Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection

Pinato, D. J. et al | 2021 | Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study | Lancet Oncology | DOI:https://doi.org/10.1016/S1470-2045(21)00573-8

The authors of this study sought to describe the prevalence of COVID-19 sequelae and their impact on the survival of patients with cancer. In addition, because deferral and modification of systemic anti-cancer therapy has been commonplace during the early phases of the pandemic, they also aimed to describe patterns of resumption and modifications of systemic anti-cancer therapy following recovery from SARS-CoV-2 infection.

Summary

Background

The medium-term and long-term impact of COVID-19 in patients with cancer is not yet known. In this study, we aimed to describe the prevalence of COVID-19 sequelae and their impact on the survival of patients with cancer. We also aimed to describe patterns of resumption and modifications of systemic anti-cancer therapy following recovery from SARS-CoV-2 infection.

Methods

OnCovid is an active European registry study enrolling consecutive patients aged 18 years or older with a history of solid or haematological malignancy and who had a diagnosis of RT-PCR confirmed SARS-CoV-2 infection. For this retrospective study, patients were enrolled from 35 institutions across Belgium, France, Germany, Italy, Spain, and the UK. Patients who were diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, and entered into the registry at the point of data lock (March 1, 2021), were eligible for analysis. The present analysis was focused on COVID-19 survivors who underwent clinical reassessment at each participating institution. We documented prevalence of COVID-19 sequelae and described factors associated with their development and their association with post-COVID-19 survival, which was defined as the interval from post-COVID-19 reassessment to the patients’ death or last follow-up. We also evaluated resumption of systemic anti-cancer therapy in patients treated within 4 weeks of COVID-19 diagnosis. The OnCovid study is registered in ClinicalTrials.gov, NCT04393974.

Findings

2795 patients diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, were entered into the study by the time of the data lock on March 1, 2021. After the exclusion of ineligible patients, the final study population consisted of 2634 patients. 1557 COVID-19 survivors underwent a formal clinical reassessment after a median of 22·1 months (IQR 8·4–57·8) from cancer diagnosis and 44 days (28–329) from COVID-19 diagnosis. 234 (15·0 per cent) patients reported COVID-19 sequelae, including respiratory symptoms (116 [49·6 per cent]) and residual fatigue (96 [41·0 per cent]). Sequelae were more common in men (vs women; p equal to 0·041), patients aged 65 years or older (vs other age groups; p=0·048), patients with two or more comorbidities (vs one or none; p equal to 0·0006), and patients with a history of smoking (vs no smoking history; p equal to 0·0004). Sequelae were associated with hospitalisation for COVID-19 (p less than 0·0001), complicated COVID-19 (p less than 0·0001), and COVID-19 therapy (p equal to 0·0002). With a median post-COVID-19 follow-up of 128 days (95 per cent CI 113–148), COVID-19 sequelae were associated with an increased risk of death (hazard ratio [HR] 1·80 [95 per cent CI 1·18–2·75]) after adjusting for time to post-COVID-19 reassessment, sex, age, comorbidity burden, tumour characteristics, anticancer therapy, and COVID-19 severity. Among 466 patients on systemic anti-cancer therapy, 70 (15·0 per cent) permanently discontinued therapy, and 178 (38·2 per cent) resumed treatment with a dose or regimen adjustment. Permanent treatment discontinuations were independently associated with an increased risk of death (HR 3·53 [95 per cent CI 1·45–8·59]), but dose or regimen adjustments were not (0·84 [0·35–2·02]).

Interpretation

Sequelae post-COVID-19 affect up to 15% of patients with cancer and adversely affect survival and oncological outcomes after recovery. Adjustments to systemic anti-cancer therapy can be safely pursued in treatment-eligible patients.

Funding

National Institute for Health Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.

Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study [paper]

International differences in lung cancer survival by sex, histological type and stage at diagnosis

Araghi, M.et al | 2021| International differences in lung cancer survival by sex, histological type and stage at diagnosis: an ICBP SURVMARK-2 Study| Thorax | Published Online First: 19 July 2021| doi: 10.1136/thoraxjnl-2020-216555

The authors of this study set out to answer the following research question: Are there international disparities in lung cancer survival by clinically relevant subgroups in the most recent population-level data?

In this paper, they present their in-depth results of the most up-to-date differences of lung cancer stage distribution and survival by histological types, age group and sex for each included country, as well as within countries, followed by a discussion of potential causes of the disparities including clinical and data factors.

Abstract

Introduction

 Lung cancer has a poor prognosis that varies internationally when assessed by the two major histological subgroups (non-small cell (NSCLC) and small cell (SCLC)).

Method

 236 114 NSCLC and 43 167 SCLC cases diagnosed during 2010–2014 in Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK were included in the analyses. One-year and 3-year age-standardised net survival (NS) was estimated by sex, histological type, stage and country.

Results

 One-year and 3-year NS was consistently higher for Canada and Norway, and lower for the UK, New Zealand and Ireland, irrespective of stage at diagnosis. Three-year NS for NSCLC ranged from 19.7 per cent for the UK to 27.1 per cent for Canada for men and was consistently higher for women (25.3% in the UK; 35.0% in Canada) partly because men were diagnosed at more advanced stages. International differences in survival for NSCLC were largest for regional stage and smallest at the advanced stage. For SCLC, 3-year NS also showed a clear female advantage with the highest being for Canada (13.8 per cent for women; 9.1 per cent for men) and Norway (12.8 per cent for women; 9.7 per cent for men).

Conclusion

 Distribution of stage at diagnosis among lung cancer cases differed by sex, histological subtype and country, which may partly explain observed survival differences. Yet, survival differences were also observed within stages, suggesting that quality of treatment, healthcare system factors and prevalence of comorbid conditions may also influence survival. Other possible explanations include differences in data collection practice, as well as differences in histological verification, staging and coding across jurisdictions.

Full paper is available from Thorax

Psychological Processes and Symptom Outcomes in Mindfulness-Based Stress Reduction for Cancer Survivors: A Pilot Study

Full reference: Chinh, K. | 2020| Psychological Processes and Symptom Outcomes in Mindfulness-Based Stress Reduction for Cancer Survivors: A Pilot Study| Mindfulness | https://doi.org/10.1007/s12671-019-01299-0

A study that conducted secondary analyses to examine the effect of mindfulness-based stress reduction (MBSR) for cancer-related fatigue on mindfulness facets, self-compassion, and psychological inflexibility. The researchers also examined whether changes in these processes were associated with the symptom outcomes of fatigue interference, sleep disturbance, and emotional distress.

Abstract

Objectives

Growing evidence supports the efficacy of mindfulness-based interventions for symptoms in cancer survivors. Identifying theory-based psychological processes underlying their effects on symptoms would inform research to enhance their efficacy and cost-effectiveness. We conducted secondary analyses examining the effect of mindfulness-based stress reduction (MBSR) for cancer-related fatigue on mindfulness facets, self-compassion, and psychological inflexibility. We also examined whether changes in these processes were associated with the symptom outcomes of fatigue interference, sleep disturbance, and emotional distress.

Methods

Thirty-five persistently fatigued cancer survivors (94% female, 77% breast cancer survivors) were randomized to either MBSR for cancer-related fatigue or a waitlist control (WC) condition. Self-report measures were administered at pre-intervention, post-intervention, and 1-month follow-up. Then the WC group received MBSR and completed a post-intervention follow-up.

Results

Linear mixed modeling analyses of the first three time points showed steady increases over time for certain mindfulness facets (observing, acting with awareness, and nonjudging) and self-compassion in favor of the MBSR group. When analyzing pre- and post-intervention data across study conditions, none of the psychological processes predicted change in fatigue interference. However, increased nonjudging was associated with decreased sleep disturbance, and increased acting with awareness was associated with decreased emotional distress. Self-compassion did not predict change in symptom outcomes.

