Changes in anticancer treatment plans in patients with solid cancer hospitalized with COVID-19: analysis of the nationwide BSMO-COVID registry providing lessons for the future

Abstract

Background: Solid cancer is an independent prognostic factor for poor outcome with COVID-19. As guidelines for patient management in that setting depend on retrospective efforts, we here present the first analyses of a nationwide database of patients with cancer hospitalized with COVID-19 in Belgium, with a focus on changes in anticancer treatment plans at the time of SARS-CoV-2 infection.

Methods: Nineteen Belgian hospitals identified all patients with a history of solid cancer hospitalized with COVID-19 between March 2020 and February 2021. Demographic, cancer-specific and COVID-specific data were pseudonymously entered into a central Belgian Society of Medical Oncology (BSMO)-COVID database. The association between survival and primary cancer type was analyzed through multivariate multinomial logistic regression. Group comparisons for categorical variables were carried out through a Chi-square test.

Results: A total of 928 patients were registered in the database; most of them were aged ≥70 years (61.0%) and with poor performance scores [57.2% Eastern Cooperative Oncology Group (ECOG) ≥2]. Thirty-day COVID-related mortality was 19.8%. In multivariate analysis, a trend was seen for higher mortality in patients with lung cancer (27.6% versus 20.8%, P = 0.062) and lower mortality for patients with breast cancer (13.0% versus 23.3%, P = 0.052) compared with other tumour types. Non-curative treatment was associated with higher 30-day COVID-related mortality rates compared with curative or no active treatment (25.8% versus 14.3% versus 21.9%, respectively, P < 0.001). In 33% of patients under active treatment, the therapeutic plan was changed due to COVID-19 diagnosis, most frequently involving delays/interruptions in systemic treatments (18.6%). Thirty-day COVID-related mortality was not significantly different between patients with and without treatment modifications (21.4% versus 20.5%).

Conclusion: Interruption in anticancer treatments at the time of SARS-CoV-2 infection was not associated with a reduction in COVID-related mortality in our cohort of patients with solid cancer, highlighting that treatment continuation should be strived for, especially in the curative setting.

Keywords: COVID-19; cancer; prognosis; solid tumours; treatment changes.

Figure 1

Mortality in function of oncological treatment setting at time of COVID-19 diagnosis. (A) 3-Month mortality according to oncological treatment setting at time of COVID-19 diagnosis. (B) Kaplan–Meier survival estimates for COVID-19-related survival according to oncological treatment setting at time of COVID-19 diagnosis. <3 months: ‘in the 3 months before COVID-19 diagnosis’. P values (Chi-square test) for % COVID-19-related survival at 3 months: no active treatment <3 months versus curative treatment P = 0.117; no active treatment versus non-curative treatment P < 0.001; curative treatment versus non-curative treatment P < 0.001.

Figure 2

Treatment modificationsaccording to timing of COVID-19 diagnosis, treatment setting and type of treatment planned. (A) Treatment modifications according to timing of COVID-19 diagnosis. First wave: 1 March 2020-30 June 2020; second wave: 1 July 2020-1 February 2021. Three patients from the first wave with unknown treatment modification status were excluded from this graph. (B) Treatment modifications according to anticancer treatment type for patients under active anticancer treatment (any type of anticancer treatment received in the 3 months before COVID-19 diagnosis).