The ongoing SARS-CoV-2 pandemic and ensuing coronavirus disease (COVID-19) is challenging cancer care and services worldwide.
A 95 items survey was distributed worldwide by 20 oncologists from 10 of the most affected countries in order to evaluate the impact on organization of oncological care.
109 representatives from oncology centers in 18 countries (62.4% academic hospitals) filled out the survey (June 17 – July 14, 2020). A swab or gargle test is systematically performed before day care unit or overnight stay admissions in 27.5% and 58.7% of the centers, respectively. A local registry (64.2%) and systematic tracing (77.1%) of infected patients was organized in many centers. Treatment modalities mostly affected by the pandemic (cancellation/delay) were surgery (44.1%) and chemotherapy (25.7%). Earlier cessation of palliative treatment was observed in 32.1% of centers, and 64.2 % of participants agree that under-treatment is a major concern. At the pandemic peak, teleconsultations were performed for follow-up (94.5%), for oral therapy (92.7%), but also for patients receiving immunotherapy (57.8%) or chemotherapy (55%). Approximately 82% of participants estimate that they will continue to use telemedicine. Most participants reported more frequent use of virtual tumor boards (82%) and oncological team meetings (92%), but 45% disagree that virtual meetings are an acceptable alternative to live international meetings. Although 60.9% report reduced clinical activity during the pandemic peak, only 28.4% had an increased scientific activity. Only 18% of participants estimate that their well-being will not recover to previous levels by the end of the year; 63% indicate easily accessible psychological support for caregivers, but only 10% used or planned to use it. All clinical trial activities are or will soon be reactivated in 72.5% of the centers. Major study protocol violations/deviations were observed in 27.5% and significant reductions of clinical trial activities are expected by 37% of centers this year.
COVID-19 has a major impact on organization of patient care, well-being of caregivers, continued medical education and clinical trial activities in oncology.
The authors.
Fondation Léon Fredericq.
G. Jerusalem: Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis; Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy, Travel/Accommodation/Expenses: Lilly; Advisory/Consultancy, Travel/Accommodation/Expenses: Amgen; Advisory/Consultancy, Travel/Accommodation/Expenses: BMS; Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca; Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo; Advisory/Consultancy: AbbVie; Travel/Accommodation/Expenses: MedImmune; Travel/Accommodation/Expenses: Merck KGaA. G. Curigliano: Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche; Advisory/Consultancy, Speaker Bureau/Expert testimony: Seattle Genetics; Speaker Bureau/Expert testimony, Writing engagement: Novartis; Advisory/Consultancy, Speaker Bureau/Expert testimony: Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer; Advisory/Consultancy, Speaker Bureau/Expert testimony: Foundation Medicine; Advisory/Consultancy, Speaker Bureau/Expert testimony: Samsung; Advisory/Consultancy, Speaker Bureau/Expert testimony: Celltrion; Leadership role, Scientific Affairs Group: Ellipsis; Speaker Bureau/Expert testimony, Writing engagement: BMS; Speaker Bureau/Expert testimony: MSD; Advisory/Consultancy: Mylan. M. Campone: Honoraria (self), Advisory/Consultancy: GT1; Honoraria (institution), Advisory/Consultancy: Sanofi; Honoraria (institution), Advisory/Consultancy: Pierre-Favre; Honoraria (institution), Advisory/Consultancy: AstraZeneca; Honoraria (institution), Advisory/Consultancy: Servier; Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis; Honoraria (institution), Advisory/Consultancy: AbbVie; Honoraria (institution), Advisory/Consultancy: Accord; Honoraria (institution), Advisory/Consultancy: Pfizer; Speaker Bureau/Expert testimony: Lilly. M. Martin: Advisory/Consultancy, Research grant/Funding (institution): Roche; Advisory/Consultancy, Research grant/Funding (institution): Novartis; Advisory/Consultancy, Research grant/Funding (institution): Puma; Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Amgen; Advisory/Consultancy: Taiho Oncology; Advisory/Consultancy: Daichii Sankyo; Advisory/Consultancy: PharmaMar; Advisory/Consultancy: Eli Lilly; Advisory/Consultancy: Pfizer. M. Cristofanilli: Advisory/Consultancy: