A multidisciplinary meeting (MDM) is mandatory in France for decision-making as regards to patients with cancer. A weekly MDM is held in the medical oncology department of Bordeaux University Hospital (Bx CHU) to decide the indications for medical treatment.
Owing to the coronavirus disease (COVID) epidemic in France, recommendations have been published [1] . Quarantine started on March 17 th , 2020. The Nouvelle-Aquitaine region which includes Bx CHU is less affected than other regions of France. To minimize the loss of chance for patients with cancer, we have organized our MDMs in accordance with the French guidelines. To assess the impact of decisions, we prospectively looked at three successive weekly MDMs held since March 19th. Our main fields of expertise are genitourinary, lung, head/neck, brain and breast/gynaecological tumours.
Ninety-eight successive medical files were discussed at three MDMs. The majority of patients (98%) were within our areas of expertise and there was a palliative intent (89$8%). Discussion was based on criteria proposed as guidelines for France [1] . Finally, the position of the patients was considered in the context of the COVID epidemic. The proposal for treatment was recorded in real-time during the MDM, and if any, as having been impacted by the COVID epidemic.
From discussions regarding curative treatment for ten patients (Table 1a) , the proposals were: standard treatment for five patients, an option considered not affecting survival for 1 patient, a delay in surveillance considered as not affecting survival for one patient. The decision was considered as potentially impacting tumour growth or symptoms but having a limited impact, if any, on overall survival for three patients: one patient e 76-years-old with a laryngeal carcinoma was planned for radiotherapy excluding cetuximab; one patient e 62years-old with an urothelial upper tract carcinoma refused adjuvant chemotherapy due to COVID and one patient e 61-years-old with an isolated peritoneal ovarian carcinoma was postponed for radical surgery. Therefore, the decision for 50% of patients to have curative treatment was modified by the COVID epidemic.
From MDM discussions for 88 patients at a palliative state (Table 1b) , proposals were: standard treatment for 38 patients (43$2%), an option considered not affecting survival for 13 patients (14$7%), a delay, a pause in treatment or a delay in surveillance considered as not affecting survival for 14 patients (15$9%). The decision was considered as potentially impacting tumour growth or symptoms by delaying treatment for at least 2e3 months or stopping specific treatment, not symptomatic treatment, but having a limited impact, if any, on overall survival for eight patients (9$1%). In addition, a decision for unspecific palliative treatment only was proposed for 15 patients (17%) but not affected by the COVID epidemic. Therefore, the decision regarding palliative treatment for 39$8% of those patients was modified by the COVID epidemic. Patients in first-line metastatic treatment had more chance of receiving a standard treatment or an option of the standard (62$7%) than patients in later lines (45$4%). Patients with aggressive brain tumours or lung carcinoma could nevertheless be affected in first-line for palliative treatment only.
During MDMs, the main discussions concerning proposals were based on comorbidities, therapeutic balance rather than age, as the pressure for access to beds or ICUs was lower than in other regions.
No patient with COVID þ has been hospitalized in our department, considered to be protected, since the outbreak of the epidemic in our region.
Our study is the first to be published regarding the impact on decision-making after the COVID epidemic. Our department is unique in two ways e it has patients with different tumour types for whom medical files are discussed during the same MDM as for medical treatment. This offers an equity in decision-making between patients e type of population, comorbidities, expected therapeutic balance and/or anticipated survival which differs when compared with MDMs dealing with a specific tumour type only; e being part of a large University Hospital dealing with all diseases, forced to anticipate the impact of our decision to start treatment or to expose patients to side effects that could impair processes in our institution (access to beds, units, ICU, medical or nursing staff availability).
In addition, our study provides information for departments which anticipate a risk of being overwhelmed in a few weeks compared with more difficult decisions that have been taken in regions where the COVID epidemic has been widely spread [1e3] .
Depending on the increase in the COVID epidemic in Nouvelle-Aquitaine, guidelines will be adapted in accordance with the prospective study.
In conclusion, even in less affected region, decision during MDM owing to the COVIC epidemic were impacted up to 40e50%, mainly by modifying the standard with expected limited impact on specific survival.
Nothing declared.