key: cord-0934240-32s5qg6c
authors: Agbarya, A.; Addeo, A.; Charpidou, A.; Araújo, A.; Cuppens, K.; Brustugun, O. T.; Rajer, M.; Jakopovic, M.; Marinca, M. V.; Pluzanski, A.
title: SARS-CoV-2 infection and lung cancer management in Europe
date: 2020-09-30
journal: Annals of Oncology
DOI: 10.1016/j.annonc.2020.08.1747
sha: e966bc91ad1e3dadaa25cdbfab3c72eec91d081f
doc_id: 934240
cord_uid: 32s5qg6c

nan

Background: COVID-19 pandemic has drastically changed the management of patients with cancer; however, limited data exists regarding which pre-conditions affect the course of COVID-19 infection. Here, we sought to assess the clinical features and outcomes of COVID-19 infection in a large cohort of patients with cancer.

Methods: We conducted a multicenter retrospective cohort study of patients with cancer diagnosed with SARS-CoV-2 infection by RT-PCR/Ag detection (n¼274) or CTscan (N¼13) between 7/March and 30/April across 12 international centers. Clinical, pathological and biological data were collected. Primary endpoints were 30-day mortality rate and the rate of severe acute respiratory failure (SARF), defined by oxygen requirements >15 L/min. Descriptive statistics were used.

Results: 287 patients were enrolled with a median follow-up of 23 days . Median age was 69 (range 35-98), 52% were male, 49% had hypertension and 23% had cardiovascular disease. As per cancer characteristics, 68% had active disease, 52% advanced stage and 79% had a baseline ECOG PS 1. Most frequent cancertypes were: 26% thoracic, 21% gastrointestinal, 19% breast and 15% genitourinary. Most patients (61%) were under systemic therapy, including chemotherapy (51%), endocrine therapy (23%) and immunotherapy (19%) . At COVID-19 diagnosis, 44% of patients had moderate/severe symptoms such as fever (70%), cough (54%) and dyspnea (48%). The majority of patients (90%) required in-patient management and the median hospital stay duration was 10 days (range 1-52); 8% of patients required intermediate or intensive care unit admission. Patients received treatment with: hydroxychloroquine (81%), azithromycin (61%), antiviral therapy (38%) and immunomodulatory drugs (14%). Finally, the overall mortality rate was 27% and the rate of SARF was 26%. In patients admitted to intermediate/intensive care units, the mortality and SARF rates were 45% and 73%, respectively. Mortality rate according to ECOG PS before COVID-19 was 20% in PS1 and 51% in PS>2 (p<0.0001).

Conclusions: Patients with cancer are a susceptible population with a high likelihood of severe complications and high mortality from COVID-19 infection. Final results and treatment outcomes will be presented at the ESMO Congress.

Legal entity responsible for the study: Aleix Prat. Background: COVID-19 has affected more than 4,000,000 patients worldwide. Patients with cancer are at a higher risk of COVID-19, but currently, there is no evidencebased guidance on the management of cancer patients during this outbreak. We report the early outcomes of cancer patients, who received radiotherapy (RT) at the time of implementation of non-pharmacological interventions (NPI) in Wuhan.

Methods: 209 patients from a single institution cancer center in Wuhan from Jan 20 to Mar 6, 2020 were reviewed. NPI measures that were implemented during the study period included city lockdown (Jan 23, 2020), cordons sanitaire, traffic restriction, social distancing and home confinement. Infection control measures at the hospital included on-site screening, physical distancing, disinfection procedures, and protection of healthcare workers (HCWs). Primary end-point was rate of COVID-19 infection. Study was approved by the institutional review board. Methods: A virtual meeting among LC experts from Belgium, Switzerland, Portugal, Slovenia, Norway, Croatia, Poland, Romania, Greece and Israel was held on April 27 to discuss the impact of the COVID-19 pandemic on the lung cancer care in each country. The discussion was based on the ESMO recommendations. Each participant described the SARS-CoV2 epidemic phase in country and filled a questionnaire based on the enforcement of each statement from the ESMO guidelines.

Results: All countries are in the community level SARS-CoV2 transmission. In 3 countries health care services exceeded their capacities. Four countries have implemented the ESMO guidelines without any modification (Switzerland, Norway, Israel and Croatia). High Level of recommendations in the outpatient and inpatient services were implemented in all countries with minor modifications. Intermediate level recommendations were implemented in 9 of 10 countries. Low priority level was implemented in 7 of 10 countries. Main modifications were: surgery for stage I NSCLC as a high priority, all non-curative surgical interventions postponed, differences in imaging priorities. In 5 of 10 countries local oncology societies issued recommendations mainly consistent with ESMO but medical oncologists also follow recommendations issued by the health ministry.

