癌症和 COVID-19 患者的延长生命治疗限制和结果：荷兰肿瘤 COVID-19 联盟的最新信息。
Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium.
机构信息
Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
出版信息
Eur J Cancer. 2022 Jan;160:261-272. doi: 10.1016/j.ejca.2021.10.009. Epub 2021 Oct 25.
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.
研究目的
2019 年冠状病毒病（COVID-19）大流行对癌症治疗产生了重大影响。本研究旨在研究癌症患者 COVID-19 结局和高级医疗计划方面与 COVID-19 相关的临床患者特征，具体涉及非肿瘤治疗限制（例如，不复苏代码）。
方法
荷兰肿瘤 COVID-19 联盟登记处于 2020 年 3 月在荷兰的 45 家医院启动，主要目的是确定癌症患者发生严重 COVID-19 结局的危险因素。在此，对该登记处进行了更新分析，并研究了癌症患者 COVID-19 结局与治疗限制（例如，不插管代码）之间的关系。未考虑肿瘤治疗限制。
结果
在 2020 年 3 月 27 日至 2021 年 2 月 4 日期间，登记了 1360 例患有 COVID-19 的癌症患者。可对 830 例患者的随访数据进行验证。总体而言，830 例患者中有 230 例（27.7%）死于 COVID-19，600 例 COVID-19 已解决的患者中有 60%住院。与其他实体瘤相比，患有血液恶性肿瘤或肺癌的患者有更高的致命结局风险。未发现抗癌治疗与致命 COVID-19 结局风险之间存在相关性。在临终关怀沟通方面，所有患者中有 50%对延长生命的治疗（例如，不插管代码）有限制。大多数确定有治疗限制的患者都有与致命 COVID-19 结局相关的危险因素。
结论
没有证据表明抗癌治疗对 COVID-19 结局有负面影响。作为高级医疗计划的一部分，及时进行临终关怀沟通可以使患者免受长时间的痛苦，并减少重症监护病房的负担。因此，应将治疗限制的早期讨论纳入常规肿瘤学护理，特别是在 COVID-19 大流行期间。
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