Impact of COVID-19 on Delivery of Chemotherapy in Hospitals in Spain and France

Abstract

Background: Advice for cancer patients on the impact of COVID 19 in terms of their therapy is available from governments and professional societies, but is open to interpretation by clinicians and their patients. We hypothesise that different healthcare systems may respond in different ways leading to variation in the delivery of chemotherapy. To this end we have charted chemotherapy usage before and during the COVID pandemic in 15 hospitals in France and Spain.Methods: We analysed de-identified data of patients on systemic anti-cancer IV therapies that was automatically and continuously transmitted by 15 hospitals in Spain and France up to and including May 2020. The data are bridged to a common data model containing information about demographics, diagnosis, and treatments.We compared the number of patients treated and number of IV administrations in April and May with hospital specific historic means up until and including February 2020. Numbers are broken down by hospital, cancer type, therapy class, new vs. existing patients, gender, and age.Findings: Total monthly patient numbers in hospitals within the Oncology Data Network (ODN) fell from a historic mean of 2643·5 (SD=54·4) to 2443·5 (SD=7·8) in the peri-COVID period (mean of April and May) (p=0·04) while number of administrations dropped from 21954·5 (SD=1730·3) to 20570·0 (SD=1115·8) (p=0·44) compared to the pre-COVID period. Spanish hospitals registered a steeper decline in both patient (1558·5 (SD=47·4) to 1416·5 (SD=0·7) (p=0·05)) and administration numbers (12868·0 (SD=1138·4) to 12054·0 (SD=770·7) (p=0·49)) than French hospitals, patients (1056·7 (SD=49·3) to 1027 (SD=7·1) (p=0·48) and administrations 8852·0 (SD=583·2) to 8516·0 (SD=245·1) (p=0·53).For most cancer types, i.e. chest and respiratory (330·5 (SD=3·5) to 308·5 (SD=6·4) (p=0·05)), gastrointestinal (606 (SD=4·2) to 566 SD=0·0) (p=0·0056)), haematology (233·5 (SD=26·2) to 175·5 (SD=17·7) (p=0·12)), urology (140·5 (SD=9·2) to 122·0 (SD=5·7) (p=0·14)), patient numbers receiving chemotherapy decreased overall, while there was an increase in patients for breast cancer (491·5 (SD=2·1) to 534·5 (SD=6·4) (p=0·01)) and gynecological cancer (196·0 (SD=5·7) to 219·5 (SD=7·8) (p=0·07)).The decrease in patient numbers was mainly driven by reduction in new patients (412·5 (SD=137·9) to 219·5 (SD=40·3) (p=0·20), initiating chemotherapy. Numbers of male patients fell from 1133 to 1013 (-11%), while numbers of female patients fell from 1377 to 1332 (-3%). We could not identify a notable reduction in elderly patients.Interpretation: Delivery of chemotherapy to patients who had already initiated treatment was maintained at broadly similar pre-COVID levels, but there was a reduction in the number of new cancer patients starting therapy during this time.Funding: The Oncology Data Network is funded by IQVIA Holdings Inc.Declaration of Interests: Nicolas Niklas is fully paid and employed by IQVIA. Ashley Woolmore is fully paid and employed by IQVIA. Lisa Chin-A-Young is fully paid and employed by IQVIA. Nathalie Bazylewicz during data analysis fully paid and employed by IQVIA. David Kerr acted as consultant to IQVIA.Ethics Approval Statement: Longi.tudinal, de-identified diagnosis and treatment data was automatically extracted from existing clinical systems and transmitted in full compliance with GDPR through the privacy protecting technology infrastructure in near real-time to IQVIA. The study was approved by the Steering Committee (https://odn-cancer.com/the-collaboration-for-oncology-data-in-europe-code-establishes-clinical-and-analytical-steering-committee/).). Beyond that, given the nature of the data and its collection, with no patient facing impact, this study is exempt from ethics.