Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

DOCC Investigators; 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

doi:10.1016/j.ejca.2021.10.009

Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

DOCC Investigators, 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. HerbschlebOtto 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^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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 COVID-19 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.

Original language	English
Pages (from-to)	261-272
Number of pages	12
Journal	European Journal of Cancer
Volume	160
DOIs	https://doi.org/10.1016/j.ejca.2021.10.009
Publication status	Published - Jan-2022

Keywords

Advanced care planning
Cancer
Cancer treatment
COVID-19
Treatment restrictions

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DOCC Investigators, de Joode, K., Tol, J., Hamberg, P., Cloos, M., Kastelijn, E. A., Borgers, J. S. W., Nuij, V. J. A. A., Klaver, Y., Herder, G. J. M., Mutsaers, P. G. N. J., Dumoulin, D. W., Oomen-de Hoop, E., van Diemen, N. G. J., Libourel, E. J., Geraedts, E. J., Bootsma, G. P., van der Leest, C. H., Peerdeman, A. L., ... van der Veldt, A. A. M. (2022). Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium. European Journal of Cancer, 160, 261-272. https://doi.org/10.1016/j.ejca.2021.10.009

@article{2725f9bcb0224af59cfccdf139ccde70,

title = "Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium",

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 COVID-19 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.",

keywords = "Advanced care planning, Cancer, Cancer treatment, COVID-19, Treatment restrictions",

author = "{DOCC Investigators} and {de Joode}, Karlijn and Jolien Tol and Paul Hamberg and Marissa Cloos and Kastelijn, {Elisabeth A.} and Borgers, {Jessica S.W.} and Nuij, {Veerle J.A.A.} and Yarne Klaver and Herder, {Gerarda J.M.} and Mutsaers, {Pim G.N.J.} and Dumoulin, {Daphne W.} and {Oomen-de Hoop}, Esther and {van Diemen}, {Nico G.J.} and Libourel, {Eduard J.} and Geraedts, {Erica J.} and Bootsma, {Gerben P.} and {van der Leest}, {Cor H.} and Peerdeman, {Anne L.} and Herbschleb, {Karin H.} and Visser, {Otto J.} and Bloemendal, {Haiko J.} and {van Laarhoven}, {Hanneke W.M.} and {de Vries}, {Elisabeth G.E.} and Hendriks, {Lizza E.L.} and Beerepoot, {Laurens V.} and Westgeest, {Hans M.} and {van den Berkmortel}, {Franchette W.P.J.} and Haanen, {John B.A.G.} and Dingemans, {Anne Marie C.} and {van der Veldt}, {Astrid A.M.} and A. Becker-Commissaris and F. Terheggen and {van den Borne}, {B. E.E.M.} and {van Warmerdam}, {L. J.C.} and {van Leeuwen}, L. and {van der Meer}, {F. S.} and Tiemessen, {M. A.} and {van Diepen}, {D. M.} and L. Strobbe and Koekkoek, {J. A.F.} and R. Heller and {de Groot}, {J. W.B.} and Faber, {L. M.} and Bouter, {B. W.} and G. Douma and Mathilde Jalving and Hiltermann, {T. J.N.} and Bakker, {S. D.} and {de Jong}, {W. K.} and Staal, {A. J.} and {van Geffen}, {W. H.}",

