Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center
Abstract:Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent… Show more
“…Furthermore, comorbidities such as hypertension, diabetes, obesity, and smoking have been described as key contributors to an undesirable outcome [ 6 ]. Other parameters, such as medical [ 7 ], genetic [ 8 ], environmental [ 9 ], physical [ 10 , 11 ], mental/psychological [ 12 ], social [ 13 ], economical [ 14 ], and political [ 15 ], whose effect cannot be precisely determined, at least at an individual level, are believed to contribute to country-specific CFR disparities. Last, concerning vaccination for SARS-CoV-2, it has been reported that vaccination uptake is closely associated with elderly people saved, independently of the vaccine type administered [ 16 ].…”
To investigate the reasons for disparity regarding the country-specific COVID-19-related case fatality rate (CFR) within the 30 countries of the European Economic Area (EEA).
Materials and methodsData regarding population, area, COVID-19-associated infections/deaths, vaccination, life expectancy, elderly population, infant mortality, gender disparity, urbanization, gross domestic product (GDP), income per capita, health spending per capita, physicians, nursing personnel, hospital beds, ICU beds, hypertension, diabetes, obesity, and smoking from all EEA countries were collected from official sources on January 16, 2022. Correlation coefficients were computed, and optimal scaling using ridge regression was used to reach the most parsimonious multivariate model assessing any potential independent correlation of public health parameters with COVID-19 CFR.
ResultsCOVID-19 CFR ranges from 0.1% (Iceland) to 4.0% (Bulgaria). All parameters but population density, GDP, total health spending (% of GDP), ICU beds, diabetes, and obesity were correlated with COVID-19 CFR. In the most parsimonious multivariate model, elderly population rate (P = 0.018), males/total ratio (P = 0.013), nurses/hospital beds (P = 0.001), physicians/hospital beds (P = 0.026), public health spending (P = 0.013), smoking rate (P = 0.013), and unvaccinated population rate (P = 0.00005) were demonstrated to present independent correlation with COVID-19 CFR. In detail, the COVID-19 CFR is estimated to increase by 1.24 times in countries with vaccination rate of <0.34, 1.11 times in countries with an elderly population rate of ≥0.20, 1.14 times in countries with male ratio values ≥0.493, 1.12 times in countries spending <2,000$ annually per capita for public health, 1.14 and 1.10 times in countries with <2.30 nurses and <0.88 physicians per hospital bed, respectively, and 1.12 in countries with smoking ratio ≥0.22, while holding all other independent variables of the model constant.
ConclusionCOVID-19 CFR varies substantially among EEA countries and is independently linked with low vaccination rates, increased elderly population rate, diminished public health spending per capita, insufficient physicians and nursing personnel per hospital bed, and prevalent smoking habits. Therefore, public health authorities are awaited to consider these parameters in prioritizing actions to manage the SARS-CoV-2 pandemic.
“…Furthermore, comorbidities such as hypertension, diabetes, obesity, and smoking have been described as key contributors to an undesirable outcome [ 6 ]. Other parameters, such as medical [ 7 ], genetic [ 8 ], environmental [ 9 ], physical [ 10 , 11 ], mental/psychological [ 12 ], social [ 13 ], economical [ 14 ], and political [ 15 ], whose effect cannot be precisely determined, at least at an individual level, are believed to contribute to country-specific CFR disparities. Last, concerning vaccination for SARS-CoV-2, it has been reported that vaccination uptake is closely associated with elderly people saved, independently of the vaccine type administered [ 16 ].…”
To investigate the reasons for disparity regarding the country-specific COVID-19-related case fatality rate (CFR) within the 30 countries of the European Economic Area (EEA).
Materials and methodsData regarding population, area, COVID-19-associated infections/deaths, vaccination, life expectancy, elderly population, infant mortality, gender disparity, urbanization, gross domestic product (GDP), income per capita, health spending per capita, physicians, nursing personnel, hospital beds, ICU beds, hypertension, diabetes, obesity, and smoking from all EEA countries were collected from official sources on January 16, 2022. Correlation coefficients were computed, and optimal scaling using ridge regression was used to reach the most parsimonious multivariate model assessing any potential independent correlation of public health parameters with COVID-19 CFR.
