Analysis of systemic therapy delivery for gastrointestinal cancer patients during the COVID-19 pandemic.

Abstract

301 Background: As of June 16, 0.51% of the Irish population has had a confirmed diagnosis of COVID-19, and incidence of new infections peaked on April 10. Cancer patients treated with systemic anticancer therapy (SACT) may have increased risk of contracting COVID-19, and greater incidence of adverse outcomes. We aimed to assess the impact of a COVID-19 SACT clinical pathway on the incidence of SARS-CoV-2 infection in gastrointestinal cancer patients, and alterations to SACT regimens attributed to the COVID-19 pandemic. Methods: A COVID-19 SACT clinical pathway for patients undergoing treatment in a haematology oncology day care (HODC) service was designed and implemented. Interventions included visitor restrictions, telephone clinics, mandatory masks and temperature checks for staff, social distancing at all workspaces, and establishment of a COVID-19 screening pod. A prospective registry of all gastrointestinal cancer patients attending the HODC clinic between February 1 and April 31 2020 was initiated following institutional ethics board approval. Clinical data were retrieved from electronic health records including demographics, performance status, comorbidities, SACT regimen (including changes to treatment), SARS-CoV-2 testing, and radiologic treatment responses. Results: In this period, 175 gastrointestinal (88 gastroesophageal, 8 hepatobiliary, 79 colorectal) cancer patients attended 931 HODC outpatient clinics. Of this, 41 (23%) underwent at least one SARS-CoV-2 test. No patients tested positive. Two gastroesophageal cancer patients undergoing neoadjuvant chemoradiotherapy presented with SARS-CoV-2-negative suspected viral pneumonia and respiratory failure; both required intensive care unit admission and one died. SACT regimen was altered in 48 (27%) patients due to the COVID-19 pandemic. Changes involved prescription of alternative oral therapies (21; 12%), treatment breaks (17; 9%), and stopping treatment (11; 6%). Most (88%) regimen changes took place in a single 3-week period (6-27 March) that coincided with the announcement of government-mandated social distancing measures. Conclusions: Implementing a COVID-19 SACT clinical pathway resulted in a low incidence of SARS-CoV-2 infection in gastrointestinal patients undergoing systemic treatment. SACT regimen changes were common; prospective monitoring of this cohort is ongoing to determine whether these alterations affect patient outcomes.