CytoDyn; Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Pfizer; Advisory/Consultancy: Lilly; Advisory/Consultancy: Novartis; Advisory/Consultancy, Speaker Bureau/Expert testimony: Foundation Medicine; Advisory/Consultancy: G1 Therapeutics; Advisory/Consultancy: Sermionexx; Advisory/Consultancy: Genentch. L. Pusztai: Honoraria (self), Research grant/Funding (institution), Clinical trial support: Merck; Honoraria (self), Research grant/Funding (institution), Clinical trial support: AstraZeneca; Honoraria (self), Research grant/Funding (institution), Clinical trial support: Seattle Genetics; Honoraria (self): Novartis; Honoraria (self), Research grant/Funding (institution), Clinical trial support: Roche Genentech; Honoraria (self): Eisai; Honoraria (self): Daiichi; Honoraria (self): Syndax; Honoraria (self): Immunomedics. R. Bartsch: Advisory/Consultancy: Accord; Honoraria (self): AstraZeneca; Advisory/Consultancy, Research grant/Funding (institution): Daiichi; Advisory/Consultancy, Travel/Accommodation/Expenses: Eli-Lilly; Advisory/Consultancy, Travel/Accommodation/Expenses: MSD; Advisory/Consultancy, Research grant/Funding (institution): Novartis; Advisory/Consultancy, Research grant/Funding (institution): Roche; Advisory/Consultancy: Puma; Advisory/Consultancy: Pierre-Favre; Advisory/Consultancy: Sandoz; Advisory/Consultancy: Eisai. M. Tagliamento: Travel/Accommodation/Expenses: Roche; Travel/Accommodation/Expenses: Bristol-Myers Squibb; Travel/Accommodation/Expenses: AstraZeneca; Travel/Accommodation/Expenses: Takeda; Travel/Accommodation/Expenses: Novartis; Travel/Accommodation/Expenses: Amgen. J. Cortés: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Honoraria (self), Advisory/Consultancy: Celgene; Advisory/Consultancy: Cellestia; Advisory/Consultancy, Research grant/Funding (institution): AstraZeneca; Advisory/Consultancy: Biothera Pharmaceutical; Advisory/Consultancy: Merus; Advisory/Consultancy: Seattle Genetics; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo; Advisory/Consultancy: Erytech; Advisory/Consultancy: Athenex + Polyphor; Advisory/Consultancy, Shareholder/Stockholder/Stock options: MedSIR; Honoraria (self), Advisory/Consultancy: Lilly; Advisory/Consultancy: Servier; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Merck Sharp Dome; Advisory/Consultancy: GSK; Advisory/Consultancy: Leuko; Advisory/Consultancy: Bioasis; Advisory/Consultancy: Clovis Oncology; Advisory/Consultancy: Boehringer Ingelheim; Honoraria (self), Travel/Accommodation/Expenses: Novartis; Honoraria (self), Travel/Accommodation/Expenses: Eisai; Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Honoraria (self): Samsung Bioepis; Research grant/Funding (institution): Ariad Pharmaceuticals; Research grant/Funding (institution): Baxalta GMBH/Servier Affaires; Research grant/Funding (institution): Bayer Healthcare; Research grant/Funding (institution): F. Hoffmann-La Roche; Research grant/Funding (institution): Guardanth Health; Research grant/Funding (institution): Piqur THerapeutics; Research grant/Funding (institution): Puma C; Research grant/Funding (institution): Queen Mary University of London. E.M. Ciruelos: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche; Advisory/Consultancy, Speaker Bureau/Expert testimony: Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis; Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Pfizer. H.S. Rugo: Research grant/Funding (institution): Eisai; Research grant/Funding (institution): Genentech; Research grant/Funding (institution): Lilly; Research grant/Funding (institution), Travel/Accommodation/Expenses: MacroGenics; Research grant/Funding (institution): Merck; Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis; Research grant/Funding (institution): Obi Pharma; Research grant/Funding (institution): Odonate Therapeutics; Research grant/Funding (institution): Immunomedics; Research grant/Funding (institution), Travel/Accommodation/Expenses: Daiichi-Sankyo; Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy: Samsung; Advisory/Consultancy: Celtrion; Travel/Accommodation/Expenses: Mylan; Travel/Accommodation/Expenses: AstraZeneca. All other authors have declared no conflicts of interest.
Poor outcomes for patients with cancer and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (COVID-19) have been reported so far. Although anti-SARS-CoV-2 IgG response is usually detectable within three weeks after infection, limited information on the seroconversion rate of patients with cancer infected by SARS-CoV-2 is available.