Conclusions

Results point to specific psychological processes that may be targeted to maximize the efficacy of future MBSR interventions for cancer survivors.

Rotherham NHS staff can have a copy of this article, just contact RFT Library here 

 

Ovarian cancer disease profile

Disease profile in England: Incidence, mortality, stage and survival for ovary, fallopian tube and primary peritoneal carcinomas |  Public Health England

This report provides a detailed insight into the status of ovarian cancer in England.  It is the first report from the Cancer Audit Feasibility Pilot project which runs for two years and includes details of disease incidence, mortality and survival.

NHS Performance Statistics

Latest figures show record numbers of patients waiting for NHS treatment in England 

This monthly release aims to provide users with an overview of NHS performance
statistics in the following key areas.

• Urgent and emergency care – Accident and Emergency, NHS 111, Ambulances, Delayed Transfers of Care
• Planned care – Referral to Treatment, Diagnostics, Mixed Sex
  Accommodation, NHS Continuing Healthcare and NHS-funded Nursing Care,
  Patient Reported Outcome Measures
• Cancer – Cancer Waiting Times, Cancer Registrations, Cancer Emergency
  Presentations, Cancer Survival Estimates
• Mental Health – Early Intervention in Psychosis, Out of Area Placements,
  Children and Young People with an Eating Disorder, Contacts and Referrals,
  Improving Access to Psychological Therapies, Physical Health Checks for
  people with Severe Mental Illness

Full detail at NHS England

See also:

• NHS England records worst A&E waiting times in 15 years | Pulse

• Latest performance stats show NHS under intolerable pressure | NHS Confederation

• Hospital waiting times at worst-ever level | BBC News

UK cancer survival rates lag behind similar countries

Arnold, M. et al |2019| Progress in cancer control: survival, mortality and incidence in seven high-income countries 1995-2014 (the ICBP SURVMARK-2 project)| The Lancet | Doi:https://doi.org/10.1016/S1470-2045(19)30456-5

The Cancer Survival in High-Income Countries (SURVMARK-2), is a longitudinal, population-based study which aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends.

Image source: scienceblog.cancerresearchuk.org

While the study’s evaluation indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. The UK was behind Australia, New Zealand, Noway, Canada, Denmark and Norway. Some of the lowest rates of 1-year survival was observed for stomach, colon, rectal, and lung cancer in the UK (Source: Arnold, et al, 2019).

Summary

Background

Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends.

 

Methods

In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control.

 

Findings

In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995–2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010–14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer.

 

Interpretation

The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival.

The full article is available from The Lancet 

See also:

Cancer Research Measuring up: how does the UK compare internationally on cancer survival?

BBC News Cancer survival in the UK improving, but lagging behind – study

Early cancer detection and survival to be prioritised by NHS

Monitoring one-year survival will be central to measuring progress in transforming cancer care, the Health and Social Care Secretary has announced.

Screening programmes will be overhauled and diagnosis made faster and more accurate with new state-of-the-art technology as part of a blueprint for rapidly improving cancer detection and survival the Health and Social Care Secretary Matt Hancock has announced.

Speaking in the House of Commons, the Health and Social Care Secretary set out how the NHS will deliver on its commitments to improve early detection of cancer.

In January, the NHS Long Term Plan set the ambition for three-quarters of all cancers to be detected at an early stage and 55,000 more people surviving cancer for 5 years each year by 2028. The Implementation Framework, agreed by the NHS, provides a blueprint for how this will be achieved at a local level. The one-year metric will be used to measure progress.

Steps in the framework include:

• a radical overhaul of screening programmes
• new state-of-the-art technology to make diagnosis faster and more accurate
• more investment in research and innovation
• the roll-out of new Rapid Diagnostic Centres across the country, building on the success of a pilot scheme with Cancer Resarch UK
• NHS England extending lung health checks, targeting areas with the lowest survival rates
• Health Education England increasing the cancer workforce, which will lead to 400 clinical endoscopists and 300 reporting radiographers by 2021

The document sets out the framework through which each of the 300 commitments in the Long Term Plan will be delivered – including the 20 headline commitments – as well as how government will monitor and support systems at a local level.

