Prolonged positive SARS CoV 2 RT PCR in cancer outpatients requires specific reorganization of cancer centres

Background: Patients with cancer are more susceptible to infection because of immunosuppressive treatment given to cure cancer Several guidelines published at the beginning of the COVID-19 pandemic recommend delaying systemic anticancer treatment until complete resolution of COVID-19 symptoms In addition, it is important to segregate patients with cancer from patients with COVID-19 to avoid transmission Nevertheless, some patients will present both diseases, and the duration of eviction from cancer units and delay of cancer treatment after COVID-19 remains unclear Notably the duration of viral excretion after COVID-19 is a concern in immunosuppressed patients Methods: We tested all patients with a confirmed initial diagnosis of COVID-19 who needed to receive cancer or immunosuppressive treatment for a solid tumour, haematological or inflammatory disease in our centre from April 1st to May 15th 2020 We have repeated SARS-COV2 RT-PCR until negative viral shedding Results: We tested 49 consecutive patients: 53% had solid tumours, 37% haematological disease and 10% inflammatory disease 59% were under 65 years Overall, 82% of patients had a positive RT-PCR from day 14 to 20 after the initial diagnosis of COVID-19 infection, 60% from day 21 to 27 and 30% from day 28 to 34 Only 4/37 patients evaluated remained with a positive RT-PCR after day 35 No predictive factors were associated with a positive RT-PCR but our results suggest that patients treated for inflammatory disease had a shorter duration of positive RT-PCR 18 patients had their treatment delayed according to guideline recommendations and 17 patients received their treatment in a dedicated COVID-19 outpatient unit No symptomatic COVID-19 recurrence was observed during follow-up in patients who had received chemotherapy despite persistent positive RT-PCR Conclusions: We report here the first assessment of SARS-CoV2 RT-PCR kinetic in cancer patients A prolonged viral excretion is observed in patients treated for cancer A systematic retest is needed after day 14 if RT-PCR remains positive A specific unit dedicated to outpatients with persistent positive RT-PCR allows urgent anticancer treatment and avoids the risk of viral exposure for other immunodepressed patients Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: All authors have declared no conflicts of interest