic acid and antibody test showed negative for twice (at least one-day interval). After excluding COVID 2019, these fever patients received corresponding treatment. See Fig. 1 for detail.

Fig. 1

The screen procedure of patients with fever in PUMCH radiation center during the the peak of convid-19 pandemic in China.

The results of screen and the treatment of fever patients in the center

According to the epidemic prevention requirements of hospitals and our center, all patients with fever were transferred to the fever clinic. Before the results of nucleic acid, antibody and chest CT examination, the treatment should be paused.

The etiology of 27 patients with fever, 8 patients with pulmonary inflammatory infection, 5 patients with urinary tract infection, 4 patients with gastrointestinal reaction, 10 patients with tumor fever. Pulmonary inflammatory infection was most common in lung cancer patients or associated with radiation treatment plan (the range of pneumonia is consistent with that of radiotherapy target area).

Patients with fever had been suspended from radiation therapy until the outcome of negative screen test results and the relive of fever symptoms, the average duration of suspension was 5.5 days (3–11), see Fig. 2 for details.

Fig. 2

The details of how 27 fever patients chronology in PUMCH radiation center all come together during the peak of convid-19 pandemic in China. *The line () shows the delay of radiation treatment, with the unit of day, the longer of the line, the more days for treatment delay. 6 patients (21.4%) with urinary tract infection delayed 7.5 days (4–11), 8 patients (28.5%) with pulmonary inflammatory infection delayed 6 days (4–9), 4 patients (14.2%) with gastrointestinal infection delayed 5.25 days (4–7), 9 patients (32.1%) with tumor fever delayed 3.8 days (3–7). As the average delay duration of radiotherapy is 5.5 days (3–11).

Other COVID-19 prevention and control schedule

During the covid-19 pandemic, the center has added free online consultation service on the information platform of the hospital. A total of 13 physicians in our hospital have conducted online consultation of 39 out-patient clinics, providing online consultation services for 93 patients, and completing 4 online MDT and tele consultation services in line with the needs outside the hospital, comforting the anxiety of patients and providing the best treatment arrangements for patients.

In summary, for cancer patients receiving radiotherapy, especially for lung cancer patients, old age, late disease staging, combined with cardiovascular or cerebrovascular diseases and combined with chemotherapy, leukocyte abnormality and hypoalbuminemia as a cause of fever are more likely to happen during radiotherapy. It is suggested that fever patients with anti-tumor therapy during COVID-19 epidemic should carefully be concerned. In order to ensure the safety treatment for these patients and other patients without fever, fast and effective screening and patient management are necessary. Scientific and reasonable arrangements for the treatment and strict screen procedure for fever patient will ensure the maximization of the rights and interests of cancer patients. We believe our approach can provide a good reference for other radiotherapy centers, especially for COVID-19 similar regions.

Funding

No.

Competing interests

None declared, the authors declare that they have no competing interests.