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.