Abstract P19: Systemic anticancer treatment changes at the start of the COVID-19 pandemic in a large Australian metropolitan health service
Authors: Liow Elizabeth , McLaren Cameron , Tipping-Smith Samuel , Latham Sarah , Kong Jun Beng , Lam Marissa , Lum Caroline , Body Amy , Briggs Peter , Segelov Eva 
Published: March 2021

Abstract
Background The COVID-19 pandemic has necessitated a restructuring of cancer care due to resourcing demands and revised risk-benefit considerations which relate the risks of cancer progression with the risks of COVID-19 related morbidity and mortality. Specific treatment adjustments for individual patients have not been widely reported. The impact of treatment changes on the outcome of cancer patients have also not been well documented. We report the experience of a large Australian metropolitan multisite cancer service that undertook proactive review of systemic anti-cancer therapy (SACT) of all patients in response to the pandemic. The aim was to re-balance the risks and benefits of current treatment strategies in light of the pandemic. Method From March-April 2020, all current SACT orders (excluding those related to clinical trials) were reviewed by an independent team of clinicians. Patients on curative therapy, or with large perceived benefit were reviewed but not included in further processing. For all other SACT orders, a documented recommendation regarding planned treatment was sent to the patient's individual clinician for consideration. A categorical assessment of the recommendations is presented. Results 570 SACT orders were reviewed, pertaining to 317 patients. 731 individual recommendations were made. The cohort consisted of 130 males and 187 females, with a median age of 62 years. Treatment was undertaken with curative intent in 38% of patients, while 62% of patients were treated with palliative intent. Distribution by tumour types was typical of epidemiology and casemix of a metropolitan oncology service. The most frequent recommendations made by the independent review team were: no change (23%), change in formulation of same drug (9%), shorten duration of treatment (9%), treatment break (8%), re-evaluate benefit of current treatment (8%), treatment cessation (7%), and referral for home-based treatment (6%). Overall, 71% of recommendations of the review team were accepted by the patient’s individual clinician. A variation to recommendations suggested by the review team was implemented for 8% of SACT orders. Recommendations which were not implemented were mostly initiated by the patient’s individual clinician (70%), while 14% were due to patient choice. Conclusion This is the only dataset known to date of the impact of COVID-19 on adjustments of SACT for cancer patients at the start of the pandemic in Australia, and provides key insights into discrete adjustments made for cancer patients. The majority of patients underwent modifications in their cancer therapy made in the context of competing risks to their health posed by COVID-19.
Citation Format: Elizabeth Liow, Cameron McLaren, Samuel Tipping-Smith, Sarah Latham, Jun Beng Kong, Marissa Lam, Caroline Lum, Amy Body, Peter Briggs, Eva Segelov. Systemic anticancer treatment changes at the start of the COVID-19 pandemic in a large Australian metropolitan health service [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P19.