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Pinato DJ, Aguilar-Company J, Ferrante D, Hanbury G, Bower M, Salazar R, Mirallas O, Sureda A, Plaja A, Cucurull M, Mesia R, Townsend S, Jackson A, Dalla Pria A, Newsom-Davis T, Handford J, Sita-Lumsden A, Apthorp E, Vincenzi B, Bertuzzi A, Brunet J, Lambertini M, Maluquer C, Pedrazzoli P, Biello F, Sinclair A, Bawany S, Khalique S, Rossi S, Rogers L, Murphy C, Belessiotis K, Carmona-García MC, Sharkey R, García-Illescas D, Rizzo G, Perachino M, Saoudi-Gonzalez N, Doonga K, Fox L, Roldán E, Gaidano G, Ruiz-Camps I, Bruna R, Patriarca A, Martinez-Vila C, Cantini L, Zambelli A, Giusti R, Mazzoni F, Caliman E, Santoro A, Grosso F, Parisi A, Queirolo P, Aujayeb A, Rimassa L, Prat A, Tucci M, Libertini M, Grisanti S, Mukherjee U, Diamantis N, Fusco V, Generali D, Provenzano S, Gennari A, Tabernero J, Cortellini A, Evans JS, Swallow J, Chung C, Patel M, Dettorre G, Ottaviani D, Chowdhury A, Merry E, Chopra N, Lee AJX, Sng CCT, Yu T, Shawe-Taylor M, Bain HDC, Wong YNS, Galazi M, Benafif S, Dileo P, Earnshaw I, Patel G, Wu A, Soosaipillai G, Cooper L, Andaleeb R, Dolly S, Apthorp E, Srikandarajah K, Jones E, Van Hemelrijck M, Moss C, Russell B, Chester J, Loizidou A, Piccart M, Cruz CA, Reyes R, Segui E, Marco-Hernández J, Viladot M, Eremiev S, Fort-Culillas R, Garcia I, Liñan R, Roqué Lloveras A, Harbeck N, Wuerstlein R, Henze F, Mahner S, Felip E, Pous A, D'Avanzo F, Scotti L, Krengli M, Marrari A, Delfanti S, Maconi A, Betti M, Tonini G, Di Fazio GR, Tondini C, Chiudinelli L, Franchi M, Libertini M, Bertulli R, Baggi A, Tovazzi V, Ficorella C, Porzio G, Saponara M, Filetti M, Zoratto F, Paoloni F, Berardi R, Guida A, Bracarda S, Iglesias M, Sanchez de Torre A, Tagliamento M, Colomba E, Pommeret F. Outcomes of the SARS-CoV-2 omicron (B.1.1.529) variant outbreak among vaccinated and unvaccinated patients with cancer in Europe: results from the retrospective, multicentre, OnCovid registry study. Lancet Oncol 2022; 23:865-875. [PMID: 35660139 PMCID: PMC9162476 DOI: 10.1016/s1470-2045(22)00273-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The omicron (B.1.1.529) variant of SARS-CoV-2 is highly transmissible and escapes vaccine-induced immunity. We aimed to describe outcomes due to COVID-19 during the omicron outbreak compared with the prevaccination period and alpha (B.1.1.7) and delta (B.1.617.2) waves in patients with cancer in Europe. METHODS In this retrospective analysis of the multicentre OnCovid Registry study, we recruited patients aged 18 years or older with laboratory-confirmed diagnosis of SARS-CoV-2, who had a history of solid or haematological malignancy that was either active or in remission. Patient were recruited from 37 oncology centres from UK, Italy, Spain, France, Belgium, and Germany. Participants were followed up from COVID-19 diagnosis until death or loss to follow-up, while being treated as per standard of care. For this analysis, we excluded data from centres that did not actively enter new data after March 1, 2021 (in France, Germany, and Belgium). We compared measures of COVID-19 morbidity, which were complications from COVID-19, hospitalisation due to COVID-19, and requirement of supplemental oxygen and COVID-19-specific therapies, and COVID-19 mortality across three time periods designated as the prevaccination (Feb 27 to Nov 30, 2020), alpha-delta (Dec 1, 2020, to Dec 14, 2021), and omicron (Dec 15, 2021, to Jan 31, 2022) phases. We assessed all-cause case-fatality rates at 14 days and 28 days after diagnosis of COVID-19 overall and in unvaccinated and fully vaccinated patients and in those who received a booster dose, after adjusting for country of origin, sex, age, comorbidities, tumour type, stage, and status, and receipt of systemic anti-cancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974, and is ongoing. FINDINGS As of Feb 4, 2022 (database lock), the registry included 3820 patients who had been diagnosed with COVID-19 between Feb 27, 2020, and Jan 31, 2022. 3473 patients were eligible for inclusion (1640 [47·4%] were women and 1822 [52·6%] were men, with a median age of 68 years [IQR 57-77]). 2033 (58·5%) of 3473 were diagnosed during the prevaccination phase, 1075 (31·0%) during the alpha-delta phase, and 365 (10·5%) during the omicron phase. Among patients diagnosed during the omicron phase, 113 (33·3%) of 339 were fully vaccinated and 165 (48·7%) were boosted, whereas among those diagnosed during the alpha-delta phase, 152 (16·6%) of 915 were fully vaccinated and 21 (2·3%) were boosted. Compared with patients diagnosed during the prevaccination period, those who were diagnosed during the omicron phase had lower case-fatality rates at 14 days (adjusted odds ratio [OR] 0·32 [95% CI 0·19-0·61) and 28 days (0·34 [0·16-0·79]), complications due to COVID-19 (0·26 [0·17-0·46]), and hospitalisation due to COVID-19 (0·17 [0·09-0·32]), and had less requirements for