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Onco-hematological patient care in times of COVID-19: a scoping review

Atención al paciente oncohematológico en tiempos de COVID-19: revisión de alcance

ABSTRACT

Objective:

to identify and map health care aimed at onco-hematological patients in times of Coronavirus 2019.

Methods:

this is a scoping review, anchored in the Joanna Briggs Institute theoretical framework, registered in the Open Science Framework, with searches carried out in June 2021, through searches in the databases.

Results:

a final sample consisting of 20 articles was obtained, with emphasis on general care, treatment and stem cell donation. The most reported care was the use of telemedicine, screening for Coronavirus Disease 2019, compliance with prevention practices and, in case of infection, postponing procedures.

Conclusions:

the study gathered the main evidence on care aimed at treating these patients in times of a pandemic. Such measures help in the clinical management with the objective of proceeding with treatment amidst the injuries caused, thus minimizing possible complications.

Descriptors:
Comprehensive Health Care; Patient Care; Coronavirus; Medical Oncology; Hematology

RESUMEN

Objetivo:

identificar y mapear la atención en salud dirigida a pacientes oncohematológicos en tiempos de Coronavirus Disease 2019.

Métodos:

se trata de una revisión de alcance, anclada en el marco teórico del Instituto Joanna Briggs, registrado en el Open Science Framework, con búsquedas realizadas en junio de 2021, a través de búsquedas en las bases de datos.

Resultados:

se obtuvo una muestra final conformada por 20 artículos, con énfasis en cuidados generales, tratamiento y donación de células madre. Los cuidados más relatados fueron el uso de telemedicina, pesquisa de infección por Coronavirus Disease 2019, adherencia a prácticas de prevención y, en caso de infección, postergación de procedimientos.

Conclusiones:

el estudio reunió las principales evidencias sobre la atención dirigida al tratamiento de estos pacientes en tiempos de pandemia. Tales medidas auxilian en el manejo clínico con el objetivo de proceder al tratamiento en medio de las lesiones ocasionadas y, así, minimizar posibles complicaciones.

Descriptores:
Atención Integral de Salud; Asistencia al Paciente; Coronavirus; Oncología Médica; Hematología

RESUMO

Objetivo:

identificar e mapear os cuidados em saúde direcionados aos pacientes onco-hematológicos em tempos de Coronavirus Disease 2019.

Métodos:

trata-se de uma scoping review, ancorada no referencial teórico do Joanna Briggs Institute, registrada na Open Science Framework, com buscas realizadas em junho de 2021, mediante pesquisas nas bases de dados.

Resultados:

obteve-se uma amostra final constituída de 20 artigos, com destaque para os cuidados gerais, de tratamento e na doação de células-tronco. Os cuidados mais relatados foram o uso da telemedicina, o rastreio de infecção por Coronavirus Disease 2019, a adesão às práticas de prevenção e, em caso de infecção, adiar os procedimentos.

Conclusões:

o estudo reuniu as principais evidências sobre os cuidados direcionados ao tratamento destes pacientes em tempos de pandemia. Tais medidas auxiliam no manejo clínico sob o objetivo de prosseguir com tratamento em meio aos agravos causados e, assim, minimizar possíveis complicações.

Descritores:
Assistência Integral à; Saúde; Assistência ao Paciente; Coronavírus; Oncologia; Hematologia

INTRODUCTION

Coronavirus Disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, spread around the world and took on the proportions of a pandemic. Among the infected patients, 80% have mild or moderate symptoms, and 20% have severe or critical symptoms. Complications develop more significantly in groups with risk factors, such as older adults, smokers and people with comorbidities(11 Organização Pan-Americana da Saúde (OPAS). Alerta Epidemiológico Complicações e sequelas da COVID-19 [Internet]. 2020[cited 2021 Jan 03]. Available from: https://www.paho.org/bra/index.php?option=com_docman&view=download&slug=alerta-epidemiologico-complicacoes-e-sequelas-da-covid-19&Itemid=965
https://www.paho.org/bra/index.php?optio...
). By mid-April 2022, approximately 500 million cases had been reported, and approximately 6.19 million deaths from the disease occurred worldwide(22 World Health Organization. WHO Coronavirus (COVID-19) Dashboard [Internet]. 2022[cited 2022 Apr 14]. Available from: https://covid19.who.int/
https://covid19.who.int/...
).

