Impact of COVID-19 in continuity of cancer treatment for lung cancer patients

Background: We aimed to analyze the impact on treatment delivery in patients with lung cancer during the COVID-19 pandemic and to describe the patterns of treatment change Methods: We accessed treatment records of all lung cancer patients treated from 02/20 to 06/20 at the oncologyday hospital in our institution (HGUGM;Madrid, Spain) We have prospectively identified all COVID-19 lung cancerpatients confirmed by SARS-CoV-2 RT-PCR and included all those on active treatment (<30 days from last dose ofany systemic therapy) Results: A total of 242 patients with lung cancer were receiving active treatment as follows: chemotherapy (117 pts,48%), immunotherapy (56 pts, 23%), targeted therapy (52 pts, 21%), chemo-immunotherapy (13 pts, 5%), radio-immuno-chemotherapy (4 pts, 2%) Intention of treatment was palliative in 84% vs curative in 16% (28 pts onchemoradiation;11 pts on adjuvant/neoadjuvant therapy) Median number of treatment lines was 1 (range 1-6) 11patients had confirmed COVID-19 illness during active cancer treatment, and 5 patients died due to COVID-19 Onaverage, 61 patients with lung cancer were treated per week before the pandemic After an initial peak during thefirst week of pandemic, treatment delivery dropped by -62 2% four weeks after the first case confirmed in ourinstitution (chemotherapy, -58 2%;immunotherapy, -72 6%;chemo-immunotherapy, -100 0%;targeted therapy,-59 0%) and came back to normal at week +7 Treatment interruption or dose delay was observed in 125 pts (28%temporal, 24% definitive) Overall, 23 patients refused to continue treatment due to fear or mobility restrictions dueto the pandemic Additionally, we identified doses skipped in 51 pts (21%), increase on dose intervals in 42 pts(17%), and dose reductions in 16 pts (7%) Route of administration remained the same for all pts but 1 (i v to oral) Although absolute use of G-CSF fell by -57 9% during the pandemic, tied to less administration of chemotherapy, the relative use of G-CSF increased in patients receiving chemotherapy-based treatments: G-CSF was initiated in31 pts who were not previously receiving G-CSF, and expanded in days of use in 7 pts already on treatment Telemedicine was used in 106/242 patients (44%) to minimize physical presence in the hospital Drug home deliverysystem was initiated in 22 patients (9% of total), all of them on targeted therapy (representing 42% of all activepatients on targeted therapy) Of the 32 patients who were receiving treatment in clinical trials (10 ptsimmunotherapy;8 pts targeted therapy;8 pts chemo-immunotherapy;2 chemotherapy, 4 radio-chemo-immunotherapy), neither treatment delays nor COVID-19 illness was documented in any patient Conclusions: COVID-19 pandemic significantly modified treatment patterns in patients with lung cancer who werereceiving active treatment Measures were taken to reduce the number of visits to outpatient facilities, and treatmenthome delivery was facilitated when feasible