Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer

Elkrief, A. et al. (2022). Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer. The Lancet Health Longevity. DOI:https://doi.org/10.1016/S2666-7568(22)00009-5

The researchers’ primary objective at the outset of this study was to determine whether a measure of geriatric risk could capture risk of severe clinical outcomes among older patients with cancer and COVID-19. Additionally, they also sought to describe the presentation, complications and effect of COVID-19 on subsequent cancer care among older adults with cancer.

Patients of 60 years of age and above who were categorised as high risk- using a novel geriatric risk index comprising age, performance status and commodities- had significantly higher COVID-19 severity, including hospitalisation, need for intensive care and mechanical ventilation, and death, within 30 days due to any cause than patients categorised as standard risk or intermediate risk (Source: Elkrief et al, 2022).

Elkrief and colleagues’ study examines the relationship between their novel geriatric risk index and adverse outcomes from COVID-19 among older adults with cancer, as well as the frequency of atypical presentations in this population.

Summary

Background

Older age is associated with poorer outcomes of SARS-CoV-2 infection, although the heterogeneity of ageing results in some older adults being at greater risk than others. The objective of this study was to quantify the association of a novel geriatric risk index, comprising age, modified Charlson comorbidity index, and Eastern Cooperative Oncology Group performance status, with COVID-19 severity and 30-day mortality among older adults with cancer.

Methods

In this cohort study, we enrolled patients aged 60 years and older with a current or previous cancer diagnosis (excluding those with non-invasive cancers and premalignant or non-malignant conditions) and a current or previous laboratory-confirmed COVID-19 diagnosis who reported to the COVID-19 and Cancer Consortium (CCC19) multinational, multicentre, registry between March 17, 2020, and June 6, 2021. Patients were also excluded for unknown age, missing data resulting in unknown geriatric risk measure, inadequate data quality, or incomplete follow-up resulting in unknown COVID-19 severity. The exposure of interest was the CCC19 geriatric risk index. The primary outcome was COVID-19 severity and the secondary outcome was 30-day all-cause mortality; both were assessed in the full dataset. Adjusted odds ratios (ORs) and 95 per cent CIs were estimated from ordinal and binary logistic regression models.

Findings

5671 patients with cancer and COVID-19 were included in the analysis. Median follow-up time was 56 days (IQR 22–120), and median age was 72 years (IQR 66–79). The CCC19 geriatric risk index identified 2365 (41·7 per cent) patients as standard risk, 2217 (39·1 per cent) patients as intermediate risk, and 1089 (19·2 per cent) as high risk. 36 (0·6 per cent) patients were excluded due to non-calculable geriatric risk index. Compared with standard-risk patients, high-risk patients had significantly higher COVID-19 severity (adjusted OR 7·24; 95 per cent CI 6·20–8·45). 920 (16·2 per cent) of 5671 patients died within 30 days of a COVID-19 diagnosis, including 161 (6·8 per cent) of 2365 standard-risk patients, 409 (18·5 per cent) of 2217 intermediate-risk patients, and 350 (32·1 per cent) of 1089 high-risk patients. High-risk patients had higher adjusted odds of 30-day mortality (adjusted OR 10·7; 95 per cent CI 8·54–13·5) than standard-risk patients.

Interpretation

The CCC19 geriatric risk index was strongly associated with COVID-19 severity and 30-day mortality. Our CCC19 geriatric risk index, based on readily available clinical factors, might provide clinicians with an easy-to-use risk stratification method to identify older adults most at risk for severe COVID-19 as well as mortality.

Geriatric risk factors for serious COVID-19 outcomes among older adults with cancer: a cohort study from the COVID-19 and Cancer Consortium [paper]

Leeds Cancer Research Centre is officially launched

University of Leeds | February 2022 | Leeds Cancer Research Centre is officially launched

An ambitious vision placing Leeds at the global forefront of cancer research has been set out by the University.

The University is partnering with Leeds Teaching Hospitals NHS Trust to create the Leeds Cancer Research Centre, a new venture bringing together experts from across a range of disciplines including biological, physical, engineering and clinical sciences; clinical practice and innovative health interventions, to tackle some of the greatest challenges facing cancer research today. 

The Centre’s goal is to transform the prevention, diagnosis, and treatment of cancer; tackle cancer-related health inequalities, and improve patient outcomes in Leeds, Yorkshire and across the globe. 

In Yorkshire, more than 31,000 new cases are diagnosed every year, with the third-worst outcomes in England. Nearly a fifth of the Leeds City Region’s population lives in areas of severe social deprivation where cancer is the leading cause of death, with lung cancer accounting for over half of the cases. 

Some 40 per cent of people from these communities who develop cancer are diagnosed at a late stage – and have a 50 per cent greater chance of dying from the disease than those who live in Leeds’s least deprived areas. 

The problems are predicted to worsen due to the impact of the COVID-19 pandemic, with more cases diagnosed at a late stage due to limitations on cancer screening and fewer patients visiting their GP during lockdown. 

