P09.48 Experience and Outcome of COVID-19-Positive Lung Cancer Patients from a Eastern Indian Hospital

Abstract

The COVID-19 pandemic has caused unprecedented crisis in the care of non-Covid patients all across the globe and care for lung cancer patients is no exception. Lung Cancer patients are at increased risks of COVID due to increased mortality from dual aggressive pathology in the lungs. Our aim was to examine the impact of COVID-19 on lung cancer therapy and factors responsible delay in optimal care during the pandemic. This study included all patients with a diagnosis of lung cancer being treated at our Institute, a tertiary level referral hospital in eastern part of India during on going pandemic. Seven developed COVID-19, confirmed by RT-PCR method (Table 1). The mean age of the patients was 49 years. All the patients had metastatic lung cancer. All males had history of smoking. Hypertension was present in only one patient. Four patients (57%) died from concomitant COVID-19 at our institution.Three patients who recovered from COVID were stable. One of them (positive for ROS1) was switched over to Crizotinib and other patient resumed chemotherapy only after he had recovered from COVID-19. Most of the patients acquired COVID-19 infection during the process of evaluatio/chemotherapy and that further delayed the treatment.Table 1Demographic characteristics, Clinical parameters, Treatments, and Outcomes of Lung Cancer patients with COVID-19DetailsCase-1Case-2Case-3Case-4Case-5Case -6Case-7Age66 years46 years36 years22 years65 years61 years48 yearsSexMaleFemaleMaleFemaleFemaleMaleMaleDiagnosisNeuroendocrine cancer of lungPoorly differentiated carcinomaPoorly differentiated carcinoma with CD 31 positiveAdenocarcinoma lung TTF1 positiveNnosmall cell lung cancerAdenocarcinoma lungAdenocarcinoma lungStage4444444ECOG score2221411Treatment receivedCisplatin and etoposideNot givenNot givenCrizotinibNot givenCarboplatin and pemetrexedCarboplatin and pemetrexedNo of cyclesTwoNANA4 cycle of Carboplatin and pemetrexedNAOne6Mutation statusNilNot doneNot doneROS 1 positiveNAEGFR – NEGATIVEEGFR NegativeCOVID statusseveresevereSevereMildSevereModerateMildOutcomePatient expiredPatient expiredPatient expiredPatient discharged after 8 days of isolationPatient expiredPatient discharged after 8 days of isolationOn observationHospitalisation Duration12 days24 days12 days8 days6 days8 daysnilOutcomedeathdeathDeathOn Crizotinib treatmentdeathOn platinum doubletOn Maintenance Pemetrexed Open table in a new tab The results were disappointing because more than half of lung cancer patients died due to COVID-19. The disease course of COVID-19 has been more severe in patients with lung cancers with Chemotherapy. There have been delay in resuming treatment among survivors by few weeks. Fear of aggressiveness of disease was the key factor for interruption or delay in chemotherapy. Other variable factors like stage of cancer, palliative intent of chemotherapy, ECOG status were key determinants for interruption of treatment. The decision to temporarily suspend chemotherapy while waiting for recovery from SARS-CoV-2 and then restart, was not easy due to the risk of cancer progression. The findings amplify the importance of optimizing of lung cancer care in the context of the COVID-19 prevalence. The decisions need to be taken on the basis of individual cases rather than rely on a generalized approach. In resource limited country like India diverting the existing resources to an emergency leads to compromise of routine outpatient care, especially patients with chronic illness. We need to be flexible in restarting of services guided by local COVID prevalence, while awaiting a definite management plan for COVID-19.