ABSTRACT
Background: Older patients with cancer remain at high risk for negative outcomes from COVID-19 infection, particularly those who have multimorbidities and on immunosuppressive therapy. These patients have been excluded or underrepresented in pivotal COVID-19 vaccine clinical trials and there are ongoing concerns that they may not acquire the same level of protection from the available vaccines as the immunocompetent adults. Moreover, the level of protection wanes over time making them more susceptible to emerging COVID-19 novel variants of concern. Despite the implementation of global vaccination campaigns which have successfully reduced COVID-related hospitalisations and deaths in many parts of the world, there remains many unresolved issues and challenges to address as the pandemic ensues. With aging, concerns for age-related dysregulation and immune dysfunctions called immunosenescence may lead to potentially lower immunogenicity to vaccines. Despite receiving the primary vaccination, real-world evidence showed that both patients aged > 65 years and those with cancer have a higher risk of developing breakthrough COVID-19 infections and related complications. Subsequent booster doses are found to be effective at improving immune response, particularly against the novel variants, and the vulnerable population should be given the priority in booster campaigns. Method(s): Since the beginning of the pandemic in 2020, The International Society of Geriatric Oncology set up a COVID-19 Working Group comprised of multidisciplinary specialists by developing recommendations, advocacy, and action plans based on expert opinion and evidence related to older adults with cancer. Result(s): The table below summarises the updated recommendations from the SIOG COVID-19 Working Group. Conclusion(s): The SIOG COVID-19 Working Group supports ongoing public health interventions, continued mass immunisations, and booster campaigns targeting the most vulnerable members of the society, including older adults with cancer (Table Presented).
ABSTRACT
Background: ESMO and SIOG created a joint WG in 2019. Their goals are to improve management of the older cancer patients through education, dedicated resources and guidelines and to raise awareness on their specific needs and requirements. Therefore, the WG initiated a survey to describe the practice patterns worldwide. Methods: All ESMO and SIOG members received a request by email to complete the survey online on 17 Feb 2020 with subsequent reminders. Questions were focused on clinical practices, perception of geriatric oncology (GO), use of screening tools such as geriatric-8 (G8), education and knowledge of guidelines. The survey was closed on 5 Apr 2020. Results: A total of 168 participants fully completed the survey. Most of them were female (65%), aged 30-39 (58%), medical oncologists (70%) and from Europe (50%). Professionals predominantly in charge of front-line care of older patients with cancer were medical oncologists (68%);however, only 19% had a physician coordinating a GO programme at their institution. According to respondents, GO brings to oncology: detection of frailty (83%), prediction of toxicity (77%), integrative management (70%), improving older patient’s understanding of treatment and adherence (64%), providing practice guidelines (46%) and prediction of survival (41%). Most of the respondents (95%) felt the need for other scales than ECOG Performance Status, 66% knew about the G8 scale and 52% used it in their clinical practice. Non-SIOG members were significantly less aware of the G8 screening tool (56% vs 97% for SIOG members;p<0.001) and less prone to use it in clinical practice (50% vs 61% for SIOG members;p=0.002). G8 use (or knowledge) was not affected by place of work nor region of the world. Finally, 76% felt that “all oncologists should be geriatric oncologists” and 96% that they needed more information and education in GO. Conclusions: The care of older patients with cancer is very heterogeneous. Despite the low number of responses, probably affected by the first lockdown of COVID-19 pandemic, there is a clear need for training in GO and information about the screening tools. Legal entity responsible for the study: ESMO/SIOG WG. Funding: Has not received any funding. Disclosure: C. Baldini: Financial Interests, Personal, Invited Speaker: BMS;Financial Interests, Personal, Invited Speaker: AZ;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Institutional, Research Grant: BMS;Financial Interests, Institutional, Principal Investigator: Seattle Genetics;Financial Interests, Institutional, Principal Investigator: Iteos;Financial Interests, Institutional, Principal Investigator: Tahio. E.G.C. Brain: Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Advisory Board: BMS;Financial Interests, Personal, Advisory