The Emirates Oncology Task Force Clinical Practice Guideline on Screening for SARS-CoV-2 in Asymptomatic Adult Cancer Patients Prior to Anti-Cancer Therapy (Preprint)

Abstract

BACKGROUND Cancer care during this pandemic is challenging given the competing risks of death from cancer versus death or serious complications from SARS- CoV-2 infection, and the likely higher lethality of COVID-19 in immunocompromised patients. Question remains on serial screening for SARS-CoV-2 in asymptomatic adult cancer patients prior to anti-cancer therapy during the COVID-19 pandemic. OBJECTIVE Formulate a consensus guideline statement to guide practicing physicians METHODS We conducted a systematic review to formulate a consensus statement to guide the practising oncologists RESULTS Most of the current guidelines recommend RT-PCR SARS-CoV-2 testing of asymptomatic patients prior to initiating and during the anti-cancer therapy despite the lack of robust evidence. We suggested the following: If screening is indicated in adult cancer patients, we recommend using RT-PCR over serum antibody or serum antigen for adult cancer patients; we also recommend assessing the risk of exposure to and infection from SARS-CoV-2 prior to each anti-cancer cycle, to consider SARS-CoV-2 in asymptomatic adult cancer patients prior to anti-cancer therapy in high risk groups : highly cytotoxic chemotherapy with potential profound neutropenia based on the physician’s risk assessment of the chemotherapy , stem cell transplantation. For asymptomatic intermediate-high risk cancer patients, we suggest performing RT-PCR 48-72 hours prior to initiating any anti-cancer therapy. For asymptomatic low-risk cancer patients, we suggest not to routinely screen prior to initiating any anti-cancer therapy (weak recommendation, low quality evidence). CONCLUSIONS SARS-CoV-2 screening might be indicated with higher certainty to certain cancer risk groups. There remains a need for prospective trials to assess this intervention, and the outcome of such intervention. Current recommendations may change based on new and emerging evidence.