Audit of chemotherapy disruption due to covid19 pandemic
Authors: H. Ahmad, A. Ahmad, M. Iqbal, L. Carter, I. Khan, H. Hambleton, A. Razzak
Journal: HemaSphere (2021)

PERSPECTIVE FROM A UK DISTRICT GENERAL HOSPITAL Background: Patients with cancer undergoing systemic chemotherapy have been postulated to be at increased risk of mortality from COVID- 19. Given this proposed risk, NICE issued COVID-19 rapid guidelines for safe delivery of systemic chemotherapy in March 2020. Based on this guidance local and regional guidelines were established. Aims: The primary objective of this audit was to assess the impact of COVID-19 on patients undergoing systemic chemotherapy and their outcomes at Queen's Hospital Burton. Methods: 115 patients undergoing active chemotherapy were identified using local records of chemotherapy administration. Retrospective data collection and analysis of these patients was undertaken from March 2020 to December 2020. Results: Patients with a diagnosis of Myeloma (36%) who had a stable disease (42%) had treatment either delayed or suspended during the first wave. Bisphosphonate treatment in 12 out of 14 patients was stopped who already completed the anti-myeloma treatment. Similarly for lymphoma patients, maintenance immunotherapy with Rituximab (6) and Obinutuzumab (3) were suspended or stopped in all cases. Other patients with aggressive Lymphomas, CML, High risk MDS/AML and those with advanced CLL either continued with their treatment or new therapy was started as clinically appropriate. In total, 31 patients had chemotherapy delayed or stopped completely. Only 2 patients on maintenance Rituximab had disease progression. COVID-19 was detected in 9 patients and sadly 4 patients passed away with COVID-19 related complications. Among these were 2 patients on Ruxolitinib, one on VMP lite and 1 on Zometa without chemotherapy at the time. Following the first wave of COVID-19, of the 31 patients 29 were re-commenced on chemotherapy. No patients on high dose chemotherapy had an increase in morbidity and mortality. Summary/Conclusion: The impact of COVID-19 and systemic anticancer therapies is poorly described and based on limited small cohort studies. A few of these studies concluded that cancer patients are not only at risk to contract the virus but also at risk of developing more severe complications as compared with the general population. The UK CORONAVIRUS CANCER MONITORING PROJECT (UKCCMP), serving as a public health surveillance registry, concluded that cytotoxic chemotherapy within 4 weeks before confirmed COVID-19 is not a significant contributor to more severe disease, or a predictor of death from COVID-19, compared with cancer patients who have not received chemotherapy in that period. Again, this analysis was based on small data sets. Our audit also confirms the findings of UKCCMP and shows no significant increased risk in mortality in patients both on active chemotherapy and where chemotherapy was temporarily stopped. The overall risks and benefits of continuing or holding chemotherapy need to be discussed in details with patients. Withholding anti-cancer therapies may well present a greater individual risk of morbidity and mortality than COVID-19. Further studies are required to assess the impact of COVID- 19 on morbidity and mortality, to better inform these discussions. Whilst these factors become clearer, additional measures within our practice have aimed to ensure safe patient care in this new environment. These included telephonic and video consultations, home delivery of oral chemotherapy and blood monitoring at local GP surgeries to avoid hospital exposures.