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Wan F, Fondrevelle J, Wang T, Duclos A. Two-stage multi-objective optimization for ICU bed allocation under multiple sources of uncertainty. Sci Rep 2023; 13:18925. [PMID: 37919324 PMCID: PMC10622532 DOI: 10.1038/s41598-023-45777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
Due to the impact of COVID-19, a significant influx of emergency patients inundated the intensive care unit (ICU), and as a result, the treatment of elective patients was postponed or even cancelled. This paper studies ICU bed allocation for three categories of patients (emergency, elective, and current ICU patients). A two-stage model and an improved Non-dominated Sorting Genetic Algorithm II (NSGA-II) are used to obtain ICU bed allocation. In the first stage, bed allocation is examined under uncertainties regarding the number of emergency patients and their length of stay (LOS). In the second stage, in addition to including the emergency patients with uncertainties in the first stage, it also considers uncertainty in the LOS of elective and current ICU patients. The two-stage model aims to minimize the number of required ICU beds and maximize resource utilization while ensuring the admission of the maximum number of patients. To evaluate the effectiveness of the model and algorithm, the improved NSGA-II was compared with two other methods: multi-objective simulated annealing (MOSA) and multi-objective Tabu search (MOTS). Drawing on data from real cases at a hospital in Lyon, France, the NSGA-II, while catering to patient requirements, saves 9.8% and 5.1% of ICU beds compared to MOSA and MOTS. In five different scenarios, comparing these two algorithms, NSGA-II achieved average improvements of 0%, 49%, 11.4%, 9.5%, and 17.1% across the five objectives.
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Affiliation(s)
- Fang Wan
- School of Computer Science, Univ Lyon, INSA Lyon, Univ Jean Monnet Saint-Etienne, Université Claude Bernard Lyon 1, Univ Lyon 2, DISP-UR4570, 69621, Villeurbanne, France.
| | - Julien Fondrevelle
- School of Computer Science, Univ Lyon, INSA Lyon, Univ Jean Monnet Saint-Etienne, Université Claude Bernard Lyon 1, Univ Lyon 2, DISP-UR4570, 69621, Villeurbanne, France
| | - Tao Wang
- School of Computer Science, Univ Lyon, INSA Lyon, Univ Jean Monnet Saint-Etienne, Université Claude Bernard Lyon 1, Univ Lyon 2, DISP-UR4570, 69621, Villeurbanne, France
| | - Antoine Duclos
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Health Data Department, Lyon University Hospital, Lyon, France
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Bogaert B, Buisson V, Kozlakidis Z, Saintigny P. Organisation of cancer care in troubling times: A scoping review of expert guidelines and their implementation during the COVID-19 pandemic. Crit Rev Oncol Hematol 2022; 173:103656. [PMID: 35337970 PMCID: PMC8942466 DOI: 10.1016/j.critrevonc.2022.103656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
This scoping review mapped the main themes in existing expert guidelines for cancer care issued during the COVID-19 crisis from the period of March 2020-August 2021. The guidelines published during the research period principally relate to the first two waves in Europe and until the beginning of the vaccination campaign. They elaborated recommendations for cancer care reorganisation, in particular triage and quality of care issues. The article highlights the ethical, epistemological, as well as practical reasons that guidelines were not always followed to provide some lessons learned for future crises to enable better guideline development processes. We also elaborate early evidence on the impact of triage decisions and different perspectives on cancer care reorganisation from ethics and social science literature.
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Affiliation(s)
- Brenda Bogaert
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Victoria Buisson
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Zizis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - Pierre Saintigny
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.
