ABSTRACT
Background: Patients with lung cancer are at high risk from COVID19. Efforts are ongoing to limit exposure ofpatients with lung cancer to the health care system. As a result, the COVID19 pandemic has drastically changedcancer care, but the extent and type of these changes are unknown. The goal of this study was to evaluate thechanges in lung cancer treatment during the peak of the COVID19 pandemic. Methods: We prospectively assessed the cancer management plan of all patients seen in the thoracic oncologyclinic at our center between March 2 and April 30, 2020. Inclusion criteria for this study were a diagnosis of eithernon-small cell lung cancer or small-cell lung cancer. Those who had a diagnosis of COVID19 were excluded fromthe study. Primary endpoints were to describe the extent of changes in the cancer treatment plan and qualify thetypes of changes observed. Results: A total of N=289 patients were evaluated between March 2 and April 30, 2020. N=14 patients wereexcluded due to presence of other tumor histology, and 2 patients were COVID19-positive. Among the 275 patientsincluded, median age was 68 and 47% were male. Among the 238 patients (86.5%) with non-small cell lung cancer,172 (62.5%) had advanced disease. Among the 37 patients (13.5%) with small-cell lung cancer, 11 (4%) hadextensive disease. 211 were receiving active treatment (76.5%), with 35.1% on chemotherapy, 21.8% on oralagents, 31.8% on immune checkpoint inhibitors, and 11.4% on combination therapy. 121 (57%) of patientsexperienced at least one change in their lung cancer treatment plan as a direct result of the COVID19 pandemic, with 19 (9.0%) patients experiencing more than one change. The majority of changes encompassed delay orcessation of palliative treatment, N=48 (39.7%), N=18 (14.9%), respectively. Mean time to resumption of palliativetreatment was 36 days, and 3% of patients stopped palliative treatment permanently as a direct result of thepandemic. Changes in dosing and schedule occurred in N=32 (26.4%), which included changing pembrolizumab toq 6 weeks or durvalumab to q 4 weeks. A minority of patients experienced delays in adjuvant chemotherapyadministration (N=3 (2.5%)) with a mean delay of 42 days. Lastly, 6.6% of patients experienced deferrals orcancellations of surveillance scans or visits due to COVID19. Other changes included the decision not to pursuepalliative chemotherapy. Conclusion: Our study demonstrated that a significant proportion (57%) of patients experienced changes in theirlung cancer management plan as a direct result of the COVID19 pandemic. Given the preliminary findings thatactive cancer treatment is not associated with increased complications from COVID19, lung cancer treatments andsurveillance visits should continue to proceed with caution, and oncology care providers should continue to carefullyproceed with evidence-based care in lung cancer.