This is a multicenter, observational, prospective study that included patients and oncology healthcare workers (HCWs) with SARS-CoV-2 infection confirmed by RT-PCR or clinical/radiological suspicious of infection as well as patients with cancer who are considered at high risk for infection. All subjects were tested with the 2019-nCoV IgG/IgM Rapid Test Cassett for the fast detection of IgG and IgM antibodies against SARS-CoV-2. The aim of the study was to evaluate anti-SARS-CoV-2 seroconversion rates by qualitative assay in patients with cancer and HCWs with confirmed or clinically suspected COVID-19.
At first interim analysis, 166 subjects were enrolled in the study. Cancer patients and HCWs were 61 (36.7%) and 105 (63.3%), respectively. HCWs were younger than patients with cancer (median age 41 vs 62 years;
Our data show that SARS-CoV-2-specific IgG antibody response is not different between cancer patients and healthy subjects. Qualitative rapid test for antibody detection represents an useful support to RNA RT-PCR testing for the diagnosis of COVID-19 in high-risk populations, including patients with cancer.
Istituto Europeo di Oncologia IRCCS.
This work was partially supported by the Italian Ministry of Health with Ricerca Corrente and 5x1000 funds. MEDnoTE srl (Spin-off of University of Trieste) supported the present study by providing the rapid test used for anti-SARS-CoV-2 antibody detection.
D.G. Generali: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Novartis, Pfizer, Lilly. G. Curigliano: Speaker Bureau/Expert testimony: MSD; Advisory/Consultancy: Mylan, Daichii Sankyo; Advisory/Consultancy, Speaker Bureau/Expert testimony: Lilly, Pfizer, Merck, Foundation Medicine, Samsung, Celltrion; Advisory/Consultancy, Speaker Bureau/Expert testimony: Seattle Genetics, Nanostring; Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche; Speaker Bureau/Expert testimony: Novartis, BMS; Honoraria (self): Ellipsis. All other authors have declared no conflicts of interest.
Patients with cancer (pts) are particularly vulnerable to SARS-CoV-2 infection (C19). In this study we aimed to characterise the supportive care needs of hospitalised pts with C19, evaluate indications for specialist palliative care (SPC) referral and describe end of life (EOL) care for in-hospital decedents.
From the OnCOVID database (n=892) we analysed a subset of 191 pts hospitalised between 9/3 and 27/4/2020 in 9 centers from the UK (n=110, 57.5%), Spain (n=79, 41.5%) and Germany (n=2, 1%). Eligible pts were those with complete SPC referral data including EOL symptomatic burden.
Of 191 eligible pts, 101 were male (52.9%) with mean age (±SD) of 68±12 years. Most prevalent tumour sites were genito-urinary (n=41, 21.5%) and breast cancer (n=33, 17.3%), with non-metastatic disease (n=118, 63.7%). At C19 diagnosis, 96 pts (50.3%) were on active cancer therapy, 95 (49.7%) had >1 co-morbidity, most commonly hypertension (n=95, 49.7%) and diabetes (n=41, 21.5%). Median Australia-modified Karnofsky Performance Status (AKPS) score was 70 (IQR 30). In total, 114 pts received SPC input, mostly from hospital-based teams (n=98, 85.9%), for 9 (±11) days before death or discharge for symptom control (n=101, 52.9%), psychological support (n=79, 41.4%) or advance care planning (n=78, 40.8%). In total 161 pts (84.3%) had evidence of a documented treatment escalation plan, with 84 (43.9%) having a valid DNACPR order. At database censoring, 72 pts had died (37.6%), 67 were prescribed anticipatory medications including opioids (n=51, 70.8%) and benzodiazepines (n=44, 61.1%). Amongst 64 in-hospital decedents, only 14 died in oncology wards (21.8%). Breathlessness (n=56, 87.5%), agitation (n=31, 48.4%) and confusion (n=23, 35.9%) were most common EOL symptoms. EOL symptomatic burden was not correlated with age, co-morbidities or AKPS at C19 diagnosis (p>0.05).
In the early phase of the C19 pandemic, the high in-hospital mortality from C19 in pts occurred mostly outside dedicated oncology inpatient areas. Complex palliative care needs and high EOL symptomatic burden of C19+ pts should inform SPC service planning in this population to optimise supportive and EOL care.
The authors.
Has not received any funding.