Board: Pfizer;Financial Interests, Personal, Advisory Board: G1 Therapeutics;Financial Interests, Personal, Advisory Board: TLC PharmaChem. L. Biganzoli: Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Advisory Board: AZ;Financial Interests, Personal, Advisory Board: Daiichi;Financial Interests, Personal, Advisory Board: Eisai;Financial Interests, Personal, Advisory Board: Genomic Health;Financial Interests, Personal, Advisory Board: Pierre Fabre;Financial Interests, Personal, Advisory Board: Novartis;Financial Interests, Personal, Advisory Board: Pfizer;Financial Interests, Institutional, Research Grant: Celgene;Financial Interests, Institutional, Research Grant: Genomic health;Financial Interests, Institutional, Research Grant: Pierre Fabre. V. Goede: Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: Janssen;Financial Interests, Personal, Invited Speaker: Gilead;Financial Interests, Personal, Invited Speaker: Heel;Financial Interests, Personal, Advisory Board: Janssen;Financial Interests, Personal, Advisory Board: Gilead;Financial Interests, Personal, Advisory Board: Abbvie;Financial Interests, Pers nal, Advisory Board: Berlin-Chemie. R. Kanesvaran: Financial Interests, Institutional, Invited Speaker: Astellas;Financial Interests, Institutional, Invited Speaker: Johnson&Johnson;Financial Interests, Institutional, Invited Speaker: Ipsen;Financial Interests, Institutional, Invited Speaker: Amgen;Financial Interests, Institutional, Invited Speaker: BMS;Financial Interests, Institutional, Invited Speaker: MSD;Financial Interests, Institutional, Invited Speaker: Sanofi;Financial Interests, Institutional, Invited Speaker: Novartis;Financial Interests, Institutional, Invited Speaker: AZ;Financial Interests, Institutional, Advisory Board: Johnson&Johnson;Financial Interests, Institutional, Advisory Board: Pfizer;Financial Interests, Institutional, Advisory Board: Ipsen;Financial Interests, Institutional, Advisory Board: Amgen;Financial Interests, Institutional, Advisory Board: BMS;Financial Interests, Institutional, Advisory Board: MSD;Financial Interests, Institutional, Advisory Board: Bayer;Financial Interests, Institutional, Advisory Board: AZ;Financial Interests, Institutional, Advisory Board: Ferring;Financial Interests, Institutional, Research Grant: Sanofi;Financial Interests, Institutional, Research Grant: Eisai;Financial Interests, Institutional, Research Grant: Johnson&Johnson. E. Quoix: Financial Interests, Personal, Advisory Board: BMS;Financial Interests, Personal, Advisory Board: Chugai;Financial Interests, Institutional, Principal Investigator: Roche;Financial Interests, Institutional, Principal Investigator: BMS;Financial Interests, Institutional, Research Grant: Boehringer;Financial Interests, Institutional, Research Grant: OSE;Financial Interests, Institutional, Research Grant: UCPVax;Financial Interests, Institutional, Research Grant: Novartis;Financial Interests, Personal, Other: BMS;Financial Interests, Personal, Other: Roche;Financial Interests, Personal, Other: Takeda. C. Steer: Financial Interests, Personal, Invited Speaker: BMS;Financial Interests, Personal, Invited Speaker: Eisai;Financial Interests, Personal, Advisory Board: MSD;Financial Interests, Personal, Advisory Board: Janssen;Financial Interests, Personal, Advisory Board: GSK;Financial Interests, Personal, Advisory Board: Specialised therapeutics;Financial Interests, Personal, Advisory Board: AZ. D. Papamichael: Financial Interests, Institutional, Invited Speaker: Ipsen;Financial Interests, Institutional, Invited Speaker: Amgen;Financial Interests, Institutional, Advisory Board: Merck;Financial Interests, Institutional, Advisory Board: Ipsen;Financial Interests, Institutional, Research Grant: MSD. H. Wildiers: Financial Interests, Institutional, Advisory Board: AZ;Financial Interests, Institutional, Advisory Board: Biocartis;Financial Interests, Institutional, Advisory Board: Daiichi;Financial Interests, Institutional, Advisory Board: Eisai;Financial Interests, Institutional, Advisory Board: KCE;Financial Interests, Institutional, Advisory Board: Lilly;Financial Interests, Institutional, Advisory Board: Novartis;Financial Interests, Institutional, Advisory Board: Orion corp;Financial Interests, Institutional, Advisory Board: Pfizer;Financial Interests, Institutional, Advisory Board: PSI Cro AG;Financial Interests, Institutional, Advisory Board: Puma Biotechnology;Financial Interests, Institutional, Advisory Board: Roche;Financial Interests, Institutional, Advisory Board: Sirtex;Financial Interests, Institutional, Research Grant: Novartis;Financial Interests, Institutional, Research Grant: Roche;Financial Interests, Institutional, Other, Travel: Pfizer;Financial Interests, Institutional, Other, Travel: Roche. All other authors have declared no conflicts of interest.