Onco-hematological patients are at high risk for COVID-19 infection due to suppression of the immune system due to the mechanisms of tumor invasion and severe systemic immunosuppression caused by chemotherapy and/or radiotherapy(33 Alves FM, Vasselai MEF, Cardoso NG, Damo RT, Garbim MR, et al. Imunopatologia da infecção por SARS-COV-2 em pacientes onco-hematológicos. Hematol Transfus Cell Ther. 2020;42(2):1-568. https://doi.org/10.1016/j.htct.2020.10.910
https://doi.org/10.1016/j.htct.2020.10.9...
). Thus, it imposes challenges to the provision of cancer care that impacts the care of these patients, a fact that can lead to delay in treatment, disease progression and even death(44 Van de Haar J, Hoes LR, Coles CE, Seamon K, Fröhling S, Jäger D, et al. Caring for patients with cancer in the COVID-19 era. Nat Med. 2020;26:665-671. https://doi.org/10.1038/s41591-020-0874-8
https://doi.org/10.1038/s41591-020-0874-...
-55 Araújo SEA, Leal A, Centrone AFY, Teich VD, Malheiro DT, Cypriano AS, et al. Impacto da COVID-19 sobre o atendimento de pacientes oncológicos: experiência de um centro oncológico localizado em um epicentro Latino-Americano da pandemia. Einstein(São Paulo). 2021;19:1-8. https://doi.org/10.31744/einstein_journal/2021AO6282
https://doi.org/10.31744/einstein_journa...
).

Accordingly, there was a remodeling of care in centers specialized in cancer treatment, where it was possible to verify a decrease in the number of returns and new face-to-face cancer consultations, which were replaced by the teleconsultation format, added to the reduction of some methods, procedures and therapies, such as intravenous systemic treatment, oncological surgery and hematopoietic stem cell transplants (HSCT). Such a situation may go against the premise that everyone has the right to adequate treatment and at the right time(55 Araújo SEA, Leal A, Centrone AFY, Teich VD, Malheiro DT, Cypriano AS, et al. Impacto da COVID-19 sobre o atendimento de pacientes oncológicos: experiência de um centro oncológico localizado em um epicentro Latino-Americano da pandemia. Einstein(São Paulo). 2021;19:1-8. https://doi.org/10.31744/einstein_journal/2021AO6282
https://doi.org/10.31744/einstein_journa...
).

In Brazil, the COVID-19 pandemic caused more than 30 million cases and 661 thousand deaths(66 Johns Hopkins University Medicine. Global map. COVID-19 Map. Baltimore (USA): Johns Hopkins Coronavirus Resource Center [Internet]. 2020[cited 2021 Sep 28]. Available from: https://coronavirus.jhu.edu/map.html
https://coronavirus.jhu.edu/map.html...
). Still, for the country, there are estimates of 625,000 new cases of cancer for each year of the 2020-2022 triennium. Of these, the onco-hematological ones stand out, with 10,810 diagnoses of leukemias, 2,640 of Hodgkin’s lymphoma and 12,030 of non-Hodgkin’s lymphoma(77 Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2020: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2019[cited 2021 jan 03]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/estimativa-2020-incidencia-de-cancer-no-brasil.pdf
https://www.inca.gov.br/sites/ufu.sti.in...
).

A survey carried out in the state of Espírito Santo, southeastern Brazil, followed patients up with onco-hematological diseases between February 2020 and February 2021, and identified that, of the 406 patients under treatment, 36 were affected by the SARS-CoV-2 virus and, of these, 39% evolved to death(88 Sonsim GS, Marcondes SS, Araújo A, Souza LFL, Binda VL, Carvalho VHR, et al. Aspectos epidemiológicos da COVID-19 em pacientes com doença onco-hematológica atendidos em hospitais universitários da grande vitória: experiência de 12 meses. Hematol Transfus Cell Ther. 2021;43(S1):529-30. https://doi.org/10.1016/j.htct.2021.10.915
https://doi.org/10.1016/j.htct.2021.10.9...
).

In this scenario, given the incidence of hematological cancer cases and the susceptibility to contagion by COVID-19, through a previous and extensive search in the literature, the opportunity to develop this research was noticed, due to the gap represented by the lack of a study that would concatenate the main care directed to this very specific public. Hence the need to summarize prevention and management measures in care aimed at onco-hematological patients. That said, the results presented in this study aim to mitigate virus installation and the harmful clinical outcomes caused by it to an individual’s immunity.

