ABSTRACT
Purpose: The COVID-19 pandemic transformed cancer care, with oncologists trying to balance the benefits of SACT against the risk of COVID-19 infection and mortality. Our study compares the demographic and treatment characteristics of BC patients treated at Guy’s Cancer Centre during the first wave of the pandemic with the same period in 2019. Methods: We conducted a retrospective analysis of all BC patients who received SACT from 1 March 2020 until 31 May 2020 and compared the demographic (age, ethnicity, socioeconomic and performance status), cancer (stage) and SACT characteristics (type, intent and line of treatment) with those from the same period in 2019. Results: In 2020, 571 BC patients received SACT during the study period, compared with 595 in 2019. Demographic characteristics were equally balanced between both years. The cancer stage, type of treatment and treatment paradigm were also similar (stage I–III: 49.8% versus 50.9%;chemotherapy: 29.8% versus 30.8%;palliative treatment: 49.9% versus 46.6%, in 2020 and 2019, respectively). However, a larger proportion of patients received first-line palliative treatment in 2020 compared with 2019 (38.6% versus 14.8%). The overall mortality rate was 3.15% in 2020 versus 4.36% in 2019. 11 BC patients were diagnosed with COVID-19 in 2020. From these patients, 10 were receiving chemotherapy and 7 were treated with palliative intent. 9 patients developed severe pneumonia and there was 1 COVID-19-related death. Conclusion: Our study shows that there were no significant differences in patient characteristics during the first wave of the pandemic, compared with a similar period in 2019, although numerically fewer patients were treated in 2020 and there was a focus on first-line palliative treatment, rather than subsequent lines. Moreover, it demonstrated that SACT during the pandemic was relatively safe. However, this study might not reflect the decrease in the number of new referrals owing to the pandemic.
ABSTRACT
Background: The provision of cancer services has been strongly impacted by the outbreak of SARS-CoV-2. Our Cancer Centre in South-East London treats about 8,800 patients annually (incl. 4,500 new diagnoses) and is one of the largest Comprehensive Cancer Centres in the UK. The first COVID-19 positive cancer patient was reported on 29 Feb 2020. Whilst we are dealing with the second wave of COVID-19, it is important to further evaluate safety of cancer treatments whilst balancing risks of COVID-19 infection and complications. Methods: Using descriptive statistics, we report on the patient/tumour characteristics as well as short-term clinical outcomes of those patients undergoing radical treatment (i.e. systemic anticancer treatment (SACT), surgery, or radiotherapy (RT)) for their cancer during the first wave as to help establish the clinical guidelines for the management of cancer patients in a SARS-CoV-2 epidemic. Results: Between March-July 2020, 1,553 patients underwent surgery, 1,125 received SACT, and 814 had RT. Compared to the same period in 2019, there was a decrease of 28% for surgery, 15% for SACT, and 10% for radiotherapy. Whilst surgery was performed on more male patients (58%), more women received SACT (75%) and RT (58%). The age distribution was similar between treatment arms, with the majority of patients aged 50 to 80 years. The most common tumour types were breast (21%), thoracic (20%), and urological (29%) for surgical treatment;breast (49%), gastrointestinal (18%), and gynaecological (10%) for SACT;and breast (40%), urology (25%), and head & neck (11%) for RT. Within SACT, 36% received combination therapy, 35% received systemic chemotherapy, 23% targeted therapy, 5% immunotherapy, and 2% biological therapy. In terms of oncological outcomes, outcomes were similar to pre-COVID-19 times;with 6 deaths at 30 days (<1%) for surgical patients and 36 readmissions (2%), 10 deaths (<1%) for SACT patients, and 52% of RT delivered with radical intent (which was the same in 2019). The COVID-19 infection rates for our patients were very low: 12 patients were positive pre-surgery (1%), 7 post-surgery (<1%), 17 SACT patients (2%) and 3 RT patients (<1%). No COVID-19 related deaths were registered for the surgical, SACT and RT patients. Conclusion: Whilst there was a decline in overall radical treatment, likely due to a delay in cancer diagnoses, those who did undergo their treatment were treated in a safe COVID-19 managed environment. Our findings highlight that cancer patients should have the confidence to attend hospitals and be reassured of the safety measurements taken.
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.