Full detail at Department of Health and Social Care

NHS England publishes Combined Performance Summary

NHS England has published its Combined Performance Summary, which provides data on key performance measures for January and February of this year. Here Jessica Morris of the Nuffield Trust shows some of these statistics and how they compare with previous years.

Commenting on the latest Combined Performance Summary, Prof John Appleby says the A&E slump and spike in cancer waits are of real concern and a reminder of the pressure that NHS staff face: A&E slump and spike in cancer waits mean stormy waters for new NHS targets

Full analysis: Combined Performance Summary: January – February 2019 | Nuffield Trust

The NHS England resource contains a summary of the performance statistics on:

Urgent and emergency care

• A&E Attendances and Emergency Admissions
• NHS 111
• Ambulance Quality Indicators
• Delayed Transfers of Care

Planned care

• Referral to Treatment
• Diagnostic Tests
• Mixed Sex Accommodation
• Patient Reported Outcomes Measures
• NHS Continuing Healthcare and NHS-funded Nursing Care

Cancer

• Cancer Waiting Times
• Cancer Registrations
• Cancer Emergency Presentations
• Cancer Survival Estimates

Mental Health

• Early Intervention in Psychosis
• Out of Area Treatments
• Children and Young People with an Eating Disorder
• Contact and Referrals
• Improving Access to Psychological Therapies

Full detail: Combined Performance Summary | NHS England

Cancer survival in England: national estimates for patients followed up to 2017

Office for National Statistics | January 2019 | Cancer survival in England: national estimates for patients followed up to 2017

The latest release of Cancer survival in England: national estimates for patients followed up to 2017 has been published by the Office for National Statistics.

Main points

• For the first time we have been able to produce robust 1-year and 5-year net cancer survival estimates by stage at diagnosis based on five years’ worth of cancer diagnoses (2012 to 2016), making them comparable with the adult cancer survival estimates.
• Adults diagnosed at stage 1 with either melanoma of the skin, prostate or breast (women only) cancer have the same chance of surviving 1-year after diagnosis as an individual in the general population.
• Melanoma of the skin had the highest net-survival estimate for 1-year survival in both men (97.4%) and women (98.6%) and for 5-year survival in both men (89.2%) and women (93.9%).
• Pancreatic cancer had the lowest net-survival estimate for 1-year survival in men (23.7%) and women (25.3%) and for 5-year survival in both men (6.4%) and women (7.5%).
• Predicted 10-year survival was also highest for melanoma of the skin for both men and women at 85.0% and 90.9% respectively, and lowest for lung cancer for both men and women at 7.0% and 10.6% respectively.

Sarah Caul, Head of Cancer Analysis, said:

“In general, we have seen an increase in people’s chances of survival across different types of cancer since our estimates for 2006 to 2010. Melanoma of the skin, prostate and breast cancer have continued to have the highest chances of survival across all age-standardised estimates compared to other cancer types. The higher survival figures could partly be explained by a high percentage of prostate and breast cancer patients being diagnosed at an earlier stage”

Cancer survival in England: national estimates for patients followed up to 2017

Read online at ONS

In the news:

BBC News ‘High’ survival for many cancers diagnosed at stages 1-3

Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology

Office of Health Economics | July 2018 | Quality of Life in Long-term Cancer Survivors: Implications for Future Health Technology Assessments in Oncology

The Office of Health Economics has undertaken a literature review which  examines whether there is evidence to support the assumption that the quality of life (QoL) of  long-term cancer survivors (LTCS) can be similar to that of age-/sex-matched population samples.  The review included 20 papers which represented  23 studies covering a range of cancers, with the LTCS in the studies were more likely to have experienced early-stage cancer relative to late-stage cancer (Source: Office of Health Economics).

The news release is available from the Office of Health Economics 

The literature review can be downloaded from the OHE