Background
The COVID-19 pandemic has resulted in reduced cancer diagnoses. Impacts on existing cancer patients has not been well documented. We report the experience of a large metropolitan multisite cancer service that undertook proactive review of systemic anti-cancer therapy (SACT) of all patients to consider changes in response to the pandemic. The aim was to re-balance the risks and benefits of current treatment strategies in light of the pandemic.
Method
From March-April 2020, all current SACT orders (excluding those related to clinical trials) were reviewed. Patients on curative therapy, or with large perceived benefit were reviewed but not included in further processing. For all other SACT orders, a documented recommendation regarding planned treatment was sent to the patient's individual clinician for consideration. A categorical assessment of the recommendations is presented.
Results
570 SACT orders were reviewed, pertaining to 317 patients. 730 individual recommendations were made. The population consisted of 130 males and 187 females, with an average age 60.6 years. Intentions of treatment were: Curative (n=16), Neoadjuvant (n=30), Adjuvant (n=74), and Palliative (n=197). Distribution by tumour types (number) was: Breast (93), Gastrointestinal (76), Thoracic (63), Gynaecological (31), Genitourinary (21), Head and Neck/Melanoma (19), CNS (8), and Other (6).
The most common recommendations (number) were: No Change (160), Change route of delivery (e.g. intravenous to subcutaneous) (67), Reduce duration of treatment (68), Consider treatment break (60), Reconsider benefit of current treatment (58), Cease treatment (53), and Refer to HITH (47).
Conclusion
This is the only dataset known to date of the actual impact of COVID-19 on the recommendations for SACT for patients on treatment at the start of the pandemic in Australia. Most patients had some type of modification in their cancer therapy made in the context of competing risk to their health posed by COVID-19.