COVID-19 infection in the onco-hematological context deserves attention, as such patients correspond to a vulnerable population group, as they are more likely to evolve with the severe form of the disease and even death, when compared to the others. Moreover, knowing the necessary care aimed at this specific public can minimize infection by the virus, with a view to reducing the risk of disease progression, delay and lower-than-expected results for treatment, among others, a fact that can represent a significant negative impact for the onco-hematologic patient(99 Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-337. https://doi.org/10.1016/S1470-2045(20)30096-6
https://doi.org/10.1016/S1470-2045(20)30...

10 Yeoh CB, Lee KJ, Rieth EF, Mapes R, Tchoudovskaia AV, Fischer GW, Tollinche LE. COVID-19 no Paciente com Câncer. Anesth Analg. 2020;131(1):16-23. doi: 10.1213/ANE.0000000000004884
https://doi.org/10.1213/ANE.000000000000...

11 Leonetti A, Facchinetti F, Zielli T, Brianti E, Tiseo M. COVID-19 in lung cancer patients receiving ALK/ROS1 inhibitors. Eur J Cancer. 2020;132:122-124. https://doi.org/10.1016/j.ejca.2020.04.004
https://doi.org/10.1016/j.ejca.2020.04.0...
-1212 Alcântara RC, Silva Júnior LCF, Arnozo GM, Oliveira TF, Santana FMS, Silva Filho ER, et al. Covid-19 em pacientes oncológicos: uma revisão do perfil clínico-epidemiológico. Rev Bras Cancerol. 2020;66. https://doi.org/10.32635/2176-9745.RBC.2020v66nTemaAtual.1046
https://doi.org/10.32635/2176-9745.RBC.2...
).

In the meantime, when considering the relevance of the number of individuals that make up this risk group and the lack of investigations regarding specific care for this part of the population(1212 Alcântara RC, Silva Júnior LCF, Arnozo GM, Oliveira TF, Santana FMS, Silva Filho ER, et al. Covid-19 em pacientes oncológicos: uma revisão do perfil clínico-epidemiológico. Rev Bras Cancerol. 2020;66. https://doi.org/10.32635/2176-9745.RBC.2020v66nTemaAtual.1046
https://doi.org/10.32635/2176-9745.RBC.2...
), this work was guided by the following guiding question “What are the health care directed to onco-hematological patients in times of COVID-19?”.

OBJECTIVE

To identify and map health care directed to onco-hematological patients in times of COVID-19.

METHOD

Ethical aspects

As this is a research with materials in the public domain that did not involve human beings, it was not necessary to be assessed by the ethics committee. However, it is important to emphasize that copyrights were respected with correct citation and referencing of studies.

Study design

This is a scoping review (ScR), prepared based on the Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)(1313 Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): checklist and explanation. Ann Intern Med. 2018;169:467-473. https://doi.org/10.7326/M18-0850
https://doi.org/10.7326/M18-0850...
) guidelines, with the research protocol registered in the Open Science Framework (OSF) (doi.org/10.17605/OSF.IO/3BPT6).

This type of study aims to identify, map, synthesize the evidence and gaps in knowledge around a given field of research. The performance process preserves methodological rigor through the following design: (1) research question identification; (2) identification of relevant studies; (3) selection of studies; (4) data analysis and extraction; and (5) synthesis and presentation of data(1313 Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): checklist and explanation. Ann Intern Med. 2018;169:467-473. https://doi.org/10.7326/M18-0850
https://doi.org/10.7326/M18-0850...
-1414 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI. 2020. https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12...
).

Methodological procedures

Step 1 consisted of formulating the research question, and for this, the mnemonic strategy PCC was used: (P (Population) - onco-hematological patients; (C) Concept - health care; and (C) Context - Coronavirus (COVID-19)). Thus, the following question was constituted: what is the health care directed to onco-hematological patients in times of COVID-19?

