Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective
Authors: Soosaipillai Gehan , Wu Anjui , Dettorre Gino M , Diamantis Nikolaos , Chester John , Moss Charlotte , Aguilar-Company Juan , Bower Mark , Sng Christopher CT , Salazar Ramon , Brunet Joan , Jones Eleanor , Mesia Ricard , Jackson Amanda , Mukherjee Uma , Sita-Lumsden Ailsa , Seguí Elia , Ottaviani Diego , Carbó Anna , Benafif Sarah , Würstlein Rachel , Carmona Carme , Chopra Neha , Cruz Claudia Andrea , Swallow Judith , Saoudi Nadia , Felip Eudald , Galazi Myria , Garcia-Fructuoso Isabel , Lee Alvin J. X. , Newsom-Davis Thomas , Wong Yien Ning Sophia , Sureda Anna , Maluquer Clara , Ruiz-Camps Isabel , Cabirta Alba , Prat Aleix , Loizidou Angela , Gennari Alessandra , Ferrante Daniela , Tabernero Josep , Russell Beth , Van Hemelrijck Mieke , Dolly Saoirse , Hulbert-Williams Nicholas J , Pinato David J , Mollà Meritxell , Reyes Roxana , Marco-Hernández Javier , Bruna Riccardo , Biello Federica , Patriarca Andrea , Zambelli Alberto , Tondini Carlo , Fotia Vittoria , Chiudinelli Lorenzo , Franchi Michela , Generali Daniele , Grisanti Salvatore , Tovazzi Valeria , Bertuzzi Alexia , Marrari Andrea , Seeva Pavetha , Dileo Palma , Rizzo Gianpiero , Libertini Michela , Maconi Antonio , Betti Marta , Provenzano Salvatore , Harbeck Nadia , Vincenzi Bruno , Bertulli Rossella , Liñan Raquel , Roqué Ariadna , Mirallas Oriol , García-Illescas David , Scotti Lorenza , Dalla Pria Alessia , D’Avanzo Francesca , Martinez Maria , Evans Joanne S , Sharkey Rachel , Rimassa Lorenza , Santoro Armando , Gaidano Gianluca , Izuzquiza Macarena 
Published: September 2021

Background: Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. Methods: From the OnCovid repository ( N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT− not referred). Results: Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more ‘Do not attempt cardio-pulmonary resuscitation’ orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. Conclusion: SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.