ABSTRACT
Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.
ABSTRACT
Background: Cancer incidence has increased among adolescents and young adults (AYA) over the last two decades. Younger patients often present with late diagnosis, aggressive disease, and are more likely to receive chemotherapy during cancer treatment. We investigated admission outcomes and postdischarge survival of AYA who were hospitalized after urgent admission. Methods: Retrospective cohort of patients with solid tumor diagnosis and age between 18 and 39 years, hospitalized after urgent admission to a tertiary, publicly-funded, cancer hospital in São Paulo, Brazil, from February 1st to December 31th 2021. We excluded patients with positive COVID-19 RT-PCR. We collected data on gender, cancer diagnosis, length of hospital stay, in-hospital mortality, chemotherapy infusion either before and during hospitalization;and last-follow up date and status. AYA admissions were compared to older adults (≥ 40 years [non-AYA]) admissions with chi-squared test. Overall survival (OS) after discharge between groups was analyzed with the log-rank test. Results: Of 4011 admissions, 312 were AYA. The median age was 34 (IQR 29-38) and most patients were female (63%). Compared to older adults (N = 3699), a higher proportion of AYA patients had breast cancer (25% vs 15%), central nervous system cancer (8.4% vs 2.6%), cervical cancer (12% vs 2.7%) and germinative cancer (4.5% vs 0.3%). The median length of hospital stay was 6 days (IQR 4-10). AYA were more likely to be under chemotherapy treatment during (11% versus 4%, p = 0.001) and within 30 days before hospitalization (32% vs 20%, p = 0.001). The overall in-hospital mortality rate was lower among AYA compared to older adults during the same period (12% vs 20%, p = 0.01). However, of those who died, a higher proportion were prescribed chemotherapy infusion before (38% vs 19%, p = 0.004) and during (15% vs 3.3%, p = 0.003) hospitalization;and a higher number of patients deceased on intensive-care unit beds, although the difference was not statistically significant (46% versus 36%, p = 0.2). Despite similar rates of 30-days readmissions (29% versus 26%, p = 0.3), AYA had better prognosis after discharge (mOS 295 days versus 181 days, p = 0.002). Conclusions: AYA patients had better hospitalization outcomes and were more likely to receive aggressive care near the end of life. Despite similar rates of early (≤ 30 days) readmissions, AYA had higher median overall survival after discharge compared to older adults. These finding should be taken into consideration when discussing hospitalization goals during admission of AYA with cancer.
ABSTRACT
Purpose: COVID-19 has deeply impacted the care and prognosis of those with preexisting acute and chronic conditions including cancer. The purpose of this study is to identify risk factors contributing to death from COVID-19 infection in the cancer population at Virginia Commonwealth University Health System (VCUHS). Materials and Methods: 507 patients were evaluated that had a diagnosis of any solid or hematologic malignancy and admitted to the inpatient service at VCUHS while having a COVID-19 PCR positive test between February 2020 and June 2021. Patient characteristics as well as comorbidities, transplant status, ventilator dependence, intensive care admission, and malignancy type were recorded. Death was recorded as being due to COVID-19 or COVID-19 complications. Logistic regression model was used to determine odds ratio (OR) of death from COVID 19. Results were listed with respective OR both unadjusted and adjusted for age, race, sex, body mass index (BMI), and comorbidities including diabetes, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), and chronic kidney disease (CKD). Results: Of the 507 patients, 37 experienced death (7.3%). Only 40 patients required ICU admission (7.9%) and 24 required ventilator support (4.7%). Increased age per 5-year increments was associated with increased risk of death in adjusted and unadjusted analysis (OR 1.30 (1.06,1.63) and 1.26 (1.10,1.46)). There was no significant risk of death in either adjusted or unadjusted analysis between Caucasian, African American, Asian or unspecified races. When not adjusted, COPD (OR 2.56, 1.28-5.11), CAD (OR 2.69, 1.36-5.32), and CKD (OR 2.14, 1.09-4.21) were all shown to have significant risk of death. However, when adjusted, there were no significant difference in odds ratio between patients with diabetes, CAD, COPD, and CKD. When adjusted, malignancies of central nervous system (CNS) (OR 70.30, 2.18-1520.3), hematologic (OR 4.79, 1.05-30.77), and head and neck (OR 11.64, 1.58-100.01) were at increased risk of death;while female associated malignancies, genitourinary (GU), lung, connective tissue, and those with multiple primary malignancies did not have significant risk. Ventilatory dependence did increase mortality risk (OR 50.54, 7.62,459.7), while transplant status and intensive care unit admission did not. Conclusions: Based on the results from this study, there is an increased risk of death from COVID-19 infections in several variables in the cancer population at VCUHS. Age, ventilator dependence, CNS, hematologic, and head and neck malignancies were all associated with increased mortality. Further evaluation will include the 13 other patients in which data was not yet available. Other variables that will be evaluated are COVID treatments, vaccination status, antibody formation, cancer treatment modality used within 30 days of COVID diagnosis, and lab values including cell counts and inflammatory markers.