In step 2, before performing the searches in the databases, the descriptors that represent the object of this study were identified, using the Medical Subject Headings (MeSH) for the terms in English, and the Descriptors in Health Sciences (DeCS), for the terms in Portuguese. The selected descriptors were: Neoplasms, Health Care, Coronavirus. The strategy was elaborated with the help of synonyms/keywords and the Boolean operators AND and OR, as follows, in Portuguese and English, respectively: Neoplasias OR (Câncer OR Neoplasia) AND Assistência à saúde OR (Cuidados de assistência à saúde OR Cuidados de saúde) AND Coronavirus OR (Infecções por coronavírus); and Neoplasms OR (Cancer OR Neoplasm) AND Health care OR (Health care care OR Health care) AND Coronavirus OR (Coronavirus infection).

Thus, after selecting the descriptors, an open and extensive prior search was carried out in the literature and on the OSF platform to ensure that reviews or protocols with the object of study in question or similar theme were not published. From the non-identification, followed with the steps for consolidation of this ScR. After that, the selection of materials began in the databases and in the gray literature through the Journal Portal of the Coordination for the Improvement of Higher Education Personnel (CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), from the identification in the Federated Academic Community (CAFe) as a way of standardizing collection in the listed databases, in June 2021.

The selection of studies consisted of reading titles and abstracts of texts rescued in the databases and repositories of theses and dissertations. To reach step 3, there was a screening of works, according to eligibility criteria, by reading the full text to check if they answered the guiding question and for data extraction. The analyses were performed by peers of reviewers independently on the same day and time. In case of disagreement, there was discussion for consensus. In cases of doubt, the opinion of a third reviewer specialized in the area of the object of study was requested.

Regarding the eligibility criteria, publications that met the study objective were included, in any language and available in full in electronic form. Studies in editorial format, letter to the editor and opinion articles were excluded. Duplicate documents were considered only once. It is worth mentioning that filters were not used.

Data source

The databases used to search for the studies were: U.S. National Library of Medicine (PubMed), Scopus, Web of Science, PsycINFO, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Health Sciences Literature (lilacs), The National Library of Australia’s Trobe (Trove), Academic Archive Online (DIVA), capes Dissertation and Thesis Database, and Brazilian Society of Bone Marrow Transplantation (SBTMO).

Data collection and organization

For step 4, separation, summarization and reporting of the essential data found, a structured instrument was used, designed specifically for this purpose. This tool allowed the synthesis, interpretation of data and basic statistical analysis of the extent, nature and distribution of the selected studies that make up the final sample.

The following variables were extracted from the studies selected for the final sample: database; author(s); language; year of publication; country where the study was developed; study objective; methodological design; level of evidence; and health care directed to onco-hematological patients in times of COVID-19. The level of evidence of studies was classified according to the Joanna Briggs Institute(1414 Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis. JBI. 2020. https://doi.org/10.46658/JBIMES-20-12
https://doi.org/10.46658/JBIMES-20-12...
), categorized from one (I) to five (V).

Data analysis

Complying with step 5, the collected data were organized in Microsoft Excel 2016®, analyzed and presented descriptively by means of simple statistics and presented in the format of figures and tables in an appropriate way and that facilitate the visualization and interpretation of results.

RESULTS

Initially, 16,480 studies were identified in the searches in databases and other sources. After the selection process, described in Figure 1, the final sample consisted of 20 articles.

Figure 1
Selection process flowchart, Brazil, 2021 (n=20)

As for the year, it was found that almost all (19; 95%) of the works were published in 2020, and only one (5%) in 2021. Regarding the language, fourteen (70%) are in English, and six (30%) in Portuguese.

Among the countries in which the documents were prepared, Brazil (8; 40%) and the United States of America (5; 25%) stand out. Among the selected studies, it is observed that one (5%) was developed by researchers from several countries, classified as a multicenter study.

Chart 1 demonstrates a detailed characterization of selected studies in terms of reference, year and country of publication, study design and number of participants (in the case of studies with human beings), summary of care directed to onco-hematologic patients in times of COVID-19 and level of evidence.

Chart 1
Characterization of studies regarding year and country of development, study design, synthesis of general care directed to onco-hematological patients in times of COVID-19 and level of evidence, Brazil, 2021 (n=17)

Chart 2 is presented below with the detailed characterization of selected studies regarding reference, year and country of publication, study design and number of participants (when in studies with humans), synthesis of treatments directed to onco-hematological patients in times of COVID-19 and level of evidence.

Chart 2
Characterization of studies for year and country of development, study design, treatments aimed at onco-hematological patients and level of evidence, Brazil, 2021 (n=15)

Chart 3 presents a detailed characterization of selected studies with regard to reference, year and country of publication, study design and number of participants (in the case of studies with human beings), synthesis of the guidelines directed to bone marrow donors in times of COVID-19 and level of evidence.