Full details from the University of Leeds

New life-extending drug for advanced womb cancer to be rolled out on the NHS

NHS England | 8 February 2022 | New life-extending drug for advanced womb cancer to be rolled out on the NHS

A 30-minute treatment, the first of its kind for advanced womb cancer, is being rolled out for women across England, the NHS announced earlier this month.

Around 100 women with advanced and often incurable endometrial cancer every year will be offered this life-extending drug after the NHS agreed early access to the treatment through the Cancer Drugs Fund.

The drug, called Dostarlimab, is the first of its kind for womb or endometrial cancer, and works by attaching to a specific protein on the surface of the cancer cells, helping the immune system to detect and attack it.

It will give eligible patients with this specific form of cancer, who would otherwise quickly deteriorate, a greater chance of survival.

NHS England New life-extending drug for advanced womb cancer to be rolled out on the NHS

10-Year Cancer Plan: Call for Evidence

Department of Health and Social Care | February 2022 | 10-Year Cancer Plan: Call for Evidence

One in every two people in this country will be told they have cancer at some point in their lives. The NHS Long Term Plan, published in 2019, set an ambition to save thousands more lives each year by dramatically improving how we diagnose and treat cancer.

The Department of Health and Social Care is seeking the views of individuals, professionals and organisations to understand whether and how we can do more to make progress against this ambition, and to build on lessons learned from the COVID-19 pandemic.

The call for evidence is open to everyone aged 16 and over. You can respond as an individual, or on behalf of an organisation. The consultation closes 11:45pm on 1 April 2022

The easiest way to participate in the call for evidence is by completing the online survey.

Full details of the consultation are available from the Department of Health and Social Care

Childhood cancer inequalities in the WHO European Region

World Health Organization | February 2022 | Childhood cancer inequalities in the WHO European Region

Key points from the report Childhood cancer inequalities in the WHO European Region

Image source: apps.who.int Image description: front cover of the report showing illustrations of children playing and reading

Childhood cancer encompasses a wide and heterogeneous range of rare cancers defined by the age group in which they occur. While significant progress has been made in recent years in improving survival and treatment quality for children with cancer, significant inequalities still exist across the
WHO European Region. This report draws together available evidence and information from a wide range of published sources to present the case for an increased focus on addressing inequalities in childhood cancer within the Region. It summarizes literature in four main areas: the childhood
cancer continuum; inequalities across countries; inequalities within countries; and childhood cancer as a driver of inequalities. The report makes recommendations on the key steps that are likely to have the greatest impact in reducing inequalities across the Region. It is hoped that these will be of value to decision-makers and politicians from all countries within the Region looking to address existing inequalities in childhood cancer care through targeted improvement activities.

This WHO report summarises literature in four main areas: the childhood cancer continuum; inequalities across countries; inequalities within countries; and childhood cancer as a driver of inequalities (Source: World Health Organization).

Childhood cancer inequalities in the WHO European Region [report]

See also:

Childhood cancer inequalities in the WHO European Region (2022)

[NICE Draft Guideline] Transperineal biopsy for diagnosing prostate cancer

NICE | February 2022 | Transperineal biopsy for diagnosing prostate cancer

Four new diagnostic devices for men with suspected prostate cancer, which reduce the chances of biopsy related sepsis, have been recommended for use by NICE.

The new diagnostics guidance looks at local anaesthetic transperineal (LATP) prostate biopsy, using the freehand needle positioning devices PrecisionPoint, EZU-PA3U device, Trinity Perine Grid, and UA1232 puncture attachment, which are recommended as options for helping to diagnose prostate cancer.

Prostate cancer is the most diagnosed cancer in men in the UK according to Cancer Research UK. It mainly affects people over 50 and the risk is higher for people of African family background and people with a family history of prostate cancer.

At present NICE guidance recommends offering people with suspected clinically localised prostate cancer a multiparametric MRI as the first-line investigation.

If prostate cancer is still suspected based on the MRI image, a prostate biopsy is offered so that samples of the prostate can be collected for analysis. There are two ways of doing a prostate biopsy. In a transrectal ultrasound guided (TRUS) biopsy samples are collected using a biopsy needle inserted through the rectal wall via the anus.

However TRUS can be associated with serious infections, sometimes requiring hospital admission and antibiotic (Source: NICE). 

NICE Transperineal biopsy for diagnosing prostate cancer

Further information and documents available from NICE

National Bowel Cancer Audit Annual Report 2021

National Bowel Cancer Audit. (2022). National Bowel Cancer Audit Annual Report 2021

Early in the COVID-19 pandemic, there was a large impact on the diagnosis and treatment of bowel cancer patients. However, bowel cancer services had largely recovered by March 2021.

For this year’s audit, The National Bowel Cancer Audit (NBOCA) has undertaken additional work looking at the impact of the COVID-19 pandemic on bowel cancer services in England and Wales. For example unplanned return to theatre (which allows evaluation of serious post-operative complications) and separation of data related to rates of stoma formation into permanent stoma rates versus unclosed diverting ileostomy rates. Furthermore, in response to the updated NICE recommendations, the report provides data on rectal cancer volumes by trust, hospital and MDT that may influence current discussions surrounding specialisation with regard to rectal cancer surgery.