J. Tabernero: Advisory/Consultancy: Array Biopharma, AstraZeneca, Bayer, BeiGene, Boehringer Ingelheim, Chugai, Genentech, Inc., Genmab A/S, Halozyme, Imugene Limited, Inflection Biosciences Limited, Ipsen, Kura Oncology, Lilly, MSD, Menarini, Merck Serono, Merrimack, Merus, Molecular Partners, Novartis, Peptomyc, Pfizer, Pharmacyclics, ProteoDesign SL, Rafael Pharmaceuticals, F. Hoffmann-La Roche Ltd, Sanofi, SeaGen, Seattle Genetics, Servier, Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS and Roche Diagnostics. A. Prat: Advisory/Consultancy: Takeda, Sanofi. D.J. Pinato: Honoraria (self), Lecture fees: ViiV Healthcare; Honoraria (self), Lecture fees: Bayer Healthcare; Research grant/Funding (institution), Travel/Accommodation/Expenses: Bristol-Myers Squibb, Bayer Healthcare; Advisory/Consultancy: Mina Therapeutics, EISAI, Roche, Astra Zeneca; Research grant/Funding (institution): MSD. All other authors have declared no conflicts of interest.
The province of Cremona had one of the highest incidence of COVID-19 (COV-19). The pandemic determined a significant shrinkage of healthcare resources with difficulty for many patients (pts) to be assisted in the hospital, especially for the risk of being infected. We created a homecare project for cancer pts with the aim of reducing hospitalizations, accesses to the oncology ward and emergency room.
The team was composed by oncologists and nurses from the Oncology Unit of Cremona Hospital, supported by a secretary with a dedicated phone number. The assistance was provided from Mon to Sat, 9 AM-5 PM. Cancer pts were eligible if presenting confirmed diagnosis or suggestive symptoms for COV-19. A telephonic triage was performed. Cancer pts and their cohabitants were tested with at least 2 nasopharyngeal swabs (NPS). Blood test, medical examinations and vital parameters were performed. We advised screened individuals to follow the quarantine procedures, providing them with an information leaflet. We administered oral/infusional treatments, including antiviral drugs.
From March 23rd to April 30th 2020, 71 cancer pts were assisted at home, with a total of 191 visits. Of the 71 pts tested with NPS, 26 resulted COV-19 positive (COV-19+). 19 of COV-19+ pts had mild symptoms; 7 pts with stable vital parameters and initial pneumonia were successfully treated at home with hydroxychloroquine, antivirals and NSAIDs. 7 pts with severe symptoms were promptly hospitalized. 4 of them died, 2 due to the infection, 2 to progression disease. 52 cohabitants were screened, 28 lived with a COV-19+ cancer patient; in this subgroup, 16 resulted COV-19+.15 of them were asymptomatic.
This project demonstrated the feasibility of an innovative model based on homecare assistance for COV-19+ cancer pts with mild symptoms. This strategy, limiting the number of hospital accesses for COV-19+ pts, might be useful to contain the spread of the infection. Further studies are needed to test this strategy in COV-19 negative cancer pts. Moreover, our experience indicates a high probability of identifying asymptomatic positive individuals. NPS screening for asymptomatic subjects is not routinely performed. There is a urgent need to extend the procedure to this population.
The authors.
MEDEA ODV, Uniti per la Provincia di Cremona.
All authors have declared no conflicts of interest.
SARS-CoV-2 pandemic has deeply modified healthcare seeking and services in Europe since February 2020 with delays in treatment delivery and changes in the standards of care. The organization of cancer centers (CC) has been transformed to minimize virus exposure in cancer patients (pts). Real-time assessment of the impact on cancer outcomes can optimize decision-making for future epidemic episodes.
A discrete-event simulation (DES) model was developed to model individual pt pathways during the pandemic in a context of constrained medical resources. Cancer pt care is modeled based on pandemic-adapted guidelines for medical practice. Pt flow is derived from medico-administrative databases using time series methods to estimate the proportion of punctual / late visits and associated delay and to extrapolate future flows. Finally, the impact of modified care on survival is estimated using literature data.
