Abstract PO-021: Impact of COVID-19 in continuity of cancer treatment for lung cancer patients
Authors: Calles Antonio , Alva Manuel , Aparicio Inmaculada , Soto Javier , Gutierrez Natalia , Bringas Marianela , Escudero Vicente , Collado Roberto , Galera Mar , Alvarez Rosa 
Published: December 2020

Abstract
Background: We aimed to analyze the impact on treatment delivery in patients with lung cancer during the COVID-19 pandemic and to describe the patterns of treatment change.
Methods: We accessed treatment records of all lung cancer patients treated from 02/20 to 06/20 at the oncology day hospital in our institution (HGUGM; Madrid, Spain). We have prospectively identified all COVID-19 lung cancer patients confirmed by SARS-CoV-2 RT-PCR and included all those on active treatment (&lt;30 days from last dose of any systemic therapy).
Results: A total of 242 patients with lung cancer were receiving active treatment as follows: chemotherapy (117 pts, 48%), immunotherapy (56 pts, 23%), targeted therapy (52 pts, 21%), chemo-immunotherapy (13 pts, 5%), radio-immuno-chemotherapy (4 pts, 2%). Intention of treatment was palliative in 84% vs. curative in 16% (28 pts on chemoradiation; 11 pts on adjuvant/neoadjuvant therapy). Median number of treatment lines was 1 (range 1-6). 11 patients had confirmed COVID-19 illness during active cancer treatment, and 5 patients died due to COVID-19. On average, 61 patients with lung cancer were treated per week before the pandemic. After an initial peak during the first week of pandemic, treatment delivery dropped by -62.2% four weeks after the first case confirmed in our institution (chemotherapy, -58.2%; immunotherapy, -72.6%; chemo-immunotherapy, -100.0%; targeted therapy, -59.0%) and came back to normal at week +7. Treatment interruption or dose delay was observed in 125 pts (28% temporal, 24% definitive). Overall, 23 patients refused to continue treatment due to fear or mobility restrictions due to the pandemic. Additionally, we identified doses skipped in 51 pts (21%), increase on dose intervals in 42 pts (17%), and dose reductions in 16 pts (7%). Route of administration remained the same for all pts but 1 (i.v. to oral). Although absolute use of G-CSF fell by -57.9% during the pandemic, tied to less administration of chemotherapy, the relative use of G-CSF increased in patients receiving chemotherapy-based treatments: G-CSF was initiated in 31 pts who were not previously receiving G-CSF, and expanded in days of use in 7 pts already on treatment. Telemedicine was used in 106/242 patients (44%) to minimize physical presence in the hospital. Drug home delivery system was initiated in 22 patients (9% of total), all of them on targeted therapy (representing 42% of all active patients on targeted therapy). Of the 32 patients who were receiving treatment in clinical trials (10 pts immunotherapy; 8 pts targeted therapy; 8 pts chemo-immunotherapy; 2 chemotherapy, 4 radio-chemo-immunotherapy), neither treatment delays nor COVID-19 illness was documented in any patient.
Conclusions: COVID-19 pandemic significantly modified treatment patterns in patients with lung cancer who were receiving active treatment. Measures were taken to reduce the number of visits to outpatient facilities, and treatment home delivery was facilitated when feasible.
Citation Format: Antonio Calles, Manuel Alva, Inmaculada Aparicio, Javier Soto, Natalia Gutierrez, Marianela Bringas, Vicente Escudero, Roberto Collado, Mar Galera, Rosa Alvarez. Impact of COVID-19 in continuity of cancer treatment for lung cancer patients [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-021.