ResultsCOVID-19 CFR ranges from 0.1% (Iceland) to 4.0% (Bulgaria). All parameters but population density, GDP, total health spending (% of GDP), ICU beds, diabetes, and obesity were correlated with COVID-19 CFR. In the most parsimonious multivariate model, elderly population rate (P = 0.018), males/total ratio (P = 0.013), nurses/hospital beds (P = 0.001), physicians/hospital beds (P = 0.026), public health spending (P = 0.013), smoking rate (P = 0.013), and unvaccinated population rate (P = 0.00005) were demonstrated to present independent correlation with COVID-19 CFR. In detail, the COVID-19 CFR is estimated to increase by 1.24 times in countries with vaccination rate of <0.34, 1.11 times in countries with an elderly population rate of ≥0.20, 1.14 times in countries with male ratio values ≥0.493, 1.12 times in countries spending <2,000$ annually per capita for public health, 1.14 and 1.10 times in countries with <2.30 nurses and <0.88 physicians per hospital bed, respectively, and 1.12 in countries with smoking ratio ≥0.22, while holding all other independent variables of the model constant.
ConclusionCOVID-19 CFR varies substantially among EEA countries and is independently linked with low vaccination rates, increased elderly population rate, diminished public health spending per capita, insufficient physicians and nursing personnel per hospital bed, and prevalent smoking habits. Therefore, public health authorities are awaited to consider these parameters in prioritizing actions to manage the SARS-CoV-2 pandemic.
“…Total of 2 qualitative studies and 12 quantitative studies helped to explore the impact of palliative care for cancer patients during the COVID‐19 epidemic. A number of studies suggest that patients receiving palliative care are more likely to die in the hospital when they are suffering from COVID‐19 (Almeida et al, 2022; de Oliveira, Rosa, et al, 2021; Strang et al, 2021), and more pronounced in COVID‐19 positive patients (de Oliveira, Rosa, et al, 2021; Moriyama et al, 2021; Strang et al, 2021). Under the influence of policies related to this period, mortality and infection rates among cancer patients have increased, and interruptions and delays in treatment have caused adverse effects such as poor prognosis and increased psychological stress among patients.…”
Section: Resultsmentioning
confidence: 99%
“…During this period, palliative care patients had longer hospital stays, higher mortality and infection rates, and poorer prognosis. Demand for palliative care is rising among cancer patients, putting them at risk of contracting COVID‐19 (Almeida et al, 2022; de Oliveira, da Costa Rosa, et al, 2021; de Oliveira, Rosa, et al, 2021; Fazilat‐Panah et al, 2022; Jeba, 2020; Moriyama et al, 2021; Onesti et al, 2021; Rahnea‐Nita et al, 2021; Strang et al, 2021; Tashkandi et al, 2021). Palliative care facilities have also been hit by the viral outbreak.…”
BackgroundDuring the COVID‐19 epidemic, palliative care has become even more indispensable for cancer patients.AimTo identify the changes in palliative care for cancer patients and improvements in palliative care quality during the COVID‐19 pandemic.DesignA systematic review and narrative synthesis was conducted in PubMed, Embase and Web of Science. An evaluation tool using mixed methods was used to assess the quality of the study. The main relevant themes identified were used to group qualitative and quantitative findings.ResultsA total of 36 studies were identified, primarily from different countries, with a total of 14,427 patients, 238 caregivers and 354 health care providers. Cancer palliative care has been experiencing several difficulties following the COVID‐19 pandemic, including increased mortality and infection rates as well as delays in patient treatment that have resulted in poorer prognoses. Treatment providers are seeking solutions such as electronic management of patients and integration of resources to care for the mental health of patients and staff. Telemedicine plays an important role in many ways but cannot completely replace traditional treatment. Clinicians strive to meet patients' palliative care needs during special times and improve their quality of life.ConclusionsPalliative care faces unique challenges during the COVID‐19 epidemic. With adequate support to alleviate care‐related challenges, patients in the home versus hospital setting will be able to receive better palliative care. In addition, this review highlights the importance of multiparty collaboration to achieve personal and societal benefits of palliative care.Patient or Public ContributionNo Patient or Public Contribution.
“…[ 3 ] In palliative care, a case-fatality rate exceeding 80% has been reported from the pre-vaccination period. [ 4 ] Among COVID-19 patients with high risk for severe disease and death, early pharmacologic intervention has been shown to significantly reduce these outcomes. [ [5] , [6] , [7] , [8] , [9] ] However, implementation of such strategy can be challenging due to limitations in available resources and medications in non-acute care settings.…”
mentioning
confidence: 99%
“…While information is limited in the literature, COVID-19 in inpatient palliative care settings has been associated with extremely high mortality. [ 4 , 11 ] In contrast, all patients on the rehabilitation ward were alive at 28 days. Fig.…”
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