From March to December 2020, based on data from Gustave Roussy CC in France (n= 4877 included pts), estimated overall treatment delay is <= 7 days in 86,6% of pts and 5,2% of pts have a delay higher than 2 months. More than 94% of this duration is delay in pt request for care, causing 99 pts to suffer a major prognosis change upon arrival. Delayed pt flows result in a highly time-variable use of medical resources, with important queues forecast for surgery care and chemotherapy. The handling of such queues will require intensified healthcare professionals effort. Projections show that, in the best-case scenario, ie without a 2nd pandemic wave, treatment delays and modifications will result in around 49 additional 5-year cancer-specific deaths (+ 2,25% of 5-year deaths), mainly in liver, sarcomas and head and neck cancer pts.
In a resource-constrained context, optimization of the benefit-risk ratio between COVID-19 and cancer care is key. Simulations of individual projections from actual hospital data, show a 2.25% increase of the 5-year risk of death and that pandemic-related cancer burden is mainly due to patient-induced lateness in seeking care. Defining optimal strategies in terms of screening, monitoring and prioritization for care could minimize the impact of future pandemic episodes.
The authors.
Has not received any funding.
A. Bardet: Advisory/Consultancy: Roche. M. Faron: Travel/Accommodation/Expenses: Ipsen; Travel/Accommodation/Expenses: Novartis; Travel/Accommodation/Expenses: Pfizer; Honoraria (self): HRA Pharma; Honoraria (self): Ipsen. I. Borget: Honoraria (self): Merck; Honoraria (self): CSL Berhing; Honoraria (self): Allergan; Honoraria (self): Novartis; Research grant/Funding (institution): BMS. S. Michiels: Advisory/Consultancy: IDDI; Advisory/Consultancy: Janssen Cilag; Honoraria (self), IDMC member: Hexal; Honoraria (self), IDMC member: Steba; Honoraria (self), IDMC member: IQVIA; Honoraria (self), IDMC member: Roche; Honoraria (self), IDMC member: Sensorion; Honoraria (self), IDMC member: Biophytis; Honoraria (self), IDMC member: Servier; Honoraria (self), IDMC member: Yuhan. F. Barlesi: Honoraria (self), further elements to be provided: AstraZeneca; Honoraria (self): Bayer; Honoraria (self): Bristol-Myers Squibb; Honoraria (self): Boehringer-Ingelheim; Honoraria (self): Eli Lilly Oncology; Honoraria (self): F.Hoffmann-La Roche Ltd; Honoraria (self): Novartis; Honoraria (self): Merck; Honoraria (self): MSD; Honoraria (self): Pierre Fabre; Honoraria (self): Pfizer; Honoraria (self): Takeda; Honoraria (institution): AbbVie; Honoraria (institution): Amgen; Honoraria (institution): AstraZeneca; Honoraria (institution): Bayer; Honoraria (institution): Bristol-Myers Squibb; Honoraria (institution): Boehringer-Ingelheim; Honoraria (institution): Eisai; Honoraria (institution): Eli Lilly Oncology; Honoraria (institution): F. Hoffmann-La Roche Ltd; Honoraria (institution): Genentech; Honoraria (institution): Ipsen; Honoraria (institution): Ignyta; Honoraria (institution): Innate Pharma; Honoraria (institution): Loxo; Honoraria (institution): Novartis; Honoraria (institution): MedImmune; Honoraria (institution): Merck, MSD, Pierre Fabre, Pfizer, Sanofi-Aventis, Takeda; Research grant/Funding (institution): AstraZeneca, BMS, Merck, Pierre Fabre, F. Hoffmann-La Roche Ltd. J. Bonastre: Honoraria (self): Bristol-Myers Squibb; Advisory/Consultancy: Bristol-Myers Squibb; Advisory/Consultancy: MSD; Advisory/Consultancy: PharmaMar (Inst); Advisory/Consultancy: Bristol-Myers Squibb (Inst); Advisory/Consultancy: Merck Serono; Travel/Accommodation/Expenses: Bristol-Myers Squibb. All other authors have declared no conflicts of interest.
The coronavirus disease 2019 (COVID-19) pandemic is having significant impact on oncological care (Joode et al, Eur J Cancer 2020;136:132-139) and patients with cancer might have an increased risk for severe outcome of COVID-19. In order to identify risk factors associated with a worse outcome of COVID-19, a nationwide registry was developed for patients with cancer and COVID-19.
This ongoing multicentre nationwide observational cohort study was designed as a quality of care registry and is executed by the Dutch Oncology COVID-19 Consortium (DOCC), a collaboration of oncology physicians in the Netherlands. A questionnaire was developed to collect pseudonymised patient data on patients’ characteristics, cancer diagnosis, cancer treatment, and outcome of COVID-19. All patients with COVID-19 and a cancer diagnosis or cancer treatment in the past 5 years were eligible for inclusion.
