The Impact of COVID-19 on the Delivery of Systemic Anti-Cancer Treatment at Guy’s Cancer Centre

SIMPLE SUMMARY: Early reports during the pandemic stated that cancer patients were at increased risk of severe COVID-19 infection and mortality than non-cancer patients. However, delaying cancer treatment can cause worsening symptoms and shorten life expectancy. This study aimed to assess the outcome of cancer patients at our centre to help inform the optimal way to deliver cancer treatment during the COVID-19 pandemic. This study of over 4000 patients found that the delivery of cancer treatment in the first wave of the pandemic did not have a significantly negative effect on mortality. There were low COVID-19 infection (2%) and death rates (6%). As expected, there was a reduction in cancer treatments mainly in later lines of palliative treatments. This likely reflects patient and clinician choice around those more vulnerable patients. This data can be used to re-assure the continuation of cancer treatment during the pandemic. ABSTRACT: Background: This study aimed to assess the outcome of cancer patients undergoing systemic anti-cancer treatment (SACT) at our centre to help inform future clinical decision-making around SACT during the COVID-19 pandemic. Methods: Patients receiving at least one episode of SACT for solid tumours at Guy’s Cancer Centre between 1 March and 31 May 2020 and the same period in 2019 were included in the study. Data were collected on demographics, tumour type/stage, treatment type (chemotherapy, immunotherapy, biological-targeted) and SARS-CoV2 infection. Results: A total of 2120 patients received SACT in 2020, compared to 2449 in 2019 (13% decrease). From 2019 to 2020, there was an increase in stage IV disease (62% vs. 72%), decrease in chemotherapy (42% vs. 34%), increase in immunotherapy (6% vs. 10%), but similar rates of biologically targeted treatments (37% vs. 38%). There was a significant increase in 1st and 2nd line treatments in 2020 (68% vs. 81%; p < 0.0001) and reduction in 3rd and subsequent lines (26% vs. 15%; p = 0.004) compared to 2019. Of the 2020 cohort, 2% patients developed SARS-CoV2 infections. Conclusions: These real-world data from a tertiary Cancer Centre suggest that despite the challenges faced due to the COVID-19 pandemic, SACT was able to be continued without any significant effects on the mortality of solid-tumour patients. There was a low rate (2%) of SARS-CoV-2 infection which is comparable to the 1.4%-point prevalence in our total cancer population.