Whanau experience of patients' deaths in Wellington Hospital during 2020 COVID-19 pandemic Levels 3 & 4.

AIM: A qualitative exploration of the experience of whanau whose relatives died in an acute hospital setting during Levels 3 ∓ 4 of the 2020 COVID-19 pandemic in Aotearoa New Zealand. METHODS: Next of kin for 22 patients who had died in Wellington Hospital during Levels 3 & 4 of the 2020 COVID-19 pandemic (16/22 under General Medicine with an additional 6/22 who identified as Maori) from a total of 70 hospital deaths were interviewed by phone in August 2020. Whanau were asked to describe their experience of a relative dying. Following transcription, thematic content analysis was undertaken by the researchers. RESULTS: Whanau provided poignant and heartbreaking accounts of their experiences. Researchers broadly categorised their feedback as positive or negative. The dominant factors that contributed to positive experiences for whanau were excellence in nursing and medical care. Maori whanau benefitted from hospital staff understanding the importance of tikanga Maori relating to dying and death practices, and incorporating these into the care of the patient. Factors that contributed to negative experiences for whanau included separation from loved ones at the time of death. The findings underscore the importance of whanau accompanying the dying patient, and non-abandonment. Other negative experiences were not having time to say goodbye, and insufficient communication with medical personnel. There were also misunderstandings and uncertainty about the changing hospital rules around isolation with great variability in interpretation by different staff. CONCLUSIONS: Pandemic policies should prioritise the needs of whanau and hospitalised patients who are dying of any illness, including: daily telephone/Zoom updates by doctors and/or nurses with whanau; emailing photos to whanau of doctors/nurses/patient's room; having a bereavement whanau coordinator keeping in touch with relatives of patients who are dying; making follow-up telephone calls to whanau after the death; prioritisation of fast COVID-19 testing if there is a possibility that the patient will die; ensuring availability of Maori healthcare staff to support Maori patients and whanau; and observation of Maori tikanga around dying and death for Maori and their whanau.

Real-world outcomes in thoracic cancer patients with severe Acute respiratory syndrome Coronavirus 2 (COVID-19): Single UK institution experience.

BACKGROUND: UK COVID-19 mortality rates are amongst the highest globally. Controversy exists on the vulnerability of thoracic cancer patients. We describe the characteristics and sequelae of patients with thoracic cancer treated at a UK cancer centre infected with COVID-19. METHODS: Patients undergoing care for thoracic cancer diagnosed with COVID-19 (RT-PCR/radiology/clinically) between March-June 2020 were included. Data were extracted from patient records. RESULTS: Thirty-two patients were included: 14 (43%) diagnosed by RT-PCR, 18 (57%) by radiology and/or convincing symptoms. 88% had advanced thoracic malignancies. Eleven of 14 (79%) patients diagnosed by RT-PCR and 12 of 18 (56%) patients diagnosed by radiology/clinically were hospitalised, of which four (29%) and 2 (11%) patients required high-dependency/intensive care respectively. Three (21%) patients diagnosed by RT-PCR and 2 (11%) patients diagnosed by radiology/clinically required non-invasive ventilation; none were intubated. Complications included pneumonia and sepsis (43% and 14% respectively in patients diagnosed by RT-PCR; 17% and 11% respectively in patients diagnosed by radiology/clinically). In patients receiving active cancer treatment, therapy was delayed/ceased in 10/12 (83%) and 7/11 (64%) patients diagnosed by RT-PCR and radiology/clinically respectively. Nine (28%) patients died; all were smokers. Median time from symptom onset to death was 7 days (range 3-37). CONCLUSIONS: The immediate morbidity from COVID-19 is high in thoracic cancer patients. Hospitalisation and treatment interruption rates were high. Improved risk-stratification models for UK cancer patients are urgently needed to guide safe cancer-care delivery without compromising efficacy.

Practice Recommendations for Lung Cancer Radiotherapy During the COVID-19 Pandemic: An ESTRO-ASTRO Consensus Statement.

BACKGROUND: The COVID-19 pandemic has caused radiotherapy resource pressures and led to increased risks for lung cancer patients and healthcare staff. An international group of experts in lung cancer radiotherapy established this practice recommendation pertaining to whether and how to adapt radiotherapy for lung cancer in the COVID-19 pandemic. METHODS: For this ESTRO & ASTRO endorsed project, 32 experts in lung cancer radiotherapy contributed to a modified Delphi consensus process. We assessed potential adaptations of radiotherapy in two pandemic scenarios. The first, an early pandemic scenario of risk mitigation, is characterized by an altered risk-benefit ratio of radiotherapy for lung cancer patients due to their increased susceptibility for severe COVID-19 infection, and minimization of patient travelling and exposure of radiotherapy staff. The second, a later pandemic scenario, is characterized by reduced radiotherapy resources requiring patient triage. Six common lung cancer cases were assessed for both scenarios: peripherally located stage I NSCLC, locally advanced NSCLC, postoperative radiotherapy after resection of pN2 NSCLC, thoracic radiotherapy and prophylactic cranial irradiation for limited stage SCLC and palliative thoracic radiotherapy for stage IV NSCLC. RESULTS: In a risk-mitigation pandemic scenario, efforts should be made not to compromise the prognosis of lung cancer patients by departing from guideline-recommended radiotherapy practice. In that same scenario, postponement or interruption of radiotherapy treatment of COVID-19 positive patients is generally recommended to avoid exposure of cancer patients and staff to an increased risk of COVID-19 infection. In a severe pandemic scenario characterized by reduced resources, if patients must be triaged, important factors for triage include potential for cure, relative benefit of radiation, life expectancy, and performance status. Case-specific consensus recommendations regarding multimodality treatment strategies and fractionation of radiotherapy are provided. CONCLUSION: This joint ESTRO-ASTRO practice recommendation established pragmatic and balanced consensus recommendations in common clinical scenarios of radiotherapy for lung cancer in order to address the challenges of the COVID-19 pandemic.