In a study reported in JCO Oncology Practice, Wu et al found that almost two-thirds of patients undergoing active cancer management who were diagnosed with COVID-19 over a 4-month period in 2020 had significant delays in planned management.
Study Details
The retrospective study involved data on 131 adult and pediatric patients diagnosed with COVID-19 between March 1 and June 30, 2020, with a current or historical diagnosis of malignancy identified from the electronic medical records at the University of California, San Francisco, and Stanford University.
Reasons for changes in management were defined as clinical or nonclinical. Clinical reasons were due to COVID diagnosis or related complications; nonclinical reasons were related to the requirement for a repeat negative COVID-19 test, resolution of symptoms, or clearance from an infectious disease specialist prior to starting or resuming cancer treatment or undergoing cancer-related procedures.
“We found significant changes in the management of [patients with] cancer with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.”— Wu et al
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Key Findings
Among the 131 patients diagnosed with COVID-19, solid malignancies included breast (18%), gastrointestinal (16%), and genitourinary (15%) cancers; 22% had hematologic malignancies.
A total of 50 patients (38%) were hospitalized due to COVID-19. Among hospitalized patients, 19 (15%) required intensive care and 9 (7%) died of complications of COVID-19. Of the nine patients who died, four (44%) were undergoing active cancer treatment at the time of COVID-19 diagnosis.
Overall, 69 patients (53%) had active cancer; of these, 55 (78%) were undergoing active cancer management in the 2 months preceding their COVID-19 diagnosis. Among these 55 patients, 35 (64%) had a change in cancer management plan. All changes in management were delays in management, with one patient also being switched from intravenous to oral chemotherapy during chemotherapy delay. An additional three patients who were not undergoing active cancer management (who were newly diagnosed or developed disease recurrence) had a delay in management.
Among the 38 patients with delay in management, management types and median durations of delay were:
- Intravenous or intramuscular systemic therapy in 19 (50%) and 21 days (range = 21–42 days)
- Oral therapy in 11 (29%) and 16 days (range = 10–28 days)
- Radiation therapy or surgery in 4 (11%) and 21 days (range = 19–26 days)
- Diagnostic procedure in 4 (11%) and 16 days (range = 14–27 days).
Among the patients with delay, intent of treatment was palliative in 24 (63%, with median delay duration of 21 days [range = 15–33 days]) and curative in 14 (37%, with median delay duration of 21 days [range = 17–29 days]).
Reasons for delay were clinical for 10 patients (26%), with median delay duration of 22 days (range = 9–46 days) and nonclinical for 28 (74%), with median delay duration of 21 days (range = 17–28 days).
Among patients with delay, date of COVID-19 diagnosis was March or April for 25 (68%), with median delay duration of 21 days (range = 17–30 days) and May or June for 13 (34%), with median delay duration of 21 days (range = 14–29 days).
The decision to change management was correlated with the time of COVID-19 diagnosis, with significantly more delays among patients treated with palliative intent earlier vs later in the course of the pandemic (March/April vs May/June; odds ratio [OR] = 4.2, 95% confidence interval [CI] = 1.03–7.3, P = .0497). Such a difference was not observed among patients treated with curative intent (OR = 0.89, 95% CI = 0.13–5.58, P = .91).
The investigators concluded, “We found significant changes in the management of [patients with] cancer with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.”
Julie Tsu-Yu Wu, MD, PhD, of the Department of Medical Oncology, Stanford University, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