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Belmont AS, Sajous C, Bruyas A, Calattini S, Cartalat S, Chauvenet M, Colombel M, Dalle S, Dagonneau T, Darrason M, Devouassoux G, Duruisseaux M, Guillet M, Glehen O, Philouze P, Tronc F, Walter T, You B, Freyer G. Impact of the First Wave of the COVID-19 Pandemic on the Lyon University Hospital Cancer Institute (IC-HCL). Cancers (Basel) 2021; 14:cancers14010029. [PMID: 35008192 PMCID: PMC8750524 DOI: 10.3390/cancers14010029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/09/2021] [Accepted: 12/18/2021] [Indexed: 11/16/2022] Open
Abstract
This article presents the protective measures put in place at the "Institut de Cancérologie des Hospices de Lyon" (IC-HCL) during the first wave of the COVID-19 pandemic in France (spring 2020) and how they impacted IC-HCL clinical activity. Spring 2020 activities were compared to winter 2019-2020. Results showed a decrease of activity of 9% for treatment dispensations, 17% for multidisciplinary team meetings, 20% for head and neck and thoracic surgeries, and 58% for new patient enrolment in clinical trials. Characteristics of patients treated for solid cancer and hospitalized for COVID-19 during spring 2020 were collected in a retrospective study. Mortality was attributed to COVID-19 for half of the cases, 82% being patients above 70 and 73% being stage IV. This is in concordance with current findings concluding that the risk of developing severe or critical symptoms of COVID-19 is correlated with factors co-occurring in cancer patients and not to the cancer condition per se. While a number of routines and treatment regimens were changed, there was no major decline in numbers of treatments conducted at the IC-HCL during the first wave of the COVID-19 pandemic that hit France between March and May 2020, except for clinical trials and some surgery activities.
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Affiliation(s)
- Anne-Sophie Belmont
- Plateforme Transversale de Recherche Clinique de l'Institut de Cancérologie, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Christophe Sajous
- Service d'Oncologie Médicale, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Amandine Bruyas
- Service d'Oncologie Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Sara Calattini
- Plateforme Transversale de Recherche Clinique de l'Institut de Cancérologie, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Stéphanie Cartalat
- Service de Neuro-Oncologie, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, 69500 Bron, France
| | - Marion Chauvenet
- Service d'Hépato-Gastroentérologie, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Marc Colombel
- Service d'Urologie et Chirurgie de la Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Stéphane Dalle
- Service de Dermatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Tristan Dagonneau
- Départment d'Information Médicale, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Marie Darrason
- Service de Pneumologie Aiguë Spécialisée et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Gilles Devouassoux
- Service de Pneumologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Michaël Duruisseaux
- Service de Pneumologie, Hôpital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Marielle Guillet
- Service d'Hépato-Gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Olivier Glehen
- Service de Chirurgie Digestive et Oncologique, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Pierre Philouze
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - François Tronc
- Service Chirurgie Thoracique Vidéothoracoscopie et Transplantation Pulmonaire, Hôpital Louis Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Thomas Walter
- Service d'Oncologie Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Benoît You
- Service d'Oncologie Médicale, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
| | - Gilles Freyer
- Service d'Oncologie Médicale, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Benite, France
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Liberale G, Van Veer H, Lemaitre J, Duinslager M, Ysebaert D, De Roover A, de Gheldere C, Komen N. Impact of the first wave of the SARS-CoV-2/Covid-19 pandemic on digestive surgical activities: a Belgian National Survey. Acta Chir Belg 2021; 122:233-239. [PMID: 34077296 DOI: 10.1080/00015458.2021.1894735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Belgium was one of the first European countries affected by the first wave of the Covid-19 epidemic after Italy and France and has the highest rate of Covid-19-related deaths. Very few studies have evaluated the impact of the pandemic on surgical activity on a large scale. The primary objective of this national survey was to evaluate the impact of the first wave of the Covid-19 pandemic on surgical activities (elective non-oncological and oncological) in Belgian hospitals. METHODS A nationwide, multicenter survey was conducted in Belgium by the Royal Belgian Surgical Society (RBSS) board. The questionnaire focused on digestive surgical activity at different time points: period 1 (P1), before the epidemic; period 2 (P2), lockdown; and period 3 (P3), after stabilization of the epidemic. RESULTS The participation rate in the survey was 28.2% (24 out of 85 solicited hospitals), including 15 (62.5%) from the French speaking part of Belgium and 9 (37.5%) from the Flemish speaking part. Eighteen (75%) were non-academic and 6 (25%) were academic hospitals. All surgical activities were impacted by the Covid-19 pandemic except for the number of cholecystectomies. No statistical differences were observed between regions or according to the type of hospital. CONCLUSIONS Our national survey confirms that the COVID-19 outbreak has severely impacted in-person consultations and surgical activity for benign and malignant disease and for acute appendicitis. However, procedures for benign disease were much more affected than those for malignancies.
