ABSTRACT
Background: The COVID-19 pandemic has impacted significantly on health systems across the globe. It has been reported to have higher incidence and to be associated with worse outcomes in patients with cancer. Beaumont Hospital is a large Dublin-based teaching hospital which was at the centre of the Irish outbreak of COVID-19. Methods: During the period 11th March to 15th May 2020, patients diagnosed with COVID-19 infection who were attending Beaumont Hospital for systemic anti-cancer therapy were included. Data were collected by chart review. Statistical analyses were performed using SPSS. Cancer-related prognosis was estimated using the Palliative Prognostic Score (PAP) with a score ≥11 associated with a 30-day survival of <30%. Results: In total, 717 patients attended oncology services for cancer directed treatment during the study period. 27 of these patients were diagnosed with COVID-19 based on RT-PCR. A further 4 patients were diagnosed clinically due to characteristic symptoms and radiology. The median age was 60 (38-84). 12 (39%) were female. The most common cancer type was lung n=9 (29%). 21 (67%) had metastatic disease;4 (13%) locally advanced disease and 6 (19%) were being treated with curative intent. Of the 31 patients diagnosed with COVID-19, 25 (80%) were hospitalised and none were admitted to intensive care. In total, 12/31 (41%) died, of which 5 (41%) had lung cancer, 10 (83%) had an PS of ≥3 and 3 (25%) had received systemic anti-cancer treatment in the last 30 days of life. The median age was 66 (38-84). 4 (33%) were female. All had incurable, locally advanced or metastatic disease. The mean time from diagnosis to death was 9.5 days. Those with an ECOG performance status (PS) ≥3 were more likely to die than those with PS ≤2 (p<0.001).Compared to those who recovered, patients who died from COVID-19 had higher mean number of organs affected by cancer (3.7 vs. 1.8, p=0.015) and higher mean PAP score (9.6 vs. 1.5, p<0.001). Conclusions: Patients with cancer who contracted COVID-19 and died had more sites of metastatic disease, a poorer performance status, and a higher Palliative Prognostic Score. The presence of multi-organ involvement appears to predict for poorer outcomes in COVID-19 positive cancer patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Background: The COVID-19 pandemic poses significant challenges for the management of patients with cancer. In our institution we adapted our delivery of outpatient systemic anti-cancer therapy (SACT) by introducing a number of ‘risk-reducing’ measures including pre-assessment screening. We sought to evaluate our patients’ experiences of this and to gain an insight into their perception of the risks associated with COVID-19. This is a cohort of patients who are at risk of increased morbidity and mortality and often have complex care needs. Methods: Patients on active SACT attending the oncology day ward during the COVID-19 pandemic were eligible for participation. Data were collected over a one week period during the most intensive phase of Government restrictions, from 11/May/20-18/May/20. Personal demographics including information on social supports were recorded. In order to assess how patients perceived their care during COVID-19 they were asked questions under three headings: risk of infection exposure, changes to treatment plan and psychological impact of COVID-19. Results: 100 patients were assessed, of these 60 (60%) were male, 41 (41%) were >65 years of age and 67 (67%) had advanced cancer. 11 (11%) patients were living alone. 95 (95%) had family/friends available to help with daily activities such as shopping and transport to medical appointments. 57 (57%) reported feeling at increased risk in general of contracting COVID-19, with 95 (95%) practising social isolation. 68 (68%) patients reported that they were not worried about contracting COVID-19 in the hospital. 96 (96%) patients stated that they wanted to continue on their treatment as originally planned, reporting feeling safer on therapy. 58 (58%) felt isolated and 40 (40%) reported increased anxiety. 10 (10%) opted to delay medical attention if unwell at home. Conclusions: Though patients on active treatment for cancer during the COVID-19 pandemic reported increased anxiety and feelings of isolation due to COVID-19, the majority of patients wanted to continue SACT as originally planned. Patients may benefit from enhanced psycho-oncological supports in the event of a 2nd peak or prolonged COVID pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Background: The delivery of systemic anticancer therapy during the COVID-19 pandemic is extremely challenging. Increased hospital visits and active anticancer therapy have been described as risk factors for developing more severe infection. In order to balance the benefits of continuing anticancer therapy with these risks, we undertook a series of system changes in the delivery of cancer care. We examined the rate of COVID-19 infection in patients attending for systemic anticancer treatments and the impact of COVID-19 on therapy delivered at our oncology dayward. Methods: Patients who attended our dayward over a 4 month period were included. Data were obtained from electronic patient records and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 infection at two separate timepoints: the day prior to their visit via telephone, and using a symptom questionnaire given in a preassessment area on arrival at the hospital. This area was established so that patients didn't have to transit through the main hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab was arranged. Results: A total of 456 patients attended from January 1st to April 30th. During this time there were 2369 patient visits to the oncology dayward and 1953 intravenous therapies administered. 416 (18%) visits did not lead to treatments, 114 (27%) of which were scheduled non-treatment visits. 194 (47%) treatments were held due to disease-related illness and 108 (26%) treatments were held due to treatment-related complications. 19 patients were identified as having COVID-19 symptoms via telephone screening. 34 patients were symptomatic on arrival at our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. Overall, 53 treatments were held due to the screening process. Conclusions: With the introduction of a new patient screening pathway, there have been few treatment disruptions due to the COVID-19 pandemic. The overall rate of symptomatic COVID-19 infection appears low in those who continue on active treatments with regular hospital visits. With careful systematic changes, it is feasible to continue to safely deliver systemic anticancer therapy during the COVID-19 pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.