Chart 3
Characterization of studies for year and country of development, study design, guidelines for bone marrow donors in times of COVID-19 and level of evidence, Brazil, 2021 (n=03)

DISCUSSION

When analyzing the identified studies, we noticed the predominance of articles published in 2020. This fact is attributed to the urgent need for scientific productions that contribute to a better understanding of the interaction between people with onco-hematological diseases and infection by the SARS-CoV-2 virus(3535 The Lancet Oncology. COVID-19: global consequences for oncology. Lancet Oncol. 2020;21(4):467. https://doi.org/10.1016/S1470-2045(20)30175-3
https://doi.org/10.1016/S1470-2045(20)30...
) and, thus, adapt care to the health demands of this public, according to the restrictions imposed by the pandemic.

It was found that the largest number of studies on this theme was developed in Brazil and the United States of America. This finding may be associated with the high impact of the pandemic in these countries, interconnected with the relevant incidence rates related to onco-hematological neoplasms, in addition to being nations with consistent and diversified locus of intense productivity of scientific research in health sciences(88 Sonsim GS, Marcondes SS, Araújo A, Souza LFL, Binda VL, Carvalho VHR, et al. Aspectos epidemiológicos da COVID-19 em pacientes com doença onco-hematológica atendidos em hospitais universitários da grande vitória: experiência de 12 meses. Hematol Transfus Cell Ther. 2021;43(S1):529-30. https://doi.org/10.1016/j.htct.2021.10.915
https://doi.org/10.1016/j.htct.2021.10.9...
,3333 Zhang X, Song K, Tong F, Fei M, Guo H, Lu Z, et al. First case of COVID-19 in a patient with multiple myeloma successfully treated with tocilizumab. Blood Adv. 2020;4(7):1307-10. https://doi.org/10.1182/bloodadvances.2020001907
https://doi.org/10.1182/bloodadvances.20...
,3636 Neiva MB, Carvalho I, Costa Filho ES, Barbosa-Junior F, Bernardi FA, Sanches TLM, et al. Brazil: the emerging epicenter of COVID-19 pandemic. Rev Soc Bras Med Trop. 2020;53. https://doi.org/10.1590/0037-8682-0550-2020
https://doi.org/10.1590/0037-8682-0550-2...
-3737 Kuchenbecker RS, Mota DM. Considerações sobre o uso de evidências científicas em tempos de pandemia: o caso da COVID-19. Vigil Sanit Debate. 2020;8(2):2-9. https://doi.org/10.22239/2317-269X.01541
https://doi.org/10.22239/2317-269X.01541...
).

There is a predominance of expert opinion in the identified articles and, consequently, a low level of evidence. In line with it, this methodological design is often used in serious, unexpected scenarios, with rapid geographic spread and which are characterized as a public health emergency, as in the case of the COVID-19 pandemic, whether in the health and general care recommendation, the use of medication or other non-pharmacological therapies(3434 Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit Rev Oncol Hematol. 2020;150. https://doi.org/10.1016/j.critrevonc.2020.102972
https://doi.org/10.1016/j.critrevonc.202...
).

The importance of constant monitoring and other preventive measures common to combating COVID-19, which are key parts for health maintenance at this time, is emphasized. This adds to the fact that there is not yet a defined treatment for infection, only supportive interventions for complications developed(11 Organização Pan-Americana da Saúde (OPAS). Alerta Epidemiológico Complicações e sequelas da COVID-19 [Internet]. 2020[cited 2021 Jan 03]. Available from: https://www.paho.org/bra/index.php?option=com_docman&view=download&slug=alerta-epidemiologico-complicacoes-e-sequelas-da-covid-19&Itemid=965
https://www.paho.org/bra/index.php?optio...
).

As for general care, although preventive measures for COVID-19 management are widely disseminated through digital media, it is up to professionals to educate patients and reinforce recommendations, as well as guide them to report the appearance of signs and symptoms related to the infection, since there is the spread of information of a dubious nature, which can generate questions, doubts or disbelief by patients(55 Araújo SEA, Leal A, Centrone AFY, Teich VD, Malheiro DT, Cypriano AS, et al. Impacto da COVID-19 sobre o atendimento de pacientes oncológicos: experiência de um centro oncológico localizado em um epicentro Latino-Americano da pandemia. Einstein(São Paulo). 2021;19:1-8. https://doi.org/10.31744/einstein_journal/2021AO6282
https://doi.org/10.31744/einstein_journa...
).