ABSTRACT
Background: The ongoing SARS-CoV-2 pandemic and ensuing coronavirus disease (COVID-19) is challenging cancer care and services worldwide. Methods: A 95 items survey was distributed worldwide by 20 oncologists from 10 of the most affected countries in order to evaluate the impact on organization of oncological care. Results: 109 representatives from oncology centers in 18 countries (62.4% academic hospitals) filled out the survey (June 17 – July 14, 2020). A swab or gargle test is systematically performed before day care unit or overnight stay admissions in 27.5% and 58.7% of the centers, respectively. A local registry (64.2%) and systematic tracing (77.1%) of infected patients was organized in many centers. Treatment modalities mostly affected by the pandemic (cancellation/delay) were surgery (44.1%) and chemotherapy (25.7%). Earlier cessation of palliative treatment was observed in 32.1% of centers, and 64.2 % of participants agree that under-treatment is a major concern. At the pandemic peak, teleconsultations were performed for follow-up (94.5%), for oral therapy (92.7%), but also for patients receiving immunotherapy (57.8%) or chemotherapy (55%). Approximately 82% of participants estimate that they will continue to use telemedicine. Most participants reported more frequent use of virtual tumor boards (82%) and oncological team meetings (92%), but 45% disagree that virtual meetings are an acceptable alternative to live international meetings. Although 60.9% report reduced clinical activity during the pandemic peak, only 28.4% had an increased scientific activity. Only 18% of participants estimate that their well-being will not recover to previous levels by the end of the year;63% indicate easily accessible psychological support for caregivers, but only 10% used or planned to use it. All clinical trial activities are or will soon be reactivated in 72.5% of the centers. Major study protocol violations/deviations were observed in 27.5% and significant reductions of clinical trial activities are expected by 37% of centers this year. Conclusions: COVID-19 has a major impact on organization of patient care, well-being of caregivers, continued medical education and clinical trial activities in oncology. Legal entity responsible for the study: The authors. Funding: Fondation Léon Fredericq. Disclosure: G. Jerusalem: Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Advisory/Consultancy, Travel/Accommodation/Expenses: Lilly;Advisory/Consultancy, Travel/Accommodation/Expenses: Amgen;Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca;Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo;Advisory/Consultancy: AbbVie;Travel/Accommodation/Expenses: MedImmune;Travel/Accommodation/Expenses: Merck KGaA. G. Curigliano: Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche;Advisory/Consultancy, Speaker Bureau/Expert testimony: Seattle Genetics;Speaker Bureau/Expert testimony, Writing engagement: Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony: Lilly;Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer;Advisory/Consultancy, Speaker Bureau/Expert testimony: Foundation Medicine;Advisory/Consultancy, Speaker Bureau/Expert testimony: Samsung;Advisory/Consultancy, Speaker Bureau/Expert testimony: Celltrion;Leadership role, Scientific Affairs Group: Ellipsis;Speaker Bureau/Expert testimony, Writing engagement: BMS;Speaker Bureau/Expert testimony: MSD;Advisory/Consultancy: Mylan. M. Campone: Honoraria (self), Advisory/Consultancy: GT1;Honoraria (institution), Advisory/Consultancy: Sanofi;Honoraria (institution), Advisory/Consultancy: Pierre-Favre;Honoraria (institution), Advisory/Consultancy: AstraZeneca;Honoraria (institution), Advisory/Consultancy: Servi r;Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis;Honoraria (institution), Advisory/Consultancy: AbbVie;Honoraria (institution), Advisory/Consultancy: Accord;Honoraria (institution), Advisory/Consultancy: Pfizer;Speaker Bureau/Expert testimony: Lilly. M. Martin: Advisory/Consultancy, Research grant/Funding (institution): Roche;Advisory/Consultancy, Research grant/Funding (institution): Novartis;Advisory/Consultancy, Research grant/Funding (institution): Puma;Advisory/Consultancy: AstraZeneca;Advisory/Consultancy: Amgen;Advisory/Consultancy: Taiho