ABSTRACT
Background: Early reports in the COVID-19 pandemic suggested higher mortality for cancer patients. The impact of potentially immunosuppressive systemic anti-cancer treatments (SACT) was unknown. This study analysed the delivery of SACT for patients with solid malignancies during the COVID-19 outbreak in 2020 compared to the same period in 2019 to inform future clinical decision-making. Methods: All patients receiving at least one SACT at Guy's comprehensive Cancer Centre during the COVID-19 outbreak for solid tumours (1st March- 31st May 2020) were compared to the same period in 2019. SARS-CoV2 infection was by positive RT-PCR test. Data collected: demographics, tumour type/stage and treatment (chemotherapy, immunotherapy (IO), biological-targeted (BT)). Results: 2125 patients received SACT in 2020, compared to 2450 in 2019 (13% decrease). Demographics were comparable with mean age of 62. 56% females in 2020 vs 54% in 2019, 85% vs 83% in the low socio-economic category, 63% vs 73% PS 0-1;30% vs 29% uro-gynaecological, 27% vs 24% breast and 20% vs 23% GI tumours. In 2020 compared to 2019, there was an increase in metastatic disease (71% vs 62%), decrease in CT (34% vs 42%), increase in IO (10% vs 6%), but similar rates of BT treatments (38% vs 37%). Treatment paradigms were similar in 2020 and 2019: neo/adjuvant (28% vs 29%), radical (4% vs 5%) and palliative (69% vs 67%). Earlier palliative treatments were prioritised in 2020 with significant increase in treatments in 1st-2nd line (72% vs 67%;p=0.02) and reduction in > 3rd line (12% vs 27%;p<0.05). 42 of 2125 patients (2%) developed SARS-CoV2 infections;38% GI, 26% breast with 69% on CT. Of 42 patients with COVID-19, 24 (57%) had severe infections and 6 (14%) resulted in COVID-related death. Conclusions: These data suggest that SACT does not put solid tumour patients at much a higher additional risk from COVID-19. Despite a 13% decline in treatment rates, radical and early palliative treatment were prioritised. There was a low frequency (2%) of SARS-CoV-2 infection;comparable to the 1.4% point prevalence rate in our cancer population. However, this was during national lockdown with limited COVID-19 testing. The next steps are to evaluate the impact of new variant strains and COVID vaccination programme. Legal entity responsible for the study: Guy's Real-World Evidence. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Background: The COVID-19 pandemic was declared in the UK in February 2020, impacting significantly on healthcare. Delivery of systemic anti-cancer treatment (SACT) rapidly adapted to minimize patient exposure to SARS-CoV-2. The risks of SACT and concomitant COVID-19 infection are unknown. Here we report the patient/tumour characteristics of pts with any GYN cancer undergoing SACT during the first wave to understand risks of SACT and establish clinical guidelines for safe management in the ongoing SARS-CoV2 pandemic. Methods: Demographic and clinical characteristics of GYN cancer pts receiving at least one SACT between 1st March- 31st May 2020 (first wave COVID-19) were compared to the same three month timeframe in 2019. SARS-CoV2 infection was defined as a positive RT-PCR test for COVID-19. Pts with symptoms or radiological changes alone were not considered SARS-COV2 positive. As part of the Guy's Cancer Cohort we collected information on age, ethnicity, performance status (PS), cancer type, stage (Stg), treatment (SACT, surgery, radiotherapy) and COVID-19 infection. Results: There were no COVID-19 related deaths. 1 pt (0.5%) had SACT delay due to confirmed SARS-CoV-2 infection. Overall mortality at 6 months in each timeframe was 6.9% in 2020 and 8.1% in 2019. In the comparative 3-month intervals, similar numbers of GYN cancer pts received SACT in 2020 compared to 2019: 170 patients (126 ovarian;44 non-ovarian) in 2020, 184 (131 ovarian;53 nonovarian) in 2019. Median age was 61y in both groups and BAME ethnicity was balanced. In 2020, more pts had Stg III/IV disease (93%) than 2019 (84%) and fewer had Stg I/II disease (7%) compared to 2019 (16%). PS was: 0-1 in 92% of patients in 2020 vs 85% in 2019. The average number of cycles of SACT delivered in each time frame was 3. In 2020 9% received neoadjuvant SACT of which 69% proceeded to planned surgery and 31% were deemed unfit. Comparatively, in 2019 7% received neoadjuvant SACT of whom 75% proceeded to surgery and 25% were deemed unfit. In 2020, 3 pt received chemoradiation compared to 8 in 2019. 40 of 170 pts (24%) had 1-5 week treatment delays in 2020 due to any aetiology with. In 2019 there were treatment delays in 63 of 184 pts (34%). The use of GCSF in support of all SACT regimens was 52% in 2020 vs 11% in 2019. Conclusions: There was no increase in mortality associated with SACT during the first wave of the COVID-19 pandemic in GYN cancer pts. 0.5% of pts had confirmed SARS-COV2 infection. We were able to maintain full SACT delivery for all GYN cancer pts with average cycle number unchanged between 2019 and 2020. There was no significant reduction in surgical debulking rates. In contrast, there was a reduction in GYN cancer pts receiving chemoradiation. More pts presented with Stg III/IV disease in 2020. Increased use of GSCF may have contributed to the reduced chemotherapy delays in 2020. Further research will explore the impact of vaccination.