Author of

• 35041

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  P09 - Health Services Research/Health Economics - Real World Outcomes (ID 121)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Health Services Research/Health Economics
  • Presentations: 2
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 35057

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    P09.15 - Severity of Lung Cancer Disease in Hospitalized Patients During COVID-19 (ID 3373)

    00:00 - 00:00  |  Presenting Author(s): Laia Fernández-Mañas
    • Abstract
    • Slides

    Introduction
    

    Covid-19 pandemic has drastically changed the management of patients with cancer; however, there is still limited data regarding the real impact of Covid-19 on patient’s outcomes due to delayed diagnosis and treatment of clinical complications. We aimed to assess the prevalence, severity and mortality of clinical complications and oncology emergencies in hospitalized patients in our institution during the Covid19 period vs. the same period of 2019.

    Methods
    

    We conducted a retrospective study of patients with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) who were admitted to the Department of Medical Oncology during Jan-Jun 2019 (before-Covid) and Jan-Jun 2020 (Covid-19 period). Clinical, pathological and biological data were collected. We assessed the clinical severity in both periods including: PS at admission, progression disease (PD), oncologic emergencies (%), start of a systemic therapy or switch to other therapy line. We also analyzed the differences on the 30-day mortality rate since hospitalization between both periods.

    Results
    

    229 admissions, 133 during and 93 before Covid-19 pandemic (N=180 patients) were enrolled; the median duration of the hospitalization was 9 days (4-16). Median age was 66 years, 35% were female, 88% with PS≥2, 27% were current smokers; 83% had NSCLC histology. Most of them (82%) had advanced disease at admission; 69% were under systemic therapy (chemotherapy 39%, immunotherapy 17%, targeted therapies 11%). Nine patients (4%) were active covid-19 cases (9 NSCLC, 0 SCLC).

    The table 1 summarized the most common clinical conditions by histology, in both periods.

    In NSCLC population, during-Covid, lower rate of admissions were observed (4 cases less per month), with no increase of oncologic emergencies. The PD during hospitalization was slightly higher during vs. before-Covid, but no differences were observed in 30-days mortality rate.

    In SCLC population, during-Covid, the rate of admissions was doubled (2 cases more per month), with more cases progressing during the hospitalization. (46% during vs. 34% before-Covid). In contrast to NSCLC, the 30-days mortality rate was higher during-Covid (38%) vs. before-Covid (20%). Updated data will be presented in the meeting.

    	NSCLC (N= 190)		SCLC (N= 39)
    	During-Covid (2020) N=83 (44%)	Before-Covid (2019) N=107 (52%)	During-Covid (2020) N=13 (33%)	Before-Covid (2019) N=26 (67%)
    Baseline characteristics
    Main reason of hospitalization Dyspnea Fever Pain Neurological symptoms Others	27 (33%) 20 (24%) 9 (11%) 11 (13%) 16 (19%)	26 (24%) 22 (21%) 16 (15%) 20 (17%) 23 (23%	3 (23%) 3 (23%) 1 (8%) 4 (30%) 2 (16%)	11 (42%) 2 (8%) 1 (4%) 6 (23%) 6 (23%)
    PS at admission 0-1 ≥2	1 (1%) 82 (99%)	22 (21%) 82 (79%)	0 (0%) 13 (100%)	3 (12%) 23 (88%)
    Stage at admission Locally Locally advanced Advanced	7 (8%) 7 (8%) 69 (84%)	7 (7%) 9 (8%) 90 (85%)	0 (0%) 4 (30%) 9 (70%)	2 (8%) 4 (15%) 20 (77%)
    N# mets. Sites at admission ≤2 >2	55 (67%) 28 (33%)	64 (60%) 43 (40%)	8 (62%) 5 (38%)	14 (54%) 12 (46%)
    Line of therapy (only advanced disease) 0-1 ≥2	55 (65%) 28 (35%)	69 (64%) 38 (36%)	10 (76%) 3 (23%)	21 (81%) 5 (19%)
    Disease severity
    N# Admissions	N= 83 (14 per month)	N=107 (18 per month)	N=26 (4 per month)	N=13 (2 per month)
    N# Readmissions	21 (25%)	22 (21%)	1 (8%)	5 (19%)
    Median duration of hospitalization (range)	8(1;47)	10(1;104)	8(1;22)	9(1;67)
    Oncology Emergencies Yes No	8 (10%) 75 (90%)	22 (20%) 85 (80%)	1 (8%) 12 (92%)	7 (27%) 19 (73%)
    Progression during hospitalization Yes No	32 (39%) 51 (61%)	35 (32%) 72 (68%)	6 (46%) 7 (54%)	9 (34%) 17 (66%)
    Early death (30-days mortality rate) Yes No	20 (24%) 63 (76%)	22 (21%) 84 (79%)	5 (38%) 8 (62%)	5 (20%) 20 (80%)

    Conclusion
    

    We preliminary observed more aggressive disease with worse outcomes in patients with SCLC hospitalized during-Covid compared to the same period in 2019. No differences were observed in NSCLC. The final outcomes will be assessed in a larger and mature cohort still ongoing.

