Abstract
Aim of the studyThe 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. MethodsThe 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. ResultsBetween 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. ConclusionThere 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.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic overwhelmed healthcare systems worldwide [1]
There was no evidence of a negative impact of anti-cancer therapies on COVID-19 outcome
The number of patients with cancer and COVID-19 in the Netherlands has increased rapidly. Risk factors for these patients leading to a severe course of COVID-19 have partly been elucidated [6,7,8,9,10], uncertainties regarding specific risks, especially regarding the safety of continuing cancer treatment, remain [11, 12]
Summary
The coronavirus disease 2019 (COVID-19) pandemic overwhelmed healthcare systems worldwide [1]. Reports from China showed an increased risk of a more severe course of COVID-19 in patients with cancer [2, 3], which has led to adjustments in oncological treatment [4, 5]. The main objective of this registry was to identify risk factors of a severe course of COVID-19 in patients with cancer. Risk factors for these patients leading to a severe course of COVID-19 have partly been elucidated (e.g., age, male sex, haematological malignancies, and lung cancer) [6,7,8,9,10], uncertainties regarding specific risks, especially regarding the safety of continuing cancer treatment, remain [11, 12]
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