Regarding the health team, although scored in only 5.26% of articles, it is worth mentioning the importance of their dedication to a transplant unit and not taking care of patients with COVID-19 alternately, since, when infected, professionals can be a transmitting agent of the disease for onco-hematologic patients(1616 Al-shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, et al. A practical approach to the management of cancer patients during the novel Coronavirus Disease 2019 (COVID-19) Pandemic: an international collaborative group. Oncologist. 2020;25:1-10. https://doi.org/10.1634/theoncologist.2020-0213
https://doi.org/10.1634/theoncologist.20...
).

From this perspective, a study reports factors that represent a risk for infection of health professionals by SARS-CoV-2, such as close contact with potentially contaminated patients and/or co-workers, scarcity of personal protective equipment (PPE), work overload, inadequate use or non-use of PPE, and inadequate hand hygiene(1616 Al-shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, et al. A practical approach to the management of cancer patients during the novel Coronavirus Disease 2019 (COVID-19) Pandemic: an international collaborative group. Oncologist. 2020;25:1-10. https://doi.org/10.1634/theoncologist.2020-0213
https://doi.org/10.1634/theoncologist.20...
).

One strategy to continue with assistance in some critical health services is to conduct virtual consultations. This remote digital follow-up was indicated by 57.89% of selected studies, through telemedicine, an initiative that takes place from telehealth, capable of providing screening support, monitoring, diagnosis, surveillance, education and health prevention (1515 Motlagh A, Yamrali M, Azghandi S, Azadeh P, Vaezi M, Ashrafi F, et al. COVID19 Prevention & Care; A Cancer Specific Guideline. Arch Iran Med. 2020;23(4):255-264. https://doi.org/10.34172/aim.2020.07
https://doi.org/10.34172/aim.2020.07...
-1616 Al-shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, et al. A practical approach to the management of cancer patients during the novel Coronavirus Disease 2019 (COVID-19) Pandemic: an international collaborative group. Oncologist. 2020;25:1-10. https://doi.org/10.1634/theoncologist.2020-0213
https://doi.org/10.1634/theoncologist.20...
). Regarding treatment, the selected studies converge to a therapeutic flexibility, in order to mitigate exposure of cancer patients to COVID-19 and their subsequent illness and/or risk of death, since many of this public are immunosuppressed, due to spinal cord ablation caused by antineoplastic chemotherapy, and also have a higher mortality rate (16.7%), presented in a Brazilian study(1515 Motlagh A, Yamrali M, Azghandi S, Azadeh P, Vaezi M, Ashrafi F, et al. COVID19 Prevention & Care; A Cancer Specific Guideline. Arch Iran Med. 2020;23(4):255-264. https://doi.org/10.34172/aim.2020.07
https://doi.org/10.34172/aim.2020.07...
).

However, this adequacy to treatment depends on many clinical determinants, in which new assessments of each case are necessary and, according to the situation of aggravation of the disease of these patients and their particular demands in relation to the assistance provided, such as the human and physical resources employed, care must be accessible, effective and safe, with in order to define a quality therapeutic plan(1616 Al-shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, et al. A practical approach to the management of cancer patients during the novel Coronavirus Disease 2019 (COVID-19) Pandemic: an international collaborative group. Oncologist. 2020;25:1-10. https://doi.org/10.1634/theoncologist.2020-0213
https://doi.org/10.1634/theoncologist.20...
,3232 Alhalabi O, Iyer S, Subbiah V. Testing for COVID-19 in patients with cancer. E Clin Med. 2020;23. https://doi.org/10.1016/j.eclinm.2020.100374
https://doi.org/10.1016/j.eclinm.2020.10...
). Moreover, it is recommended to postpone non-urgent cases of HSCT, as well as to reassess the use of intensive care with high-risk complications and intensive care needs. This reality is consistent with the critical situation of intensive care unit bed occupancy and the lack of human resources and equipment in the pandemic scenario, as transplantation and other therapies deal with procedures requiring intensive care(1818 Teodoro JL, Tirapelli B. Covid-19 e TCTH: Recomendações para a Equipe Enfermagem. SBTMO [Internet]. 2020[cited 2020 Apr 30]. Available from: https://sbtmo.org.br/kcfinder/upload/file/Enfermagem_ORIENTA%C3%87%C3%95ES%20COVID%20EM%20PACIENTES%20PRE%20E%20P%C3%93S%20TMO.pdf
https://sbtmo.org.br/kcfinder/upload/fil...
-1919 Lupo-Stanghellini MT, Messina C, Marktel S, Carrabba MG, Peccatori J, Corti C, et al. Following-up allogeneic transplantation recipients during the COVID-19 pandemic. Lancet Hematol. 2020;7(8). https://doi.org/10.1016/S2352-3026(20)30176-9
https://doi.org/10.1016/S2352-3026(20)30...
).

