Department of Medical Oncology, Stanford University, Stanford, CA.
Department of Medical Oncology, University of California, San Francisco, San Francisco, CA.
JCO Oncol Pract. 2021 Mar;17(3):e377-e385. doi: 10.1200/OP.20.00790. Epub 2020 Dec 17.
The response to the COVID-19 pandemic has affected the management of patients with cancer. In this pooled retrospective analysis, we describe changes in management patterns for patients with cancer diagnosed with COVID-19 in two academic institutions in the San Francisco Bay Area.
Adult and pediatric patients diagnosed with COVID-19 with a current or historical diagnosis of malignancy were identified from the electronic medical record at the University of California, San Francisco, and Stanford University. The proportion of patients undergoing active cancer management whose care was affected was quantified and analyzed for significant differences with regard to management type, treatment intent, and the time of COVID-19 diagnosis. The duration and characteristics of such changes were compared across subgroups.
A total of 131 patients were included, of whom 55 were undergoing active cancer management. Of these, 35 of 55 (64%) had significant changes in management that consisted primarily of delays. An additional three patients not undergoing active cancer management experienced a delay in management after being diagnosed with COVID-19. The decision to change management was correlated with the time of COVID-19 diagnosis, with more delays identified in patients treated with palliative intent earlier in the course of the pandemic (March/April 2020) compared with later (May/June 2020) (OR, 4.2; 95% CI, 1.03 to 17.3; = .0497). This difference was not seen among patients treated with curative intent during the same timeframe.
We found significant changes in the management of cancer patients with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.
对 COVID-19 大流行的应对措施影响了癌症患者的管理。在这项汇总回顾性分析中，我们描述了在旧金山湾区的两个学术机构中，诊断患有 COVID-19 的癌症患者的管理模式的变化。
从加利福尼亚大学旧金山分校和斯坦福大学的电子病历中确定了患有 COVID-19 且目前或既往患有恶性肿瘤的成年和儿科患者。量化了正在接受积极癌症治疗且其治疗受到影响的患者比例，并根据治疗类型、治疗目的以及 COVID-19 诊断时间对其进行了分析。比较了这些变化在亚组之间的持续时间和特征。
共纳入 131 例患者，其中 55 例正在接受积极的癌症治疗。其中，55 例中有 35 例（64%）的治疗管理发生了重大变化，主要表现为延迟。另外 3 例未接受积极癌症治疗的患者在诊断为 COVID-19 后也经历了治疗管理的延迟。改变管理决策与 COVID-19 诊断时间相关，在大流行早期（2020 年 3 月/4 月）接受姑息治疗的患者中发现更多的延迟（OR，4.2；95%CI，1.03 至 17.3； =.0497）。在同一时间段内接受根治性治疗的患者中并未观察到这种差异。
我们发现，对 COVID-19 合并癌症患者的管理发生了重大变化，且这些变化随时间而演变。未来的研究需要确定管理和治疗变化对 COVID-19 合并癌症患者的癌症结局的影响。
