Delivery of Cancer Care at Home during the First COVID-19 Pandemic in Italy: A Case Series Study (DomOnCOVID Project)

Abstract

Background: Cancer represents a major risk factor for COVID-19 poor outcomes. During the crucial phase of the pandemic, we launched a home care project, called DomOnCOVID, aiming to provide care to patients in their own homes, enabling to keep immunocompromised individuals away from health care facilities, decrease hospital use, and strengthen hospital capacity for subjects with COVID-19 and other conditions. This paper describes this intervention in terms of feasibility and clinical outcomes. Methods: This is a descriptive study of cancer patients with confirmed or suspected COVID-19 infection assisted at home in the Italian Province of Cremona during the pandemic’s first peak. We devised an organizational home care system which included a medical and nursing team equipped with a car for home visits, and a nurse manager who screened patient calls requesting inclusion in the project. The team administered oral drugs at home (chemotherapy, TKis, etc.) and was equipped with all necessary tools to conduct examinations, check vital signs, take blood samples, and nasopharyngeal swabs for COVID-19 testing. Results: From March 23rd to May 15th 2020, 71 cancer patients were assisted at home (181 visits, mean 2.5, SD 1.6 range 1-7). All had symptoms that could be traced back to COVID infection, but only 26/71 (37%) were found to be COVID+; 19/26 (73%) had mild symptoms, while 7 with severe symptoms were hospitalized and 2 died for COVID-19. The remaining patients recovered. 43/71 (60%) received at home oral or subcutaneous drugs and no particular problems or toxicity were observed. 16/28 (57%) of individuals living with COVID+ patients were found to be COVID+, while none of the non-cohabiting were COVID+. Conclusion: Delivery of cancer care at home is feasible and may be particularly useful not only during health crises but also after the epidemic in order to reduce hospital access, patient and care-giver travel and improve their quality of life. Further implementation studies on home-based care in oncology are warranted.