The report is divided into two sections. Part 1: Pre-pandemic (Patients diagnosed 01 April 2019 to 31 March 2020), and Part 2: Recovery of bowel cancer services from the COVID-19 pandemic (Patients diagnosed 01 April 2020 to 31 March
2021). (Source: National Bowel Cancer Audit).

Image shows the diagnosis and care pathways for patients with bowel cancer. Image source: nboca.org.uk

National Bowel Cancer Audit Annual Report 2021

See also:

NBOCA Quality Improvement Plan

World Cancer Day: closing the care gap

World Health Organization | February 2022 | World Cancer Day: closing the care gap

On World Cancer Day (4 February 2022), WHO released Setting Up a Cancer Centre: a WHO-IAEA Framework, being released by the World Health Organization and the International Atomic Energy Agency for World Cancer Day, proposes a framework for both establishing a cancer centre and strengthening the provision of services in existing centres. Intended for policy-makers, programme managers and health professionals, it provides details of the  infrastructure, human resources and equipment required for essential services, taking into consideration local context and resources available.

Cancer is one of the world’s leading causes of death, and its burden is growing. In 2021, the world crossed a sobering new threshold – an estimated 20 million people were diagnosed with cancer, and 10 million died. These numbers will continue to rise in the decades ahead. And yet all cancers can be treated, and many can be prevented or cured.

Care for cancer, however, like so many other diseases, reflects the inequalities and inequities of our world. The clearest distinction is between high- and low-income countries, with comprehensive treatment reportedly available in more than 90 per cent of high-income countries but less than 15 per cent of low-income countries.

Similarly, the survival of children diagnosed with cancer is more than 80 per cent in high-income countries, and less than 30 per cent in low- and middle-income countries. And breast cancer survival five years after diagnosis now exceeds 80 per cent in most high-income countries, compared with 66 per cent in India and just 40 per cent in South Africa.

Furthermore, a recent WHO survey found that cancer services are covered by a country’s largest, government health financing scheme in an estimated 37 per cent of low- and middle-income countries, compared to at least 78 per cent of high-income countries. This means that a cancer diagnosis has the potential to push families into poverty, particularly in lower-income countries, an effect that has been exacerbated during the COVID-19 pandemic. 

Closing the care gap 

For all of these reasons, the theme for this year’s World Cancer Day is “closing the care gap”.

Full details from WHO

Setting Up a Cancer Centre: A WHO–IAEA Framework

ICR: NICE misses golden opportunity to enhance access to innovative cancer drugs

Institute of Cancer Research | n.d | NICE misses golden opportunity to enhance access to innovative cancer drugs

The Institute of Cancer Research (ICR) has responded to NICE’s proposals to reform its methods for assessing drugs for the NHS fell short of what was needed and in one important respect could make access to new cancer drugs worse. The ICR said too little had been done to favour drugs with innovative mechanisms of action, speed up approval of new drugs, or remove barriers to drug approval for rare diseases such as children’s cancer.

While the research institute is welcoming some of the changes NICE has proposed – especially its recommendation that review panels should accept more uncertainty in data when considering new medicines. But it wants to see further consideration and movement in several important areas:

• Greater recognition of the barriers for rare diseases.
• Risks of removing the end-of-life modifier
• Prioritising innovative medicines
• Using surrogate measures of survival (Source: ICR)

NICE misses golden opportunity to enhance access to innovative cancer drugs [news release]

See also:

MedScape NICE ‘Missed Golden Opportunity’ to Encourage Innovative Drugs

NICE: More than 100 people a year in England could benefit from new endometrial cancer treatment within the Cancer Drugs Fund

NICE | February 2022 | More than 100 people a year in England could benefit from new endometrial cancer treatment within the Cancer Drugs Fund

An innovative new drug for treating advanced or recurrent endometrial cancer in adults who have had platinum-based chemotherapy is being recommended by NICE as an option for use within the Cancer Drugs Fund.

NICE has published its final appraisal document on dostarlimab, an immunotherapy treatment which could benefit 124 people a year in England as a second-line treatment for endometrial cancer with high microsatellite instability or mismatch repair deficiency.

Endometrial cancer (EC) is a type of uterine cancer originating in the lining of the womb. Endometrioid carcinoma is the most common subtype, resulting in an estimated 2 162 deaths every year in the UK.

In normal cells, the body’s mismatch repair (MMR) system recognises and repairs genetic mismatches. However, 26 per cent of endometrial tumours have a defect in the MMR system, meaning unstable and dysfunctional DNA is not addressed.

There are currently a range of different treatment options available to people with advanced or recurrent endometrial cancer after having platinum-based chemotherapy. However, there are no standard second-line treatments, and the options provide limited survival benefit. Therefore, the prognosis for patients is poor.

Standard chemotherapy can take up to a day to be administered in hospital, but a dostarlimab infusion takes around 30 minutes (Source: NICE).

Full details are available from NICE