To date, > 600 cancer patients diagnosed with COVID-19 have been registered by 45 Dutch hospitals. Data of 442 registered patients with at least 4 weeks follow-up were cleaned and 351 patients could be included for the first analyses. The main cancer diagnoses were non-small cell lung cancer (13.4%), breast cancer (13.4%), and chronic lymphocytic leukaemia (8.8%). Overall, 114 (32.3%) out of 351 patients with cancer died from COVID-19. In multivariate analyses, age ≥ 65 years (p < 0.001), male gender (p = 0.035), prior or other malignancy (p = 0.045), and active diagnosis of haematological malignancy (p = 0.046) or lung cancer (p = 0.003) were independent risk factors for a fatal outcome of COVID-19. In a subgroup analysis of patients with active malignancy, the risk for a fatal outcome was mainly determined by tumour type (haematological malignancy or lung cancer) and age (≥ 65 years).
The findings in this registry indicate that patients with a haematological malignancy or lung cancer have an increased risk of a worse outcome of COVID-19. During the ongoing COVID-19 pandemic, these vulnerable patients should avoid exposure to SARS-CoV-2, whereas treatment adjustments and prioritizing vaccination, when available, should also be considered.
Erasmus Medical Center.
Dutch Cancer Society.
D.W. Dumoulin: Honoraria (self), Speakers fee: MSD; Honoraria (self), Speakers fee : Roche; Honoraria (self), Speakers fee: Astazeneca; Honoraria (self), Speakers fee: BMS; Honoraria (self), Speakers fee: Novartis; Honoraria (self), Speakers fee: Pfizer. H.M. Westgeest: Honoraria (self): Astellas; Honoraria (self): Roche; Travel/Accommodation/Expenses: Ipsen. L.E.L. Hendriks: Advisory/Consultancy, Mentorship program with key opinion leaders: funded by AstraZeneca: AstraZeneca; Honoraria (self), Educational webinars: Quadia; Research grant/Funding (institution): AstraZeneca; Advisory/Consultancy, Paid to institution: Eli Lilly; Advisory/Consultancy, Paid to institution: Roche Genentech; Advisory/Consultancy, Paid to institution: Pfizer; Advisory/Consultancy, Advisory board and speakers fee all paid to institution: MSD; Advisory/Consultancy, Paid to institution: Takeda; Leadership role, Local PI of pharma initiated research: AstraZeneca; Leadership role, Local PI of pharma initiated research: Novartis; Leadership role, Local PI of pharma initiated research: BMS; Leadership role, Local PI of pharma initiated research: MSD / Merck; Leadership role, Local PI of pharma initiated research: GSK; Leadership role, Local PI of pharma initiated research: Takeda; Leadership role, Local PI of pharma initiated research: Blueprint Medicines; Leadership role, Local PI of pharma initiated research: Roche Genentech; Advisory/Consultancy, Paid to institution: Amgen; Advisory/Consultancy, Paid to institution: Boehringer Ingelheim; Advisory/Consultancy, Paid to institution: BMS; Advisory/Consultancy, Travel/Accommodation/Expenses, Advisory board paid to institution: Roche Genentech; Travel/Accommodation/Expenses: BMS; Research grant/Funding (institution): Roche Genentech; Research grant/Funding (institution): Boehringer Ingelheim. A-M.C. Dingemans: Honoraria (self): Roche; Honoraria (self): Eli Lilly; Honoraria (self): Boehringer Ingelheim; Honoraria (self): Pfizer; Honoraria (self): BMS; Honoraria (self): Novartis; Honoraria (self): Takeda; Honoraria (self): PharmaMar; Advisory/Consultancy, non financial support: AbbVie; Research grant/Funding (institution): BMS; Research grant/Funding (institution): Amgen. A.A.M. Van der Veldt: Honoraria (institution), Advisory/Consultancy: BMS; Honoraria (institution), Advisory/Consultancy: MSD; Honoraria (institution), Advisory/Consultancy: Pfizer; Honoraria (institution), Advisory/Consultancy: Sanofi; Honoraria (institution), Advisory/Consultancy: Eisai; Honoraria (institution), Advisory/Consultancy: Ipsen; Honoraria (institution), Advisory/Consultancy: Roche; Honoraria (institution), Advisory/Consultancy: Novartis; Honoraria (institution), Advisory/Consultancy: Merck; Honoraria (institution), Advisory/Consultancy: Pierre Fabre. All other authors have declared no conflicts of interest.