Oncology;Advisory/Consultancy: Daichii Sankyo;Advisory/Consultancy: PharmaMar;Advisory/Consultancy: Eli Lilly;Advisory/Consultancy: Pfizer. M. Cristofanilli: Advisory/Consultancy: CytoDyn;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Pfizer;Advisory/Consultancy: Lilly;Advisory/Consultancy: Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony: Foundation Medicine;Advisory/Consultancy: G1 Therapeutics;Advisory/Consultancy: Sermionexx;Advisory/Consultancy: Genentch. L. Pusztai: Honoraria (self), Research grant/Funding (institution), Clinical trial support: Merck;Honoraria (self), Research grant/Funding (institution), Clinical trial support: AstraZeneca;Honoraria (self), Research grant/Funding (institution), Clinical trial support: Seattle Genetics;Honoraria (self): Novartis;Honoraria (self), Research grant/Funding (institution), Clinical trial support: Roche Genentech;Honoraria (self): Eisai;Honoraria (self): Daiichi;Honoraria (self): Syndax;Honoraria (self): Immunomedics. R. Bartsch: Advisory/Consultancy: Accord;Honoraria (self): AstraZeneca;Advisory/Consultancy, Research grant/Funding (institution): Daiichi;Advisory/Consultancy, Travel/Accommodation/Expenses: Eli-Lilly;Advisory/Consultancy, Travel/Accommodation/Expenses: MSD;Advisory/Consultancy, Research grant/Funding (institution): Novartis;Advisory/Consultancy, Research grant/Funding (institution): Roche;Advisory/Consultancy: Puma;Advisory/Consultancy: Pierre-Favre;Advisory/Consultancy: Sandoz;Advisory/Consultancy: Eisai. M. Tagliamento: Travel/Accommodation/Expenses: Roche;Travel/Accommodation/Expenses: Bristol-Myers Squibb;Travel/Accommodation/Expenses: AstraZeneca;Travel/Accommodation/Expenses: Takeda;Travel/Accommodation/Expenses: Novartis;Travel/Accommodation/Expenses: Amgen. J. Cortés: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche;Honoraria (self), Advisory/Consultancy: Celgene;Advisory/Consultancy: Cellestia;Advisory/Consultancy, Research grant/Funding (institution): AstraZeneca;Advisory/Consultancy: Biothera Pharmaceutical;Advisory/Consultancy: Merus;Advisory/Consultancy: Seattle Genetics;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo;Advisory/Consultancy: Erytech;Advisory/Consultancy: Athenex + Polyphor;Advisory/Consultancy, Shareholder/Stockholder/Stock options: MedSIR;Honoraria (self), Advisory/Consultancy: Lilly;Advisory/Consultancy: Servier;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Merck Sharp Dome;Advisory/Consultancy: GSK;Advisory/Consultancy: Leuko;Advisory/Consultancy: Bioasis;Advisory/Consultancy: Clovis Oncology;Advisory/Consultancy: Boehringer Ingelheim;Honoraria (self), Travel/Accommodation/Expenses: Novartis;Honoraria (self), Travel/Accommodation/Expenses: Eisai;Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Honoraria (self): Samsung Bioepis;Research grant/Funding (institution): Ariad Pharmaceuticals;Research grant/Funding (institution): Baxalta GMBH/Servier Affaires;Research grant/Funding (institution): Bayer Healthcare;Research grant/Funding (institution): F. Hoffmann-La Roche;Research grant/Funding (institution): Guardanth Health;Research grant/Funding (institution): Piqur THerapeutics;Research grant/Funding (institution): Puma C;Research grant/ unding (institution): Queen Mary University of London. E.M. Ciruelos: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;Advisory/Consultancy, Speaker Bureau/Expert testimony: Lilly;Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Pfizer. H.S. Rugo: Research grant/Funding (institution): Eisai;Research grant/Funding (institution): Genentech;Research grant/Funding (institution): Lilly;Research grant/Funding (institution), Travel/Accommodation/Expenses: MacroGenics;Research grant/Funding (institution): Merck;Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Research grant/Funding (institution): Obi Pharma;Research grant/Funding (institution): Odonate Therapeutics;Research grant/Funding (institution): Immunomedics;Research grant/Funding (institution), Travel/Accommodation/Expenses: Daiichi-Sankyo;Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Advisory/Consultancy: Samsung;Advisory/Consultancy: Celtrion;Travel/Accommodation/Expenses: Mylan;Travel/Accommodation/Expenses: AstraZeneca. All other authors have declared no conflicts of interest.