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  • 35076

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    P09.28 - Access to Intermediate and Intensive Care for Patients With Lung Cancer During the COVID-19 Period (ID 3419)

    00:00 - 00:00  |  Author(s): Laia Fernández-Mañas
    • Abstract
    • Slides

    Introduction
    

    COVID-19 pandemic has dramatically impacted the health national systems, interfering with the access to standard care of other illnesses. However, the real impact of COVID-19 crisis on the cancer care remains unknown. We assessed the access to invasive procedures and critically ill patient units (intensive and intermediate care) in patients with lung cancer hospitalized during pandemic period (during-Covid) compared to the same period in 2019 (before-Covid).

    Methods
    

    Single-center retrospective study of lung cancer patients hospitalized before (Jan-Jun.2019) and during-Covid (Jan-Jun.2020). Clinical data, access to care and interventions were collected. Patients were also classified in 3 groups according to an estimated life expectancy (based on stage, histology, molecular profile and line-therapy): favorable group (FG) with median (m) overall survival (OS) >5 years, intermediate (IG) 1-5 years and poor (PG) <1 year. We primarily compared the number of admissions to intensive and intermediate-unit care (ICU and intermCU respectively), between both periods, and then stratified by prognostic group. We also assessed the invasive procedures in each period.

    Results
    

    229 admissions were registered (N=180 patients). Median age was 66 years, 64% were male, 67% with Performance status ≥2; 83% had non-small cell lung cancer and median length of stay was 9 days (1-104). Most of them (82%) had advanced disease; 63% were under systemic therapy. By prognostic groups: 17 patients were considered FG (7%), 161 as IG (70%) and 51 as PG (22%). Nine patients were admitted due to active COVID-19 infection.

    The table 1 summarized the clinical characteristics and interventions in both periods.

    During-Covid, only 2% (n=2) of patients was admitted in ICU vs. 6% (n=8) before-Covid, although, no differences were observed in access to intermCU. The number of invasive interventions was also lower (15%, n=15) vs. before-Covid (33%, n=43).

    By prognostic: 20% of patients in FG (n=2) and 9% in IG (n=6) were admitted to ICU/intermCU during Covid vs. none FG cases and 9% in IG (n=8) before-Covid. In contrast, in the PG lower admissions were observed during-Covid (6%, n=1) vs. before-Covid (20%, n=7)

    With a mOS since date of hospitalization of 3.3 months (95% CI 2.6-4.8), the 30-days-mortality rate was 23% overall; slightly higher during (26%) vs. before-Covid (20%). Updated data will be presented in the meeting.

    	During-Covid (2020) (N, %)	Before-Covid (2019) (N, %)
    Baseline characteristics
    Admissions	N=96 (16 per month)	N=133 (21 per month)
    Sex Female Male	42 (44%) 54 (56%)	40 (30%) 93 (70%)
    Age <65 years >65 years	48 (50%) 48 (50%)	59 (44%) 74 (56%)
    Performance Status at admission 0-1 ≥2	1 (1%) 95 (99%)	25 (19%) 105 (81%)
    Stage at admission Locally Locally advanced Advanced	9 (9%) 13 (14%) 74 (77%)	8 (6%) 11 (8 %) 114 (86%)
    Number of metastasis sites at admission ≤2 >2	69 (72%) 27 (28%)	72 (54%) 61 (46%)
    Line of therapy (only advanced disease) 0-1 ≥2	65 (68%) 31 (32%)	90 (68%) 43 (32%)
    Prognostic groups Favorable (FG) Intermediate (IG) Poor group (PG)	10 (10%) 70 (73%) 16 (17%)	7 (5%) 91 (69%) 35 (26%)
    Access to care
    Intermediate Care Yes No	7 (7%) 89 (93%)	7 (5%) 126 (95%)
    Invasive Care Yes No	2 (2%) 94 (98%)	8 (6%) 125 (94%)
    N# Invasive interventions (e.g. pleural, pericardial punction…)	14 (14%)	38 (29%)
    Elective procedures	1 (1%)	5 (4%)

    Conclusion
    

    The access to critically ill patient units and invasive interventions for lung cancer patients seems to have been affected during-Covid vs. same period in 2019. The impact on outcomes will be assessed in a larger cohort ongoing.

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