There is ongoing controversy regarding the outcome of COVID-19 in cancer patients. This is one of few registries on the impact of COVID-19 in cancer patients in a country severly affected by the pandemic.
This cohort study is collecting data on symptomatic Sars-CoV-2 infected patients with a cancer diagnosis from 23 Swiss sites, starting March 1, 2020. The main objective of the study is to assess the outcome of COVID-19 infection in patients with solid and hematological malignancies, while the main secondary objective is to define prognostic factors of COVID-19 outcome.
With a cutoff date of July 16, 2020, 357 patients with a diagnosis of cancer and symptomatic COVID-19 were included into this first analysis. The most frequent malignancies were breast in 63 cases (18%), lung in 40 cases (11%), prostate cancer in 24 cases (7%) and myeloma in 16 cases (5%), with 104 (38%) patients having non-curative disease. Anticancer treatment within 3 months prior to the diagnosis of COVID-19 included chemotherapy in 65 patients (18%), targeted therapy in 54 patients (15%), steroids in 39 (11%), checkpoint inhibitors in 22 (6%) or no anticancer treatment in 155 patients (43%). 230 patients (65%) were hospitalized for COVID-19 or were already in hospital; 167 of the hospitalized patients (73%) required oxygen treatment, 43 patients (19%) intensive care, 31 (14%) invasive ventilation. 63 patients died from COVID-19 infection, resulting in a mortality rate of 18%. Significant risk factors for death included age ≥65 versus <65 (HR 5.84, p<0.001) and non-curative versus curative disease (HR 2.34, p=.01). Neither male versus female gender (HR 1.59, p=0.12), type of cancer, geographic region, chemotherapy (HR 1.31, p=0.44), cardiovascular disease (HR 2.25, p=0.09) nor pulmonary comorbidity (HR 0.93, p=0.86) were significant risk factors for death.
We found a COVID-19 mortality rate in real-world cancer patients in a country with a decentralized, high-quality health care system that is substantially higher than in all COVID-19 infected patients in Switzerland (18% versus 5%). The rate of hospitalization and intensive care from COVID-19 in cancer patients is substantial.
Swiss Clinical Cancer Research Group.
Swiss Clinical Cancer Research Group.
All authors have declared no conflicts of interest.
The novel COVID-19 outbreak spread rapidly around the world. Cancer patients (pts) consist of a highly vulnerable group due to underlying malignancy and/or treatment-induced immunosuppression. A high mortality rate from COVID-19 in cancer pts was previously reported. France is the fourth most affected country, with more than 150,000 infected individuals and over 28,000 deaths. GCO-002 CACOVID-19 study is a large French nationwide cohort of COVID-19 pts with solid tumors with the aim to identify risk factors of COVID-19 severity and evaluate impact on cancer treatment.
Bispective multicenter cohort set up by the French Cooperative Groups in solid cancers: ANOCEF-IGCNO (CNS tumors), ARCAGY-GINECO (gynecological and breast cancers), FFCD (digestive cancers), GERCOR (digestive and other solid cancers), GORTEC/intergroupe ORL (head and neck cancers (H&N), and IFCT (thoracic cancers). French pts with solid cancers and COVID-19 diagnosed since 1 March 2020 were accrued. Exclusion criteria: pts treated curatively > 5 years ago.
From 6 April to 15 May 2020, 835 pts from 136 institutions (general hospitals 35%, university hospitals 35%, private centers 25%, cancer centers 5%) were registered. Men: 61%, median age: 69 years (20-100). Digestive cancers: 43% (16%/9% colorectal/pancreatic cancers), lung cancers: 22%, gynecological: 14%, (9% breast cancers), H&N: 10%, CNS: 4%, urologic cancers: 3%. Advanced or metastatic: 61%. Within 3 months before COVID-19 diagnosis, 69% of pts received a systemic anticancer treatment (chemotherapy, targeted or immune therapy) and 22% a local therapy (surgery, radiotherapy or local destruction). Diagnosis of COVID-19 was confirmed by RT-PCR, CT-scan or both in 91% or serology in 1.4%. COVID was treated in the same oncological center in 78%. During the follow-up period (mean 14 days), 208 (25%) pts died, including 173 (21%) COVID-19 related deaths.
