1. Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium
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Karlijn de Joode, Jolien Tol, Paul Hamberg, Marissa Cloos, Elisabeth A. Kastelijn, Jessica S.W. Borgers, Veerle J.A.A. Nuij, Yarne Klaver, Gerarda J.M. Herder, Pim G.N.J. Mutsaers, Daphne W. Dumoulin, Esther Oomen-de Hoop, Nico G.J. van Diemen, Eduard J. Libourel, Erica J. Geraedts, Gerben P. Bootsma, Cor H. van der Leest, Anne L. Peerdeman, Karin H. Herbschleb, Otto J. Visser, Haiko J. Bloemendal, Hanneke W.M. van Laarhoven, Elisabeth G.E. de Vries, Lizza E.L. Hendriks, Laurens V. Beerepoot, Hans M. Westgeest, Franchette W.P.J. van den Berkmortel, John B.A.G. Haanen, Anne-Marie C. Dingemans, Astrid A.M. van der Veldt, A. Becker-Commissaris, F. Terheggen, B.E.E.M. van den Borne, L.J.C. van Warmerdam, L. van Leeuwen, F.S. van der Meer, M.A. Tiemessen, D.M. van Diepen, L. Strobbe, J.A.F. Koekkoek, P. Brocken, J.C. Drooger, R. Heller, J.W.B. de Groot, J.A. Stigt, C.C.M. Pitz, M. Slingerland, F.J. Borm, B.C.M. Haberkorn, S.C. van 't Westeinde, M.J.B. Aarts, J.W.G. van Putten, M. Youssef, G.A. Cirkel, C.R. van Rooijen, E. Citgez, N.P. Barlo, B.M.J. Scholtes, R.H.T. Koornstra, N.J.M. Claessens, L.M. Faber, C.H. Rikers, R.A.W. van de Wetering, G.L. Veurink, B.W. Bouter, I. Houtenbos, M.P.L. Bard, G. Douma, M. Jalving, T.J.N. Hiltermann, O.C.J. Schuurbiers-Siebers, K.P.M. Suijkerbuijk, A.S.R. van Lindert, A.J. van de Wouw, V.E.M. van den Boogaart, S.D. Bakker, E. Looysen, W.K. de Jong, E.J.M. Siemerink, A.J. Staal, B. Franken, W.H. van Geffen, Pulmonologie, MUMC+: MA Med Staf Spec Longziekten (9), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Interne Geneeskunde, MUMC+: MA Medische Oncologie (9), Medical Oncology, Hematology, Pulmonary Medicine, Radiology & Nuclear Medicine, Urology, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Translational Immunology Groningen (TRIGR), Targeted Gynaecologic Oncology (TARGON), Oncology, CCA - Cancer Treatment and Quality of Life, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
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Oncology ,Male ,Cancer Research ,Fatal outcome ,IMPACT ,Patient characteristics ,Withholding Treatment/statistics & numerical data ,Risk Factors ,Neoplasms ,Pandemic ,80 and over ,Netherlands ,Original Research ,COVID-19/epidemiology ,Cancer ,Aged, 80 and over ,RISK ,SARS-CoV-2/isolation & purification ,Middle Aged ,Mortality/trends ,Prognosis ,Hospitalization ,Survival Rate ,Urological cancers Radboud Institute for Health Sciences [Radboudumc 15] ,Cancer treatment ,Female ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Netherlands/epidemiology ,SDG 3 - Good Health and Well-being ,Intensive care ,Internal medicine ,Treatment restrictions ,medicine ,Humans ,In patient ,Mortality ,Lung cancer ,Aged ,Hospitalization/statistics & numerical data ,SARS-CoV-2 ,business.industry ,Advanced care planning ,COVID-19 ,medicine.disease ,Life Support Care/statistics & numerical data ,Life Support Care ,Withholding Treatment ,business ,Neoplasms/epidemiology - Abstract
Aim of the study: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do not-resuscitate codes), were studied in patients with cancer and COVID-19. Methods: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account. Results: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome. Conclusion: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic. 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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- 2022