This document has been developed to provide guidance on the implementation and management of COVID-19 surveillance testing in outpatient cancer services. It is not intended to replace policy, processes, or guidelines in place at individual services but may inform existing guidelines.
The Clinical Excellence Commission (CEC)
Recommendations for COVID Surveillance Testing in NSW HealthCare Facilities Version 1.4 recommends that patients attending chemotherapy/radiotherapy appointments undergo surveillance COVID-19 rapid antigen testing (RAT) during periods when the system is at Red (as per the NSW
COVID-19 Risk Monitoring Dashboard).
COVID-19 testing is used to detect SARS-CoV-2, or an immune response to SARS-CoV-2. For the purposes of this document types of tests are defined as:
Cancer services should follow local procurement guidelines for orders for Rapid Antigen Test kits. HealthShare are working to provide further communications and guidance on procurement or RATs. Information will be updated when available
Outpatient cancer services will provide patients with a self-administered RAT kit including instructions prior to their scheduled appointment.
Self-administered rapid antigen test (RAT)
Patients will be advised to perform a self-administered RAT on the day of their appointment (where possible) and provide confirmation of thee test result to the clinic in advance of the appointment. If a patient requires a carer to accompany them to the appointment, the carer should also perform a RAT and provide a negative result prior to attending the service.
If a patient receives a negative result, the patient can then proceed with the scheduled appointment.
If a patient receives a positive result, the patient is required to notify the cancer service by telephone. The cancer service will determine the next steps as per local procedures and provide the patient with guidance on PCR testing, isolation, and continuation of care.
The cancer service will advise the patient to register the positive RAT result on the
Service NSW website in line with the NSW Health Guidelines. Registering positive test results via the
Service NSW website or app is mandatory.
If a patient receives an invalid result, the patient is required to notify the cancer service by telephone. The patient may then be asked to repeat the test or perform a PCR test prior to the appointment.
The cancer service will provide further advice to patient in line with local procedures.
Patients unable to perform a self-administered RAT(including those without RAT kits)
Some patients may be unable to perform a self-administered RAT. In this instance the cancer service will:
The availability to undertake a POC RAT will depend on local staffing, policy, and infrastructure.
If Point of Care (POC) Rapid Antigen test (RAT) is required:
Each cancer service will determine how POC RATs will be administered at their facility in line with local procedures.
Cancer services to ensure:
If a patient receives a negative POC RAT result, the patient can then proceed to the scheduled appointment.
If a patient receives a positive POC RAT result, the cancer service will:
A repeat COVID test by PCR may be required at the request of the facility to confirm the result.
Patients that are symptomatic but have returned a negative self-administered RAT should contact the cancer service directly by telephone. The cancer service will provide advice in line with local procedures.
Patients may be asked to perform another RAT in 24 hours or have a PCR test before continuation of care.
Patients who are symptomatic but returned a negative POC RAT may be asked to have a rapid PCR test performed onsite with local Infectious Diseases/Respiratory team approval.
Guidelines recommend to routinely test all cancer patients prior to systemic therapy, radiation therapy and haematopoietic cell therapy as infected patients may be asymptomatic, mildly symptomatic, or may not report symptoms from fear of being denied treatment.
In situations where resources are limited, it may be appropriate to only test those asymptomatic patients undergoing treatment with highly immunosuppressive therapies or those having anti-CD20 monoclonal antibodies for haematologic malignancies, which are associated with B-cell depletion. Noting that these conditions/treatments are also associated with a suboptimal response to COVID-19 vaccination.
After initial evaluation, risk stratification and patient counselling, outpatient management is appropriate for majority of positive patients who are having treatment with immunosuppressive therapies.
For those patients who are not deemed critical or require immediate services or treatment, and who are at highest risk of progression to severe disease, hospital admission or death; evidence1,2 suggests that neutralising monoclonal antibodies (nMABs) or oral antivirals significantly improve clinical outcomes in non-hospitalised patients. Both classes are to be commenced as soon as possible following COVID-19 diagnosis and within 5 days of symptom onset.
Patients are eligible if:
Note: A positive RAT is sufficient to establish indication for the use of nMABs or oral antivirals. The positive RAT should be confirmed via PCR/rapid PCR prior to treatment. However, treatment should not be withheld if there is a delay in receiving the PCR result.
Where an nMAB is contraindicated or the administration of an nMAB is not possible, patients may be treated with a five-day course of oral antiviral therapy if the onset of symptoms is in the last 5 days. Treatment must not be extended beyond 5 days and patients advised to complete the whole course of treatment even if their symptoms improve and/or they feel better.
For detailed information see:
For patients attending appointments intermittently as day only visits testing will only be required on the day of attendance.
Patients attending for multi-day anti-cancer therapy, including those protocols with continuous infusions e.g. flurouracil pump or daily radiation therapy, should self-test, if able, test at a minimum of every 72 hours. However, local protocol specific recommendations should be followed.
eHealth has been working with Oncologist and infectious disease experts to build a system to record and make COVID positive results visible across districts.
Clinicians will be asked to record their patient's positive RAT result in the Cerner EMR. This process will trigger relevant alerts and send result to the Patient Flow Portal.
Recording positive RATs is not available in the Oncology Information System.
In language written instructions for taking RATs are now available in
15 priority languages, these include:
What type of rapid antigen tests should I use?
Anyone who receives a positive rapid antigen test is now required to register with Service NSW. Registering via the
Service NSW website or app is mandatory.If Culturally and Linguistically Diverse Communities patients require support registering their result a free telephone interpreter services is available.
Patients can call the Translating and Interpreting Services on 131 450, state the language they require in English and ask the interpreter to connect them to Service NSW on 13 77 88
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Cancer and blood and marrow transplant Community of Practice
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
Outpatient cancer services