Another situation in which the postponement of transplantation is required is cases in which patients had contact with people infected with COVID-19. With this, the incubation period of the virus is considered and that any transplant procedure should be postponed for at least 14 days, completed through home isolation. As in cases of proven infections, HSCT should be considered only after two consecutive negative RT-PCR tests. Compliance with prevention and management measures for COVID-19 should be adopted by health services, especially HSCT services. Disease care and management measures are essential for the identification and prevention of contamination by SARS-CoV-2, and may be adapted according to institutional and/or sector characteristics, in addition to the availability of human and material resources and the specifics of patients(1818 Teodoro JL, Tirapelli B. Covid-19 e TCTH: Recomendações para a Equipe Enfermagem. SBTMO [Internet]. 2020[cited 2020 Apr 30]. Available from: https://sbtmo.org.br/kcfinder/upload/file/Enfermagem_ORIENTA%C3%87%C3%95ES%20COVID%20EM%20PACIENTES%20PRE%20E%20P%C3%93S%20TMO.pdf
https://sbtmo.org.br/kcfinder/upload/fil...
-1919 Lupo-Stanghellini MT, Messina C, Marktel S, Carrabba MG, Peccatori J, Corti C, et al. Following-up allogeneic transplantation recipients during the COVID-19 pandemic. Lancet Hematol. 2020;7(8). https://doi.org/10.1016/S2352-3026(20)30176-9
https://doi.org/10.1016/S2352-3026(20)30...
,2525 Ministério da Saúde (BR). Secretaria de Atenção Especializada à Saúde. Nota Técnica Nº 36/2020-CGSNT/DAET/SAES/MS [Internet]. Brasília: 2020 [cited 2020 Apr 23]. Available from: https://acreditacao.abhh.com.br/adm/doc/ec1db83e7f8467bebfc2a0034952a537.pdf
https://acreditacao.abhh.com.br/adm/doc/...
).

Postponing therapies, consultations or transplantation, for example, can lead to a negative outcome, given the delays in treatment, increase in the number of patients on the waiting list, the risk of progression, relapse or recurrence of the disease and a greater chance of death from the health condition itself or from opportunistic diseases. At this pandemic moment, it is essential that health professionals, especially nurses, are oriented and trained to act with responsibility and technical-scientific knowledge based on the best evidence, to work in different scenarios of daily care, such as in the care of onco-hematological patients(3838 Xavier JM, Silva AFM, Torres DVO, Rocha MCS, Soares KD, Silva AF, et al. COVID-19 no contexto do transplante de células-tronco hematopoéticas: elaboração de cartilha educativa. Res, Soc Develop. 2022;11(4). https://doi.org/10.33448/rsd-v11i4.27005
https://doi.org/10.33448/rsd-v11i4.27005...
).

