Pandemic Altered Treatment Plans for Patients With Lung Cancer, Study Finds

A recent study evaluated the changes in treatment of non–small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) during the coronavirus disease 2019 (COVID-19) pandemic and found that more than half of the patients experienced changes in their treatment plan.

The authors of the Research Letter, published Thursday in JAMA Oncology, noted that patients with cancer, particularly those with lung cancer, have higher mortality rates from COVID-19. Oncology practices have changed how they deliver care over the past few months in an effort to limit exposure for vulnerable patients, but the extent and type of these changes are not known.

The authors used the medical records of all patients seen in the thoracic oncology clinic at the McGill University Health Centre (MUHC) between March 2 and May 30, 2020. Besides looking at the extent of treatment changes, they also wanted to know what types of changes occurred. The changes came from the record itself and not inferred, the authors wrote.

A total of 289 patients were included; after excluding 14 patients because of the presence of other tumors or being COVID-19 positive, 275 were included in the analysis. The median age of the patient was 68 and 52.7% were female.

Among the 238 patients (86.5%) with NSCLC, 172 (62.5%) had stage IV disease; adenocarcinomas were the largest category of NSCLC. Among the 37 patients (13.5%) with SCLC, 11 (4%) had extensive disease.

The results showed that most of the changes to cancer treatment plans happened between April 26 and May 19, 2020, which represented the pandemic’s height in Canada.

Of the 211 patients on active treatment, 121 (57%) patients experienced at least 1 change in their lung cancer treatment plan, and 19 patients (9%) had more than 1 change.

The area most affected by delivery care changes was palliative chemotherapy; 48 patients (39.7%) had a delay in care, and 18 (14.9%) ceased palliative chemotherapy.

Mean time-to-resumption of palliative chemotherapy was 36 days, and 4 patients (3%) stopped palliative treatment permanently.

Changes in dosing and schedule were classified separately from therapeutic delays in treatment; this occurred in 32 patients, (26.4%), which included changing pembrolizumab every 6 weeks or durvalumab every 4 weeks.

Three patients (2.5%) had delays in adjuvant chemotherapy administration, with a mean delay of 42 days. Eight 8 patients (6.6%) had deferred or cancelled surveillance visits.

Among patients on active therapy who experienced a treatment change:

• 2.4% of these changes represented oral targeted agents
• 17% represented cytotoxic chemotherapy
• 30% represented immunotherapy
• 8% represented combination chemotherapy and immunotherapy

The researchers cited preliminary findings from The Lancet that active cancer treatment is not linked with increased COVID-19 complications.

Therefore, they recommended that “lung cancer treatments and surveillance visits should proceed with caution, and clinicians should proceed with evidence-based care provision in lung cancer.”

In addition, oncology clinics should track these changes in order to evaluate the effect of these changes on clinical outcomes, they concluded.

Reference

Elkrief A, Kazandjian S, Bouganim N. Changes in lung cancer treatment as a resultof the coronavirus disease 2019 pandemic. JAMA Oncol. doi:10.1001/jamaoncol.2020.4408