Cancer patients are considered vulnerable due to an increased risk of developing severe cases of COVID-19 disease compared with non-oncological population. Patients with advanced forms of cancer receiving palliative care at home are particularly frail. In recent article published on July 1, 2020 at the Journal of Pain and Symptom Management of the American Academy of Hospice and Palliative Medicine, Tuscany Tumor Association, a home care service company in central Italy, shared their experience in managing oncological homecare visits after an earthquake that occurred in central Italy in 2009 and pointed out how post-natural disaster management tools and strategies can be applicable to cancer population requiring services at home in the light of COVID-19 pandemic. And even though the challenges that healthcare team at Tuscany Tumor Association faced after the earthquake of 2009 were very different than with current pandemic, there may be some similarities that, in the absence of available literature on the subject, may serve as a baseline for initiation of procedures and tools to aid with pandemic relief in the vulnerable cancer patients in the community. 

With the goals of maintaining the continuity of care for the patients as much as possible, adapting the operating procedures according to the circumstances, and protecting the healthcare workers, a double triage protocol was established. The initial triage scans the patients for the symptoms of COVID via a telephone interview with a trained nurse a day prior to the scheduled home visit. The nurse asks the patients, their relatives and/or cohabiters whether they have experienced fever, breathlessness, or cough, have recently travelled to known outbreak areas in Italy, have had direct contact with people known to have COVID-19, and other risk assessment questions. Should any of the above statements receive a positive answer, the patient would be referred to a general practitioner for a follow up according to the guidelines established by the national health system of Italy. 

Patients who are cleared at the initial triage step would have their health and symptoms related to cancer care evaluated. Symptoms of cancer disease severity and disease burden are assessed with the PERSONS (Pain, Eating, Rehabilitation, Sleep, Oxygen, Nausea/vomiting, and Suffering) score and life expectancy is evaluated via Palliative Prognostic (PaP) score. Based on the score summary, each patient would be assigned a three color-based priority category: red indicating severe symptoms not controlled with the ongoing therapy, yellow indicating moderate symptoms, and green signifying mild disease 

symptoms. Home visits are then scheduled based on the color-based priority indicators. In case of red, the visits would be performed on a daily basis; in case of yellow, a visit would occur twice a week; and for green, once weekly. The double triage protocol helps the organization avoid unnecessary visits and protects the healthcare professionals from the risk of infection while providing continuity of care. 

To date the double triage protocol has been tested in a small number of cancer patients (n=78) to evaluate its feasibility and acceptability and a good level of patients’ acceptance has been noticed. The organization is also collecting data for additional research and publication purposes. 

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To learn more about PERSONS score, follow supportive-care/article/persons-score-for-symptoms-assessment-in-simultaneous-care-setting-a-pilot- study/03745B4B8B879E6CFF6C767F3198AE5E 

To learn more about Palliative Prognostic score, follow 3924(98)00146-8/fulltext 


By Olga Ivanova, PharmD Candidate 2022

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