COVID-19 and Cancer

With over 25 million confirmed cases and almost 1 million deaths in the first 6 months since the start of the pandemic, COVID-19 has changed our lives dramatically. In addition, the way cancer care is delivered, and thus the working practice of oncology professionals, has been changed. At the ESMO 2020 Virtual Meeting, several presentations addressed the impact of COVID-19 on clinical oncology care as well as on the wellbeing and professional performance of oncologists. (Note: scientific insights in COVID-19 (care) are rapidly changing, so data presented at ESMO could be out of date now).

COVID-19 in patients with cancer

SARS-CoV-2 is associated with diverse clinical presentations ranging from asymptomatic infection to lethal complications. Small studies have suggested inferior outcomes in patients on active cancer treatment. The US COVID-19 and Cancer Consortium (CCC19) registry was set up to collect data about patients with cancer who have been diagnosed with COVID-19. Data were collected by online survey. Based on data of 3,654 patients (>18 years) with a current or historical invasive solid or haematologic malignancy who have been diagnosed with COVID-19, the correlation was investigated between timing of anti-cancer treatment and COVID-19-related complications and 30-day mortality [1].

Of the included patients, 1,610 (44%) were treated for cancer within 1 year before COVID-19 infection. Approximately 2/3 of cancer patients diagnosed with COVID-19 had a solid tumour, regardless timing of most recent treatment. Only 28% of patients had stage IV/distant disease in the group that had not received treatment for at least 3-12 months prior to COVID-19 infection. More than 50% of cancer patients with COVID-19 were hospitalised, about 15% required intensive care. Observed 30-day mortality was highest amongst cancer patients treated 1-3 months prior to COVID-19 diagnosis; all-cause mortality was 28%. With respect to treatment modality, 30-day mortality was highest in patients treated with chemoimmunotherapy (see Figure). Mortality was particularly high in patients who received anti-CD20 therapy 1-3 months prior to COVID-19, the time period for which B-cell depletion develops. As this was a retrospective study with descriptive statistics, these data should be interpreted with caution.

Figure: 30-day mortality by most recent treatment type [1]

Management of medical cancer treatments and psychological consequence for the patients

COVIPACT is an ongoing, longitudinal study among outpatient cancer patients and caregivers working in the outpatient department. Aim of the study was to measure stress, sleep quality, and quality of life of patients, as well as stress, scale of professional exhaustion, and feeling of personal efficiency of caregivers during the lockdown in outpatient departments of 2 cancer centres [2]. A total of 621 patients and 73 caregivers were enrolled.

Of all patients, 27% experienced treatment modifications; 30% had adapted monitoring (mainly phone-consultation), 15% had treatment interruptions, 32% had postponed treatment, and 19% had administration rhythm modifications. Treatment modifications were less frequent in first-line therapy compared to subsequent lines of therapy (21% vs 31%). Immunotherapy was most frequently modified (49%), chemotherapy was least modified (18%). Modifications of treatment were associated with higher levels of perceived stress among the patients. Despite a high level of stress, 2/3 of caregivers reported a feeling of personal efficiency and accomplishment.

Wellbeing and professional performance of oncology professionals

The ESMO Resilience Task Force conducted a survey to evaluate the impact of COVID-19 and the changes in working (and daily) practice on the wellbeing and professional performance of oncology professionals [3]. Two anonymous survey series were disseminated via email and social media, the first in April/May 2020 and the second in July/August 2020.

In the first survey (including 1,520 participants from 101 countries worldwide), 67% of the participants reported a change in professional duties, including more remote consultations, more hours working at home, covering for non-oncology specialties, and reduced clinical trial activity. Importantly, wellbeing and job performance since COVID-19 appeared to have an inverse relationship to the estimated COVID-19 crude mortality rate. As the mortality rate increased in a geographical location, perceptions of job performance and wellbeing deteriorated. In contrast, burnout did not appear to follow patterns of COVID-19 crude mortality rates. Positive predictors for wellbeing or distress are feeling valued by the organisation, age over 40 years, being male, and a change in physical activity. Some negative predictors are worrying about current wellbeing, increased amount of work, concerns about the impact on training and career, and need to self-isolate. Psychological resilience was also predictive of wellbeing and burnout levels. In light of these findings, resilience training is one of the key measures that could be implemented to help improve wellbeing among oncology professionals.

In the second survey, the percentage of participants at risk for distress was higher compared with the first survey (33% vs 25%) and the percentage of self-reported burnout had increased, from 38% to 49%. On the other hand, job performance had improved over time, with 51% reporting a favourable job performance in July/August compared with 34% in April/May. When asked what they think would be helpful going forward, participants mentioned counselling and psychological support, courses on wellbeing, burnout, and coping strategies, a practical guide or self-help resource, and flexible working hours including working from home.

1. Wise-Draper TM, et al. Systemic cancer treatment-related outcomes in patients with SARS-CoV-2 infection: A CCC19 registry analysis. ESMO 2020 Virtual Meeting, abstract LBA71.
2. Joly F, et al. Impact of the COVID-19 pandemic on management of medical cancer treatments and psychological consequence for the patients. ESMO 2020 Virtual Meeting, abstract LBA69.
3. Banerjee S, et al. The impact of COVID-19 on oncology professionals: Initial results of the ESMO resilience task force survey collaboration. ESMO 2020 Virtual Congress , abstract LBA70.