COVID-19-specific therapy (0·22 [0·15-0·34]) and oxygen therapy (0·24 [0·14-0·43]) than did those diagnosed during the alpha-delta phase. Unvaccinated patients diagnosed during the omicron phase had similar crude case-fatality rates at 14 days (ten [25%] of 40 patients vs 114 [17%] of 656) and at 28 days (11 [27%] of 40 vs 184 [28%] of 656) and similar rates of hospitalisation due to COVID-19 (18 [43%] of 42 vs 266 [41%] of 652) and complications from COVID-19 (13 [31%] of 42 vs 237 [36%] of 659) as those diagnosed during the alpha-delta phase. INTERPRETATION Despite time-dependent improvements in outcomes reported in the omicron phase compared with the earlier phases of the pandemic, patients with cancer remain highly susceptible to SARS-CoV-2 if they are not vaccinated against SARS-CoV-2. Our findings support universal vaccination of patients with cancer as a protective measure against morbidity and mortality from COVID-19. FUNDING National Institute for Health and Care Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.
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Soosaipillai G, Wu A, Dettorre GM, Diamantis N, Chester J, Moss C, Aguilar-Company J, Bower M, Sng CCT, Salazar R, Brunet J, Jones E, Mesia R, Jackson A, Mukherjee U, Sita-Lumsden A, Seguí E, Ottaviani D, Carbó A, Benafif S, Würstlein R, Carmona C, Chopra N, Cruz CA, Swallow J, Saoudi N, Felip E, Galazi M, Garcia-Fructuoso I, Lee AJX, Newsom-Davis T, Wong YNS, Sureda A, Maluquer C, Ruiz-Camps I, Cabirta A, Prat A, Loizidou A, Gennari A, Ferrante D, Tabernero J, Russell B, Van Hemelrijck M, Dolly S, Hulbert-Williams NJ, Pinato DJ. Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective. Ther Adv Med Oncol 2021; 13:17588359211042224. [PMID: 34497669 PMCID: PMC8419540 DOI: 10.1177/17588359211042224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. METHODS From the OnCovid repository (N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT- not referred). RESULTS Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more 'Do not attempt cardio-pulmonary resuscitation' orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. CONCLUSION SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.
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Affiliation(s)
| | - Anjui Wu
- Cancer Division, University College London Hospitals, London, UK
- UCL Cancer Institute, Fitzrovia, London, UK
| | - Gino M Dettorre
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | | | - John Chester
- Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK
- Medical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Juan Aguilar-Company
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC. Hospitalet de Llobregat, Spain
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Eleanor Jones
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Ricard Mesia
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Elia Seguí
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Diego Ottaviani
- Cancer Division, University College London Hospitals, London, UK
| | - Anna Carbó
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sarah Benafif
- Cancer Division, University College London Hospitals, London, UK
| | - Rachel Würstlein
- Department of Gynaecology and Obstetrics, Breast Centre and Gynaecological Cancer Centre and CCC Munich, University Hospital Munich, Munich, Germany
| | - Carme Carmona
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Neha Chopra
- Cancer Division, University College London Hospitals, London, UK
| | | | - Judith Swallow
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Nadia Saoudi
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Eudald Felip
- Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain
| | - Myria Galazi
- Cancer Division, University College London Hospitals, London, UK
| | - Isabel Garcia-Fructuoso
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Alvin J. X. Lee
- Cancer Division, University College London Hospitals, London, UK
| | - Thomas Newsom-Davis
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| | | | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Spain
| | - Isabel Ruiz-Camps
- Infectious Diseases, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alba Cabirta
- Department of Haematology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumours, IDIBAPS, Barcelona, Spain
| | - Angela Loizidou
- Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Josep Tabernero
- Medical Oncology, Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, UK
| | - Nicholas J Hulbert-Williams
- Professor of Behavioural Medicine, Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chritchley Building, Parkgate Road, Chester, Cheshire, CH1 4BJ, UK
| | - David J Pinato
- Department of Surgery and Cancer, Clinical Senior Lecturer and Consultant Medical Oncologist, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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