Conclusions: ESMO guidelines prioritizing LC management are implemented in all participating countries. High and intermediate level recommendations are implemented with minor modification regardless the phase of the pandemic. The differences among countries are not related to the phase of pandemic but mostly to the health system capacity and socioeconomic factors in each country.

Legal entity responsible for the study: The authors.

Funding: Has not received any funding. Background: After COVID-19 was declared a pandemic by the World Health Organization, a response from the Italian Health System to react to an unprecedented condition became necessary and sudden. COVID-19 pandemic required oncologists to redefine clinical organization and management of cancer patients. The aim of our study was to take a picture of the situation of Italian oncologies and to evaluate the difficulties in patients management.

Methods: Between 18th March and 9th April 2020 we conducted an online survey (Google Forms). It consisted of 45 questions ranging from individual perception of pandemic management by oncological centers to physicians and nurses psychological distress and patient care. The survey was anonymous and broadcasted to oncology health workers by mailing contacts, word of mouth and social networks.

Results: A total of 383 oncology health workers participated in the survey. The majority was female (72%) and from central Italy (46%). Impressively, a total of 357 (93%) participants declared the Oncologic Department reorganized routine clinical activity, but only 41% was adequately trained about the required procedures. 20% of the survey attendees think they have not received adequate and timely protective devices with respect to clinical needs and according to 58% the supply of these devices was only partial. 34% of professionals declared they do not have or know a defined common guideline to reschedule patients' treatments. More than 80% of interviewees declared to feel worry about being at greater risk of contagion than the general population, 92% feared to transmit virus to family members. Deferring treatments has caused fear / anxiety in 228 of the interviewed (60%). Symptoms of stressful situations emerged with a deterioration in sleep quality in 62% of professionals, worsening of mood (69%) and lower concentration ability (49%).

Conclusions: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response quality has been heterogeneous, and several drawbacks emerged from this first analysis. Information, protection, testing, and training of healthcare professionals are keywords that should be kept in mind to encourage recovery after this tragedy and to be ready to face a similar emergency in the next future.

Legal entity responsible for the study: The authors.

Funding: Has not received any funding. 

There are no large reported series determining the outcome of cancer patients with COVID-19. We aimed to determine whether differences exist in COVID-19 related mortality between cancer patients and the general population in our hospital

Only 2/85 patients were admitted to ICU. Mortality was associated with older median age (79.5 vs 73, P¼0.03), high d dimer levels (1630 vs 830, P¼0.03), high LDH levels (315.5 vs 224, P¼0.003), bilateral pneumonia (24/42 vs 5/22 with unilateral pneumonia, P¼0.02), acute respiratory distress syndrome (ARDS) (12/13 vs 28/72 without ARDS, P<0.0001) and metastatic disease (20/32 metastatic vs 20/53 non-metastatic, P¼0.02). Differences were maintained in multivariate analyses regarding ARDS (OR 23.7, P¼0.007) and metastatic disease (OR 2.5, P¼0.05). Combined treatment with hydroxychloroquine and azithromycin showed a better outcome in uni and multivariate analyses with only 21/61 dead patients (OR 0.13, P¼0.005), adjusted by sex, histology, staging, ARDS and comorbidities. Conclusions: COVID-19 had significant mortality in cancer patients. High D dimer and LDH levels and ARDS development in elderly metastatic patients carry an elevated risk of death in cancer patients diagnosed with COVID-19. However, only 2/85 patients were admitted to ICU and this data was decisive. Combined hydroxychloroquine and azithromycin could be a good treatment option in COVID-19 cancer patients

1686P The impact of the COVID-19 crisis on perceived changes in care and wellbeing of cancer patients and norm participants: Results of the PROFILES registry

Background: We aimed to assess the impact of the COVID-19 crisis on 1) perceived changes in cancer treatment and follow-up care

Analyses included cohorts of colon, rectal, breast, melanoma, gynecological, prostate, hematological, pancreas, and esophagogastric cancer patients diagnosed between 1/2006 and 3/2020. Logistic regression analysis assessed factors associated with changes in cancer care. General Linear Models were computed to assess differences in QoL, anxiety/depression and loneliness between patients and age-and sex matched norm participants. Results: Of 3,960 cancer patients, 213/768 (28%) in treatment and 448/2575 (17%) in follow-up reported that their treatment or appointment was cancelled or replaced by a telephone consult (TC) in the COVID-19 crisis. Older age, type of cancer, higher BMI, more comorbidities, metastasized cancer and being worried about getting infected with SARS-CoV-2 were independently associated with these changes