The report of any clinical manifestations by patients should be collected, recorded and monitored, especially adverse reactions, which include classic respiratory signs and symptoms of SARS-CoV-2 infection, from the perspective that any symptomatology associated with COVID-19 requires greater attention and immediate intervention from the team, given the criticality of transplant patients(1919 Lupo-Stanghellini MT, Messina C, Marktel S, Carrabba MG, Peccatori J, Corti C, et al. Following-up allogeneic transplantation recipients during the COVID-19 pandemic. Lancet Hematol. 2020;7(8). https://doi.org/10.1016/S2352-3026(20)30176-9
https://doi.org/10.1016/S2352-3026(20)30...
). Also, a report by the Brazilian Association of Organ Transplantation (ABTO - Associação Brasileira de Transplante de Órgãos) pointed out that, in 2020, there was a drop in the number of HSCT, with a drop of 18.64% compared to 2019. Therefore, it is possible to consider that one of the factors for such reductions is associated with the strict exclusion criteria for donor selection and transplantation only in urgent cases, as presented by studies(2323 Hamerschlak N. Recomendações da SBTMO para o tratamento da leucemia mieloide aguda na era da COVID. SBTMO [Internet]. 2020[cited 2020 Apr 15. Available from: https://www.sbtmo.org.br/kcfinder/upload/file/LMA%20na%20era%20COVID_Recomenda%C3%A7%C3%B5es%20da%20SBTMO.pdf
https://www.sbtmo.org.br/kcfinder/upload...
,2525 Ministério da Saúde (BR). Secretaria de Atenção Especializada à Saúde. Nota Técnica Nº 36/2020-CGSNT/DAET/SAES/MS [Internet]. Brasília: 2020 [cited 2020 Apr 23]. Available from: https://acreditacao.abhh.com.br/adm/doc/ec1db83e7f8467bebfc2a0034952a537.pdf
https://acreditacao.abhh.com.br/adm/doc/...
,2828 Waghmare A, Abidi MZ, Boeckh M, Chemaly RF, Dadwal S, Boghdadly ZE, et al. Guidelines for COVID-19 Management in Hematopoietic Cell Transplantation and Cellular Therapy Recipients. Biol Blood Marrow Transplant. 2020;26(11):1983-94. Available from: https://doi.org/10.1016/j.bbmt.2020.07.027
https://doi.org/10.1016/j.bbmt.2020.07.0...
-2929 Ljungman P, Mikulska M, Styczynski J. Coronavirus Disease COVID-19: EBMT recommendations update. EBMT [Internet]. 2020[cited 2020 Apr 07]. Available from: https://www.ebmt.org/covid-19-and-bmt
https://www.ebmt.org/covid-19-and-bmt...
,3434 Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit Rev Oncol Hematol. 2020;150. https://doi.org/10.1016/j.critrevonc.2020.102972
https://doi.org/10.1016/j.critrevonc.202...
).

Other factors that could explain this decline are the fear of contagion by donors when moving to health services, the low mobilization of non-governmental organizations (NGOs) and the lack of campaigns, due to the restrictions of social distancing.

Study limitations

As a limitation of the study, the tep of identification of works is imposed due to the periodic daily updates in the databases, which may have interfered in the final sample and had repercussions on the results presented.

Moreover, the studies selected for the sample have a low level of evidence, which shows the need for studies with more complex methodologies that cover participants/patients of the various levels of health care.

Contributions to nursing, health, and public policies

It is emphasized as a contribution of the research developed the summarization of analyzed care. Furthermore, the results presented will expand the health team’s knowledge regarding the clinical management of onco-hematologic patients in times of COVID-19, with the aim of continuing with cancer treatment amidst the complications caused by the pandemic and, thus, minimizing possible complications, evolution or worsening of the underlying disease, death, delay or ineffective outcome related to cancer treatment.

Thus, it is possible to encourage the production of new studies with a qualitative, quantitative or mixed approach, such as reviews, epidemiological and/or clinical studies, that explore the health care of people with onco-hematological diseases, to increase care to minimize contagion by COVID-19, since praxis, especially nursing, occurs under constant updates, with a view to meeting the health needs of patients.

CONCLUSION

The present study brought together the main scientific evidence on care aimed at the treatment of onco-hematologic patients in times of a pandemic. Health professionals, especially nurses and nursing staff, need to know and understand such information, since care is a living act that materializes in patients. With the advent of the pandemic, the care provided to onco-hematological patients, who were already considered critical, became even more specific, due to their health-disease status.

Thus, it is concluded that, in addition to screening for COVID-19 before starting therapy, postponing procedures in case of positive PCR and postponement of non-urgent HSCT, it is important to perform general care, such as telemedicine consultations, minimizing clinical/outpatient visits or patient stays in health facilities, compliance with prevention practices, such as the use of face masks, hand hygiene and social distancing.

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Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho
ASSOCIATE EDITOR: Hugo Fernandes

Publication Dates

  • Publication in this collection
    19 Sept 2022
  • Date of issue
    2022

History

  • Received
    24 Jan 2022
  • Accepted
    16 May 2022
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