1671MO - Provision of palliative care for patients with cancer and SARS-CoV-2 infection

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

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.