This first nationwide study of cancer pts with COVID-19 from France reports a high mortality rate. Updated and detailed data on anti-cancer treatments, risk factors of severe and fatal COVID-19 and impact of COVID-19 on cancer management will be presented.
Fédération Francophone de Cancérologie Digestive.
Has not received any funding.
A. Lièvre: Honoraria (self), Advisory/Consultancy: AAA; Amgen, Pierre Fabre; Sandoz; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Bayer; Novartis; Honoraria (self): Celgene; HalioDx; Lilly; Honoraria (self), Travel/Accommodation/Expenses: BMS; Roche; Honoraria (self), Research grant/Funding (self): Incyte; Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen; Merck; Servier; Research grant/Funding (self): Integragen; Travel/Accommodation/Expenses: AAA; Pfizer. A. Turpin: Honoraria (self): Servier; Advisory/Consultancy: Mylan; Merck Serono; Amgen; Travel/Accommodation/Expenses: Merck; Sanofi; Pfizer; AstraZeneca. I.L. Ray-Coquard: Honoraria (self), Advisory/Consultancy: Abbvie; Agenus; Advaxis; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Research grant/Funding (institution): BMS; MSD; Honoraria (self), Advisory/Consultancy: PharmaMar; Genmab; Pfizer; Deciphera; Mersena; Amgen; Tesaro; Clovis; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Merck Serono; Novartis; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Travel/Accommodation/Expenses: GSK; Non-remunerated activity/ies: GINECO; ENGOT; GCIG; European community; ESMO; ASCO; ESGO; IGSC; Inca; Swiss and German Health Authorities; Italian Health Authority; Belgium Health Authority. J. Thariat: Honoraria (self): BMS; Honoraria (institution), Travel/Accommodation/Expenses, Full/Part-time employment: Centre François Baclesse; Leadership role: President of the French Head and Neck Intergroup, GORTEC secretary; Non-remunerated activity/ies: Director of Easy-CRF society; Research grant/Funding (institution): Nanobiotix. G. Ahle: Travel/Accommodation/Expenses: Abbvie; Biogen; Novartis; Roche; Sanofi; Non-remunerated activity/ies: ANOCEF; NENO; AlSacEP. R. Mathieu: Honoraria (self), Research grant/Funding (self): Astellas; Honoraria (self): AstraZeneca; Ferring; Ipsen; Janssen; MSD; Pfizer; Sanofi; Takeda. D. Debieuvre: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Roche; Novartis; BMS; MSD; Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Research grant/Funding (institution): Chugaï; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Boerhinger-Ingelheim; Research grant/Funding (institution): Chiesi; Sandoz; Takeda; GSK; Research grant/Funding (self): Lilly. A. Canellas: Honoraria (self), Advisory/Consultancy: BMS; Honoraria (self), Travel/Accommodation/Expenses: AstraZeneca; Travel/Accommodation/Expenses: Oxyvie; LVL Medical; Boerhinger Ingelheim. A-C. Hardy-Bessard: Advisory/Consultancy: Clovis; Novartis; Roche; MSD; AstraZeneca; GSK. L. Mansi: Honoraria (institution), Advisory/Consultancy: Sandoz; Advisory/Consultancy: Roche; Eisai; Pfizer; Novartis; Speaker Bureau/Expert testimony: Exact Sciences; Travel/Accommodation/Expenses: Lilly. P. Gorphe: Honoraria (self): Intuitive Surgical; Non-remunerated activity/ies: Chair, scientific board, French Head and Neck Intergroup; Research grant/Funding (institution): MSD. A. IDBAIH Ahmed: Research grant/Funding (institution): Transgene; Sanofi; Air Liquide; Travel/Accommodation/Expenses: Carthera; Leo Pharma. G. Zalcman: Honoraria (self), Honoraria (institution), Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS; Honoraria (self), Honoraria (institution), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (institution), Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche; Honoraria (institution): Takeda; Travel/Accommodation/Expenses: Pfizer; AbbVie; MSD. O. Bouche: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Roche; Honoraria (self), Advisory/Consultancy: Merck KgaA; Bayer; AstraZeneca; Grunenthal; MSD; Honoraria (self), Speaker Bureau/Expert testimony: Amgen; Pierre Fabre;Honoraria (self), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Servier. All other authors have declared no conflicts of interest.