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Affiliation(s)
- Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- BREATHE Laboratory, Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jean Lemaitre
- Department of Surgery, Ambroise-Paré Hospital, Mons, Belgium
| | - Marc Duinslager
- Department of Surgery, Academic Hospital, Vrije Universiteit van Brussel (VUB), Brussels, Belgium
| | - Dirk Ysebaert
- Department of Surgery, Antwerp Academic Hospital (UZA), Antwerp, Belgium
| | - Arnaud De Roover
- Department of Surgery, Université de Liège (ULG), Liège, Belgium
| | | | - Niels Komen
- Department of Surgery, Antwerp Academic Hospital (UZA), Antwerp, Belgium
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Frelaut M, Vaflard P, Vuagnat P, Bozec L, Moreau P, Kriegel I, Vanjak D, Brisse H, Bouleuc C, Cottu P. [COVID-19 and patients with cancer: Experiment of a French comprehensive cancer center]. Bull Cancer 2021; 108:571-580. [PMID: 33896587 PMCID: PMC8030710 DOI: 10.1016/j.bulcan.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
The emergence of the Coronavirus Disease 2019 (COVID-19) has caused profound upset in health systems around the world. As cancer patients seem to be at greater risk, the organization of oncological care had to be adapted. We first report the progress of the "first wave" of COVID-19 at the Institut Curie, a French comprehensive cancer center, by describing the measures implemented to limit the risk of transmission of COVID-19 while ensuring as much as possible the continuation of anticancer treatments. Then, we present the results of a prospective institutional database in which the characteristics and outcome of our patients with cancer and suffering from COVID-19 were collected. From March 13 to April 25, 2020, 141 patients followed at Institut Curie for cancer developed COVID-19, of which 26 (18%) died from it. The minimum incidence of COVID-19 in Institut Curie is estimated at 1.4% over this period. No risk factors for developing a severe form of COVID-19 related to cancer have been identified. Cancer patients do not appear to be at greater risk of developing COVID-19, nor of having a more severe form than the general population. With the current increase of COVID-19 cases, it seems essential to share the experience already acquired to minimize the impact of this crisis on the long-term outcome of patients followed for cancer.
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Affiliation(s)
- Maxime Frelaut
- Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
| | - Pauline Vaflard
- Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
| | - Perrine Vuagnat
- Institut Curie, département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Laurence Bozec
- Institut Curie, département d'oncologie médicale, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Pauline Moreau
- Institut Curie, service des consultations non programmées, 26, rue d'Ulm, 75005 Paris, France
| | - Irène Kriegel
- Institut Curie, département d'anesthésie, 26, rue d'Ulm, 75005 Paris, France
| | - Dominique Vanjak
- Institut Curie, service hygiène hospitalière, 26, rue d'Ulm, 75005 Paris, France
| | - Hervé Brisse
- Institut Curie, département de radiologie, 26, rue d'Ulm, 75005 Paris, France
| | - Carole Bouleuc
- Institut Curie, département de soins de support, 26, rue d'Ulm, 75005 Paris, France.
| | - Paul Cottu
- Institut Curie, département d'oncologie médicale, 26, rue d'Ulm, 75005 Paris, France
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Akhtar N, Rajan S, Chakrabarti D, Kumar V, Gupta S, Misra S, Chaturvedi A, Azhar T, Parveen S, Qayoom S, Niranjan P, Tiwari S. Continuing cancer surgery through the first six months of the COVID-19 pandemic at an academic university hospital in India: A lower-middle-income country experience. J Surg Oncol 2021; 123:1177-1187. [PMID: 33567139 PMCID: PMC8014154 DOI: 10.1002/jso.26419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
Background The novel coronavirus pandemic (COVID‐19) hinders the treatment of non‐COVID illnesses like cancer, which may be pronounced in lower‐middle‐income countries. Methods This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID‐19‐related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. Results From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% — 14.12%). Postoperative complications were similar (p = .593, 95% CI: −2.61% — 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID‐19‐related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID‐19‐related mishaps were averted. Conclusions We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID‐19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.
