The COVID-19 impacts on Cancer care study (COVCan)

The COVCan study aims to evaluate the impacts of the COVID-19 crisis on cancer management at The Alfred Hospital. Background: Cancer patients are at increased risk of COVID-19 infection due to increased age, increased comorbidity Extermann-M et al EJC 2000 and increased likelihood of treatment related lymphopenia and T cell exhaustion Tan-L et al STTT 2020, Zheng-M et al CMI 2020. Studies of COVID-19 infected patients in China have shown that cancer is overrepresented amongst infected patients (1% vs 0.29% background), and associated with a higher risk of severe events (ICU admissions, requirement for invasive ventilation, or death) compared with patients without cancer especially in those who had undergone recent surgery or chemotherapy Liang-W et al Lancet Oncology 2020 see Figure. The fatality rate for infected cancer patients in China is 28.6% Zhang-L et al Ann Oncol 2020, compared to a 2.3% fatality rate for all COVID-19 patients Onder-G et al JAMA 2020. The capacity to manage cancer during the COVID challenge is impacted by hospital demands to free in-patient/ICU beds to meet surge demand, availability of blood products, fear and uncertainty of attending patients, managing delay in provision of immunosuppressant treatments and the need for protection of staff, patients and families during the period of infection risk Ueda-M et al NCCN 2020. The impacts of COVID-19 on health care workers appears substantial with high level reporting of symptoms of depression (50.4%), anxiety (44.6%), insomnia (34.0%), and distress (71.5%), which appears accentuated in those working on the frontline Lai-J et al JAMA 2020. Mental health support for health professionals has also been lacking during the crisis with mental health training and support hampered by quarantine and isolation Lima-C et al PsychRes 2020. The Alfred Hospital serves a community of >700,000 people providing a fully integrated range of cancer treatment services and modalities onsite, from surgical diagnosis, ED and ICU support, bone marrow transplantation, medical and radiation oncology and palliative care. In 2019, the Alfred provided 117,797 episodes of inpatient care 189,453 specialist outpatient appointments and our Cancer Service cared for 5,116 patients in inpatient and outpatient settings, including clinical trials, Alfred Annual Report 2018-19. The Alfred Hospital Cancer service has been heavily impacted by COVID-19 including the care of Victoria’s first two coronavirus deaths. Aims: To study the impacts of COVID-19 on vulnerable cancer management and outcomes for staff and patients at The Alfred Hospital and to explore opportunities to enhance future care. Objectives: 1. To investigate the impacts of the COVID-19 crisis on the presentation, management and survival of key high burden cancers at The Alfred Hospital using epidemiological methods engaging the Clinical Quality Registry unit of the Department of Epidemiology and Preventive Medicine, Monash University. Research plan: A registry-based study will explore diagnosis and management related outcomes. This study will use existing cancer registries established within DEPM to describe changes in rates of presentation, diagnosis, treatment delivery, timeliness and survival using interrupted time series analyses (ITSA) Figure 2 with appropriate adjustment for confounding and bias through multivariate regression models (case-crossover methods) and propensity score matching.