ABSTRACT
Purpose/Objective(s): The COVID-19 pandemic has had considerable impact on volume of outpatient procedures, including radiation therapy, a critical treatment option for cancer patients. In order to measure the impact, we performed a retrospective review of patients treated at our multicenter institution with curative or palliative radiation over the past three years. Materials/Methods: Patients treated with radiation (n = 7,935) at our institution between 1/1/2018 and 12/31/2020 were retroactively enrolled in this IRB exempt study. Data elements such as primary cancer site, age, sex, and treatment intent were captured through our oncology analytics platform. Pearson's Chi square test for significance was used to assess a null hypothesis that there was no significant difference in treatment volume or treatment intent by disease system between 2018-2019 and 2020. Results: Median patient age in 2018-2019 was 67.3 (IQR: 59-75) vs. 67.55 (59-75) in 2020. The total number of patients starting treatment per year declined between 2018-2019 and 2020 from 1774.5 to 1606 (curative intent) and 1001 to 778 (palliative intent). Patient counts by disease system and treatment intent are summarized in the table. There were significant differences in the distribution of disease systems over time (X2 = 30.386, df = 10, P <.001) with breast and secondary disease exhibiting the largest drop in patients compared to the average of the prior two years (143.5 and 118). There were significant differences in treatment intent over time (X2 = 8.988, df = 1, P =.003) with fewer palliative treatments than expected in 2020. Conclusion: Differences in patient volumes may be attributable to several factors related to the COVID-19 pandemic. Fewer breast patients may have been treated due to a decrease in diagnostic mammography or an increase in patients opting for surgery over multi-week outpatient radiotherapy due to exposure risks. Fewer patients with secondary disease may have been treated due to a decrease in cancer surveillance or patients choosing to forego palliative treatment due to exposure risk. Further analysis is needed to understand the factors related to changes in treatment volume and treatment patterns in response to the COVID-19 pandemic.
ABSTRACT
BACKGROUND: Barts Health National Health Service Trust (BHNHST) serves a diverse population of 2.5 million people in London, UK. We undertook a health services assessment of factors used to evaluate the risk of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection.METHODS: Patients with confirmed polymerase chain reaction (PCR) test results admitted between 1 March and 1 August 2020 were included, alongwith clinician-diagnosed suspected cases. Prognostic factors from the 4C Mortality score and 4C Deterioration scores were extracted from electronic health records and logistic regression was used to quantify the strength of association with 28-day mortality and clinical deterioration using national death registry linkage.RESULTS: Of 2783 patients, 1621 had a confirmed diagnosis, of whom 61% were male and 54% were from Black and Minority Ethnic groups; 26% died within 28 days of admission. Mortality was strongly associated with older age. The 4C mortality score had good stratification of risk with a calibration slope of 1.14 (95% CI 1.01-1.27). It may have under-estimated mortality risk in those with a high respiratory rate or requiring oxygen.CONCLUSION: Patients in this diverse patient cohort had similar mortality associated with prognostic factors to the 4C score derivation sample, but survival might be poorer in those with respiratory failure.