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Affiliation(s)
- Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deep Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sameer Gupta
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjeev Misra
- Director, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arun Chaturvedi
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tashbihul Azhar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shirin Parveen
- Department of Anaesthesiology, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
| | - Sumaira Qayoom
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Palavalasa Niranjan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shashwat Tiwari
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Gosset M, Gal J, Schiappa R, Dejode M, Fouché Y, Alazet F, Roux E, Delpech Y, Barranger E. [Impact of COVID-19 pandemic on breast and gynecologic cancers management. Experience of the Surgery Department in the Nice Anticancer Center]. Bull Cancer 2020; 108:3-11. [PMID: 33358012 PMCID: PMC7690308 DOI: 10.1016/j.bulcan.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022]
Abstract
Introduction Durant la pandémie de COVID-19, les mesures de confinement et les recommandations des sociétés savantes de cancérologie ont pu impacter le recours aux soins des patients. Méthodes Cette étude rétrospective unicentrique comparaît le nombre et les caractéristiques des patientes reçues pour une première consultation pour une tumeur du sein ou gynécologique entre la période du confinement et une période contrôle, ainsi que les délais de prise en charge et les traitements proposés. Résultats Durant le confinement, 91 patientes ont été vues pour une demande de prise en charge, contre 159 durant la période contrôle, soit une baisse de 43,5 %. Les patientes étaient plus âgées (62,9 contre 60,9 ans), sans que cette différence soit significative (p = 0,339). Le stade tumoral n’était pas modifié. En sénologie, le délai entre la biopsie et la première consultation a été allongé de 5,5 jours (différence non significative). Parmi les 51 patientes ayant une indication opératoire durant le confinement, 16 (31,4 %) ont été reportées après la levée du confinement. Malgré tout, le délai entre la consultation et le début des traitements n’a pas été impacté. Nous n’avons pas non plus mis en évidence de modification statistiquement significative des pratiques. Discussion Au plus fort de la pandémie, les bénéfices et les risques du traitement du cancer ont dû être évalués en permanence, face au risque d’exposition au SARS-CoV-2. L’évaluation des pratiques en oncologie est essentielle pour comprendre le réel impact de cette pandémie, et se préparer à d’éventuelles crises futures.
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Affiliation(s)
- Marie Gosset
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France.
| | - Jocelyn Gal
- Université Côte d'Azur, centre Antoine-Lacassagne, département d'épidémiologie, de biostatistiques et des données de santé (DEBDS), 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Renaud Schiappa
- Université Côte d'Azur, centre Antoine-Lacassagne, département d'épidémiologie, de biostatistiques et des données de santé (DEBDS), 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Magali Dejode
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Yves Fouché
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Fanny Alazet
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Emilie Roux
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Yann Delpech
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
| | - Emmanuel Barranger
- Université Côte d'Azur, centre Antoine-Lacassagne, département de chirurgie sénologique et onco-gynécologique, 33, avenue de Valombrose, 06189 Nice cedex, France
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Lièvre A, Turpin A, Ray-Coquard I, Le Malicot K, Thariat J, Ahle G, Neuzillet C, Paoletti X, Bouché O, Aldabbagh K, Michel P, Debieuvre D, Canellas A, Wislez M, Laurent L, Mabro M, Colle R, Hardy-Bessard AC, Mansi L, Colomba E, Bourhis J, Gorphe P, Pointreau Y, Idbaih A, Ursu R, Di Stefano AL, Zalcman G, Aparicio T; GCO-002 CACOVID-19 collaborators/investigators. Risk factors for Coronavirus Disease 2019 (COVID-19) severity and mortality among solid cancer patients and impact of the disease on anticancer treatment: A French nationwide cohort study (GCO-002 CACOVID-19). Eur J Cancer 2020; 141:62-81. [PMID: 33129039 DOI: 10.1016/j.ejca.2020.09.035] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022]
Abstract
Background Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. Patients and methods In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and 11th June 2020. The primary end-point was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary end-points. Results From April 4 to 11th June 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18–2.52), The Eastern Cooperative Oncology Group Performance Scale (ECOG PS) ≥ 2 (OR 3.23, 95%CI: 2.27–4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01–1.16) and admission to ICU (OR 3.62, 95%CI 2.14–6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except for cytotoxic chemotherapy in the subgroup of patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR), which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00–2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment (such as chemotherapy, targeted or immune therapy) interrupted or stopped following diagnosis of COVID-19. Conclusions Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis.
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Affiliation(s)
- Manuel Rodrigues
- Institut Curie, PSL research university, département d'oncologie médicale, 75005 Paris, France.
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