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Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium.
de Joode, Karlijn; Tol, Jolien; Hamberg, Paul; Cloos, Marissa; Kastelijn, Elisabeth A; Borgers, Jessica S W; Nuij, Veerle J A A; Klaver, Yarne; Herder, Gerarda J M; Mutsaers, Pim G N J; Dumoulin, Daphne W; Oomen-de Hoop, Esther; van Diemen, Nico G J; Libourel, Eduard J; Geraedts, Erica J; Bootsma, Gerben P; van der Leest, Cor H; Peerdeman, Anne L; Herbschleb, Karin H; Visser, Otto J; Bloemendal, Haiko J; van Laarhoven, Hanneke W M; de Vries, Elisabeth G E; Hendriks, Lizza E L; Beerepoot, Laurens V; Westgeest, Hans M; van den Berkmortel, Franchette W P J; Haanen, John B A G; Dingemans, Anne-Marie C; van der Veldt, Astrid A M.
  • de Joode K; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
  • Tol J; Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
  • Hamberg P; Department of Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
  • Cloos M; Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands.
  • Kastelijn EA; Department of Pulmonology, St. Antonius Hospital Utrecht/Nieuwegein, Utrecht, the Netherlands.
  • Borgers JSW; Department of Medical Oncology, Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
  • Nuij VJAA; Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
  • Klaver Y; Department of Internal Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
  • Herder GJM; Department of Pulmonary Medicine, Meander Medical Center, Amersfoort, the Netherlands.
  • Mutsaers PGNJ; Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
  • Dumoulin DW; Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
  • Oomen-de Hoop E; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
  • van Diemen NGJ; Department of Internal Medicine, Bernhoven, Uden, the Netherlands.
  • Libourel EJ; Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
  • Geraedts EJ; Department of Pulmonology, Groene Hart Hospital, Gouda, the Netherlands.
  • Bootsma GP; Department of Pulmonology, Zuyderland Medical Center, Heerlen, the Netherlands.
  • van der Leest CH; Department of Pulmonology, Amphia Hospital, Breda, the Netherlands.
  • Peerdeman AL; Department of Internal Medicine, Bernhoven, Uden, the Netherlands.
  • Herbschleb KH; Department of Internal Medicine, St. Antonius Hospital Utrecht/Nieuwegein, Utrecht, the Netherlands.
  • Visser OJ; Department of Hematology, Isala Hospital, Zwolle, the Netherlands.
  • Bloemendal HJ; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
  • van Laarhoven HWM; Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
  • de Vries EGE; Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
  • Hendriks LEL; Department of Pulmonary Diseases GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
  • Beerepoot LV; Department of Internal Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
  • Westgeest HM; Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands.
  • van den Berkmortel FWPJ; Department of Internal Medicine, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.
  • Haanen JBAG; Department of Medical Oncology, Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
  • Dingemans AC; Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
  • van der Veldt AAM; Department of Medical Oncology and Department of Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands. Electronic address: a.vanderveldt@erasmusmc.nl.
Eur J Cancer ; 160: 261-272, 2022 01.
Article in English | MEDLINE | ID: covidwho-1719649
ABSTRACT
AIM OF THE STUDY The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do-not-resuscitate codes), were studied in patients with cancer and COVID-19.

METHODS:

The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID-19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account.

RESULTS:

Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life-prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome.

CONCLUSION:

There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Mortality / Withholding Treatment / SARS-CoV-2 / COVID-19 / Hospitalization / Life Support Care / Neoplasms Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Eur J Cancer Year: 2022 Document Type: Article Affiliation country: J.ejca.2021.10.009

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Mortality / Withholding Treatment / SARS-CoV-2 / COVID-19 / Hospitalization / Life Support Care / Neoplasms Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Eur J Cancer Year: 2022 Document Type: Article Affiliation country: J.ejca.2021.10.009