note = "Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: P.H. reports consulting fees from Astellas, MSD, Pfizer, AstraZeneca, BMS, Ipsen, all outside the submitted work; D.D. reports personal speakers fees from MSD, Roche, AstraZeneca, BMS, Novartis, Pfizer, all outside the submitted work; EGEdV reports an advisory role at Daiichi Sankyo, NSABP and Sanofi (all outside the submitted work and paid to UMCG), and research funding from Amgen, AstraZeneca, Bayer, Chugai Pharma, Crescendo, CytomX Therapeutics, G1 Therapeutics, Genentech, Nordic Nanovector, Radius Health, Regeneron, Roche, Servier and Synthon (all outside the submitted work and paid to UMCG); L.H. reports others from boehringer ingelheim, others from BMS, others from Roche Genentech, others from BMS, grants from Roche Genentech, grants from Boehringer Ingelheim, others from AstraZeneca, personal fees from Quadia, grants from Astra Zeneca, others from Eli Lilly, others from Roche Genentech, others from Pfizer, others from MSD, others from Takeda, non-financial support from AstraZeneca, non-financial support from Novartis, non-financial support from BMS, non-financial support from MSD/Merck, non-financial support from GSK, non-financial support from Takeda, non-financial support from Blueprint Medicines, non-financial support from Roche Genentech, others from Amgen, all outside the submitted work; H.W. reports personal fees and non-financial support from Astellas, personal fees from roche, non-financial support from Ipsen, all outside the submitted work; JH has received financial compensation for advisory roles from Achilles Tx, BMS, BioNTech, Eisai, Immunocore, Instil Bio, Ipsen, MSD, Merk Serono, Molecular Partners, Neogene Tx, PokeAcel, Pfizer, Roche, Sanofi, T-knife, Third Rock Ventures, all outside the submitted work. JH received research grants from Amgen, Asher Bio, BMS, BioNTech, MSD and Novartis, all outside the submitted work. JH owns stock options from Neogene Therapeutics, outside the submitted work; A.D. reports personal fees from Roche, Eli Lily, Boehringer Ingelheim, Pfizer, BMS, Novartis, Takeda, Pharmamar, non-financial support from Abbvie, grants from BMS, grants from Amgen, all outside the submitted work; A.V. reports advisory board of BMS, MSD, Merck, Pfizer, Ipsen, Eisai, Pierre Fabre, Roche, Novartis, Sanofi, all paid to Erasmus MC and outside the submitted work; J.G. reports advisory board of Pierre Fabre, BMS, MSD, and Servier, all outside the submitted work; T.H. reports grants from Roche, Astra Zeneca, BMS, advisory board from MSD and BMS, congress support from Takeda, all outside the submitted work; K.S. reports grants and personal fees from Novartis, personal fees from Bristol Myers Squibb, MSD, Roche, Pierre Fabre, and Abbvie, all outside the submitted work; all remaining authors declare no competing interests. Funding Information: This study was supported by a grant from the Dutch Cancer Society , a non-profit organisation. The Dutch Cancer Society had no role in study design, data collection, data analysis, data interpretation or writing of the report. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = jan,

doi = "10.1016/j.ejca.2021.10.009",

language = "English",

volume = "160",

pages = "261--272",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "ELSEVIER SCI LTD",

}

DOCC Investigators, de Joode, K, Tol, J, Hamberg, P, Cloos, M, Kastelijn, EA, Borgers, JSW, Nuij, VJAA, Klaver, Y, Herder, GJM, Mutsaers, PGNJ, Dumoulin, DW, Oomen-de Hoop, E, van Diemen, NGJ, Libourel, EJ, Geraedts, EJ, Bootsma, GP, van der Leest, CH, Peerdeman, AL, Herbschleb, KH, Visser, OJ, Bloemendal, HJ, van Laarhoven, HWM, de Vries, EGE, Hendriks, LEL, Beerepoot, LV, Westgeest, HM, van den Berkmortel, FWPJ, Haanen, JBAG, Dingemans, AMC & van der Veldt, AAM 2022, 'Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium', European Journal of Cancer, vol. 160, pp. 261-272. https://doi.org/10.1016/j.ejca.2021.10.009

TY - JOUR

T1 - Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19

T2 - an update from the Dutch Oncology COVID-19 Consortium

AU - DOCC Investigators

AU - de Joode, Karlijn

AU - Tol, Jolien

AU - Hamberg, Paul

AU - Cloos, Marissa

AU - Kastelijn, Elisabeth A.

AU - Borgers, Jessica S.W.

AU - Nuij, Veerle J.A.A.

AU - Klaver, Yarne

AU - Herder, Gerarda J.M.

AU - Mutsaers, Pim G.N.J.

AU - Dumoulin, Daphne W.

AU - Oomen-de Hoop, Esther

AU - van Diemen, Nico G.J.

AU - Libourel, Eduard J.

AU - Geraedts, Erica J.

AU - Bootsma, Gerben P.

AU - van der Leest, Cor H.

AU - Peerdeman, Anne L.

AU - Herbschleb, Karin H.

AU - Visser, Otto J.

AU - Bloemendal, Haiko J.

AU - van Laarhoven, Hanneke W.M.

AU - de Vries, Elisabeth G.E.

AU - Hendriks, Lizza E.L.

AU - Beerepoot, Laurens V.

AU - Westgeest, Hans M.

AU - van den Berkmortel, Franchette W.P.J.

AU - Haanen, John B.A.G.

AU - Dingemans, Anne Marie C.

AU - van der Veldt, Astrid A.M.

