INTRODUCTION
Due to outbreak of a novel severe acute respiratory syndrome (SARS)
coronavirus 2019-nCoV (COVID-19), at the end of 2019, all efforts of
health-care workers and a large part of health centres had to be
allocated to overcome this epidemic. As increase in the prevalence of
COVID-19, the routine diagnosis and treatment procedures of most of
chronic illnesses has been affected. To prevent virus transmission from
other patients or healthcare providers, strict protections are required.
Therefore, a vital guidance and its’ updates prepared by World
Health Organization (WHO) should be followed (2). As each country’s own
epidemiological and clinical data about COVID-19 accumulates, they can
modify the patient approach and clinical practice with their own guides,
as in our country, Turkey (1).
Oncology practice is a more difficult clinical situation due to the
immunosuppression secondary to tumour and the treatments given.
Epidemiological data from China revealed that, while total mortality is
2.3%, it is 5.6% among patients with malignant tumour (3). Among
patients with cancer, lung cancer (5/18, 28%) is the most common type,
but patients with lung cancer have no higher incidence of malignant
events (20% and 62%, respectively, p = 0.294) (4). So an additional
concern is needed depending on the capabilities of the health systems of
countries.
Another difficulty is differential diagnosis of infection related
complications in lung cancer patients, especially in the epidemic
process. If a suspected or confirmed case of COVID-19 pneumonia is
diagnosed in a lung cancer patient, transfer to specially prepared
hospital department for isolation must be provided (5). Possibility of
false-negative detection of nasopharyngeal swabs for new coronavirus
nucleic acids should be concerned and in case of persistence clinical
suspicion, secondary sampling should be done (6). While waiting test
results of COVID-19, other causes related to infection or non-infection
(radiation pneumonia, immune-checkpoint inhibitor-associated pneumonia,
progression, pulmonary embolism, cardiac insufficiency etc.) must be
examined not to lose time.
After a thoracic surgery for lung cancer, in case of existence of
indication for adjuvant therapy, decision should be given case by case.
If patient with pathological stage ⅠB- ⅡA, is elderly and has poor
physical condition, the follow-up treatment plan should be considered
using a network platform with relevant physician (5). For patients with
pathological stage ⅡB-ⅢA time for adjuvant chemotherapy can be extended.
In the presence of pathological N2, presence of epidermal growth factor
receptor (EGFR) gene mutations may be evaluated as one of the adjuvant
treatment options (7).
In advanced stage patients without targetable mutation, initiating or
continuing of chemotherapy must be comprehensively evaluated. Being in
process of consolidation chemotherapy or 2 and above line protocols,
getting fragile to prior chemotherapies are clinical factors to extend
the interval of chemotherapy by close communication with physician (5).
So these study aimed to reveal, how lung cancer patients with
respiratory symptoms were managed during epidemic in a thoracic oncology
unite.