Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

Karlijn de Joode; Jolien Tol; Paul Hamberg; Marissa Cloos; Elisabeth A Kastelijn; Jessica S W Borgers; Veerle J A A Nuij; Yarne Klaver; Gerarda J M Herder; Pim G N J Mutsaers; Daphne W Dumoulin; Esther Oomen-de Hoop; Nico G J van Diemen; Eduard J Libourel; Erica J Geraedts; Gerben P Bootsma; Cor H van der Leest; Anne L Peerdeman; Karin H Herbschleb; Otto J Visser; Haiko J Bloemendal; Hanneke W M van Laarhoven; Elisabeth G E de Vries; Lizza E L Hendriks; Laurens V Beerepoot; Hans M Westgeest; Franchette W P J van den Berkmortel; John B A G Haanen; Anne-Marie C Dingemans; Astrid A M van der Veldt; DOCC investigators

doi:10.1016/j.ejca.2021.10.009

Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

Eur J Cancer. 2022 Jan:160:261-272. doi: 10.1016/j.ejca.2021.10.009. Epub 2021 Oct 25.

Authors

Karlijn de Joode¹, Jolien Tol², Paul Hamberg³, Marissa Cloos⁴, Elisabeth A Kastelijn⁵, Jessica S W Borgers⁶, Veerle J A A Nuij², Yarne Klaver⁷, Gerarda J M Herder⁸, Pim G N J Mutsaers⁹, Daphne W Dumoulin¹⁰, Esther Oomen-de Hoop¹, Nico G J van Diemen¹¹, Eduard J Libourel¹², Erica J Geraedts¹³, Gerben P Bootsma¹⁴, Cor H van der Leest¹⁵, Anne L Peerdeman¹¹, Karin H Herbschleb¹⁶, Otto J Visser¹⁷, Haiko J Bloemendal¹⁸, Hanneke W M van Laarhoven¹⁹, Elisabeth G E de Vries²⁰, Lizza E L Hendriks²¹, Laurens V Beerepoot⁷, Hans M Westgeest²², Franchette W P J van den Berkmortel²³, John B A G Haanen⁶, Anne-Marie C Dingemans¹⁰, Astrid A M van der Veldt²⁴; DOCC investigators

Collaborators

DOCC investigators:
A Becker-Commissaris²⁵, F Terheggen²⁶, B E E M van den Borne²⁷, L J C van Warmerdam²⁸, L van Leeuwen²⁹, F S van der Meer³⁰, M A Tiemessen³¹, D M van Diepen³¹, L Strobbe³², J A F Koekkoek³³, P Brocken³⁴, J C Drooger³⁵, R Heller³⁶, J W B de Groot³⁷, J A Stigt³⁸, C C M Pitz³⁹, M Slingerland⁴⁰, F J Borm⁴¹, B C M Haberkorn⁴², S C van 't Westeinde⁴³, M J B Aarts⁴⁴, J W G van Putten⁴⁵, M Youssef⁴⁶, G A Cirkel⁴⁷, C R van Rooijen⁴⁸, E Citgez⁴⁹, N P Barlo⁵⁰, B M J Scholtes⁵¹, R H T Koornstra⁵², N J M Claessens⁵³, L M Faber⁵⁴, C H Rikers⁵⁵, R A W van de Wetering⁵⁶, G L Veurink⁵⁷, B W Bouter⁵⁸, I Houtenbos⁵⁹, M P L Bard⁶⁰, G Douma⁶¹, M Jalving²⁰, T J N Hiltermann⁶², O C J Schuurbiers-Siebers⁶³, K P M Suijkerbuijk⁶⁴, A S R van Lindert⁶⁵, A J van de Wouw⁶⁶, V E M van den Boogaart⁶⁷, S D Bakker⁶⁸, E Looysen⁶⁹, W K de Jong⁷⁰, E J M Siemerink⁷¹, A J Staal⁷², B Franken⁷³, W H van Geffen⁷⁴