AU - Becker-Commissaris, A.

AU - Terheggen, F.

AU - van den Borne, B. E.E.M.

AU - van Warmerdam, L. J.C.

AU - van Leeuwen, L.

AU - van der Meer, F. S.

AU - Tiemessen, M. A.

AU - van Diepen, D. M.

AU - Strobbe, L.

AU - Koekkoek, J. A.F.

AU - Heller, R.

AU - de Groot, J. W.B.

AU - Faber, L. M.

AU - Bouter, B. W.

AU - Douma, G.

AU - Jalving, Mathilde

AU - Hiltermann, T. J.N.

AU - Bakker, S. D.

AU - de Jong, W. K.

AU - Staal, A. J.

AU - van Geffen, W. H.

N1 - Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: P.H. reports consulting fees from Astellas, MSD, Pfizer, AstraZeneca, BMS, Ipsen, all outside the submitted work; D.D. reports personal speakers fees from MSD, Roche, AstraZeneca, BMS, Novartis, Pfizer, all outside the submitted work; EGEdV reports an advisory role at Daiichi Sankyo, NSABP and Sanofi (all outside the submitted work and paid to UMCG), and research funding from Amgen, AstraZeneca, Bayer, Chugai Pharma, Crescendo, CytomX Therapeutics, G1 Therapeutics, Genentech, Nordic Nanovector, Radius Health, Regeneron, Roche, Servier and Synthon (all outside the submitted work and paid to UMCG); L.H. reports others from boehringer ingelheim, others from BMS, others from Roche Genentech, others from BMS, grants from Roche Genentech, grants from Boehringer Ingelheim, others from AstraZeneca, personal fees from Quadia, grants from Astra Zeneca, others from Eli Lilly, others from Roche Genentech, others from Pfizer, others from MSD, others from Takeda, non-financial support from AstraZeneca, non-financial support from Novartis, non-financial support from BMS, non-financial support from MSD/Merck, non-financial support from GSK, non-financial support from Takeda, non-financial support from Blueprint Medicines, non-financial support from Roche Genentech, others from Amgen, all outside the submitted work; H.W. reports personal fees and non-financial support from Astellas, personal fees from roche, non-financial support from Ipsen, all outside the submitted work; JH has received financial compensation for advisory roles from Achilles Tx, BMS, BioNTech, Eisai, Immunocore, Instil Bio, Ipsen, MSD, Merk Serono, Molecular Partners, Neogene Tx, PokeAcel, Pfizer, Roche, Sanofi, T-knife, Third Rock Ventures, all outside the submitted work. JH received research grants from Amgen, Asher Bio, BMS, BioNTech, MSD and Novartis, all outside the submitted work. JH owns stock options from Neogene Therapeutics, outside the submitted work; A.D. reports personal fees from Roche, Eli Lily, Boehringer Ingelheim, Pfizer, BMS, Novartis, Takeda, Pharmamar, non-financial support from Abbvie, grants from BMS, grants from Amgen, all outside the submitted work; A.V. reports advisory board of BMS, MSD, Merck, Pfizer, Ipsen, Eisai, Pierre Fabre, Roche, Novartis, Sanofi, all paid to Erasmus MC and outside the submitted work; J.G. reports advisory board of Pierre Fabre, BMS, MSD, and Servier, all outside the submitted work; T.H. reports grants from Roche, Astra Zeneca, BMS, advisory board from MSD and BMS, congress support from Takeda, all outside the submitted work; K.S. reports grants and personal fees from Novartis, personal fees from Bristol Myers Squibb, MSD, Roche, Pierre Fabre, and Abbvie, all outside the submitted work; all remaining authors declare no competing interests. Funding Information: This study was supported by a grant from the Dutch Cancer Society , a non-profit organisation. The Dutch Cancer Society had no role in study design, data collection, data analysis, data interpretation or writing of the report. Publisher Copyright: © 2021 The Authors

PY - 2022/1

Y1 - 2022/1

N2 - 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 COVID-19 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.

AB - 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 COVID-19 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.

KW - Advanced care planning

KW - Cancer

KW - Cancer treatment

KW - COVID-19

KW - Treatment restrictions

U2 - 10.1016/j.ejca.2021.10.009

DO - 10.1016/j.ejca.2021.10.009

M3 - Article

AN - SCOPUS:85119334869

SN - 0959-8049

VL - 160

SP - 261

EP - 272

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

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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