Affiliations

¹ Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
² Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
³ Department of Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
⁴ Department of Internal Medicine, Groene Hart Hospital, Gouda, the Netherlands.
⁵ Department of Pulmonology, St. Antonius Hospital Utrecht/Nieuwegein, Utrecht, the Netherlands.
⁶ Department of Medical Oncology, Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
⁷ Department of Internal Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands.
⁸ Department of Pulmonary Medicine, Meander Medical Center, Amersfoort, the Netherlands.
⁹ Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
¹⁰ Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
¹¹ Department of Internal Medicine, Bernhoven, Uden, the Netherlands.
¹² Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
¹³ Department of Pulmonology, Groene Hart Hospital, Gouda, the Netherlands.
¹⁴ Department of Pulmonology, Zuyderland Medical Center, Heerlen, the Netherlands.
¹⁵ Department of Pulmonology, Amphia Hospital, Breda, the Netherlands.
¹⁶ Department of Internal Medicine, St. Antonius Hospital Utrecht/Nieuwegein, Utrecht, the Netherlands.
¹⁷ Department of Hematology, Isala Hospital, Zwolle, the Netherlands.
¹⁸ Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁹ Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
²⁰ Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
²¹ Department of Pulmonary Diseases GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
²² Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands.
²³ Department of Internal Medicine, Zuyderland Medical Center, Sittard-Geleen, the Netherlands.
²⁴ Department of Medical Oncology and Department of Radiology & Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands. Electronic address: a.vanderveldt@erasmusmc.nl.
²⁵ Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
²⁶ Department of Internal Medicine, Bravis Hospital, Bergen op Zoom, the Netherlands.
²⁷ Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, the Netherlands.
²⁸ Department of Internal Medicine, Catharina-Hospital, Eindhoven, the Netherlands.
²⁹ Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands.
³⁰ Department of Pulmonology, Diakonessenhuis, Utrecht, the Netherlands.
³¹ Department of Pulmonology, Dijklander Hospital, Purmerend, the Netherlands.
³² Department of Internal Medicine, Gelre Hospital, Zutphen, the Netherlands.
³³ Departments of Neurology, Haaglanden Medical Center and Leiden University Medical Center, Den Haag, Leiden, the Netherlands.
³⁴ Department of Pulmonary Diseases, Haga Ziekenhuis, Den Haag, the Netherlands.
³⁵ Department of Medical Oncology, Ikazia Hospital, Rotterdam, the Netherlands.
³⁶ Department of Pulmonology, Ikazia Hospital, Rotterdam, the Netherlands.
³⁷ Department of Medical Oncology, Isala Oncology Center, Zwolle, the Netherlands.
³⁸ Department of Respiratory Medicine, Isala Hospital, Zwolle, the Netherlands.
³⁹ Department of Pulmonology, Laurentius Hospital, Roermond, the Netherlands.
⁴⁰ Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
⁴¹ Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands.
⁴² Department of Medical Oncology, Maasstad Hospital, Rotterdam, the Netherlands.
⁴³ Department of Pulmonology, Maasstad Hospital, Rotterdam, the Netherlands.
⁴⁴ Division of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.
⁴⁵ Department of Pulmonary Diseases, Martini Hospital, Groningen, the Netherlands.
⁴⁶ Department of Respiratory Medicine, Máxima Medical Center, Veldhoven, the Netherlands.
⁴⁷ Department of Internal Medicine, Meander Medical Center, Amersfoort, the Netherlands.
⁴⁸ Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
⁴⁹ Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
⁵⁰ Department of Respiratory Medicine, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
⁵¹ Department of Internal Medicine, Maasziekenhuis Pantein, Beugen, the Netherlands.
⁵² Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, the Netherlands.
⁵³ Department of Respiratory Medicine, Rijnstate Ziekenhuis, Arnhem, the Netherlands.
⁵⁴ Department of Internal Medicine, Rode Kruis Hospital, Beverwijk, the Netherlands.
⁵⁵ Department of Pulmonology, Rode Kruis Hospital, Beverwijk, the Netherlands.
⁵⁶ Department of Internal Medicine, Slingeland Hospital, Doetinchem, the Netherlands.
⁵⁷ Department of Medical Oncology, Saxenburgh, Hardenberg, the Netherlands.
⁵⁸ Department of Pulmonology, Saxenburgh, Hardenberg, the Netherlands.
⁵⁹ Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands.
⁶⁰ Department of Pulmonology, Spaarne Gasthuis, Haarlem, the Netherlands.
⁶¹ Department of Pulmonary Diseases, Treant Zorggroep, Scheper Hospital, Emmen, the Netherlands.
⁶² Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁶³ Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
⁶⁴ Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
⁶⁵ Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
⁶⁶ Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands.
⁶⁷ Department of Respiratory Medicine, VieCuri Medical Center Venlo, the Netherlands.
⁶⁸ Department of Internal Medicine, Zaans Medical Center, Zaandam, the Netherlands.
⁶⁹ Department of Pulmonology, Zaans Medical Center, Zaandam, the Netherlands.
⁷⁰ Department of Pulmonology, Hospital Gelderse Vallei, Ede, the Netherlands.
⁷¹ Department of Internal Medicine, Ziekenhuis Groep Twente (ZGT), Hengelo, the Netherlands.
⁷² Department of Pulmonary Diseases, Ziekenhuis Groep Twente (ZGT), Hengelo, the Netherlands.
⁷³ Department of Hematology, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
⁷⁴ Department of Respiratory Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands.

Abstract

Aim of the study: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do-not-resuscitate codes), were studied in patients with cancer and COVID-19.

Methods: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID-19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account.

Results: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life-prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome.

Conclusion: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic.

Keywords: Advanced care planning; COVID-19; Cancer; Cancer treatment; Treatment restrictions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
COVID-19 / epidemiology
COVID-19 / mortality*
COVID-19 / therapy
COVID-19 / virology
Female
Hospitalization / statistics & numerical data*
Humans
Life Support Care / statistics & numerical data*
Male
Middle Aged
Mortality / trends*
Neoplasms / epidemiology
Neoplasms / mortality*
Neoplasms / therapy
Neoplasms / virology
Netherlands / epidemiology
Prognosis
Risk Factors
SARS-CoV-2 / isolation & purification*
Survival Rate
Withholding Treatment / statistics & numerical data*