Specialist palliative and end-of-life care for patients with cancer and SARS-CoV-2 infection: a European perspective

Abstract

Background: Specialist palliative care team (SPCT) involvement has been shown to improve symptom control and end-of-life care for patients with cancer, but little is known as to how these have been impacted by the COVID-19 pandemic. Here, we report SPCT involvement during the first wave of the pandemic and compare outcomes for patients with cancer who received and did not receive SPCT input from multiple European cancer centres. Methods: From the OnCovid repository ( N = 1318), we analysed cancer patients aged ⩾18 diagnosed with COVID-19 between 26 February and 22 June 2020 who had complete specialist palliative care team data (SPCT+ referred; SPCT− not referred). Results: Of 555 eligible patients, 317 were male (57.1%), with a median age of 70 years (IQR 20). At COVID-19 diagnosis, 44.7% were on anti-cancer therapy and 53.3% had ⩾1 co-morbidity. Two hundred and six patients received SPCT input for symptom control (80.1%), psychological support (54.4%) and/or advance care planning (51%). SPCT+ patients had more ‘Do not attempt cardio-pulmonary resuscitation’ orders completed prior to (12.6% versus 3.7%) and during admission (50% versus 22.1%, p < 0.001), with more SPCT+ patients deemed suitable for treatment escalation (50% versus 22.1%, p < 0.001). SPCT involvement was associated with higher discharge rates from hospital for end-of-life care (9.7% versus 0%, p < 0.001). End-of-life anticipatory prescribing was higher in SPCT+ patients, with opioids (96.3% versus 47.1%) and benzodiazepines (82.9% versus 41.2%) being used frequently for symptom control. Conclusion: SPCT referral facilitated symptom control, emergency care and discharge planning, as well as high rates of referral for psychological support than previously reported. Our study highlighted the critical need of SPCTs for patients with cancer during the pandemic and should inform service planning for this population.

Symptom Management and Support in Dying Patients with Cancer and Coronavirus Disease-19—A Register-Based Study

“…Furthermore, because of the unpredictable course of COVID-19, it might have been difficult to assess which patients would not benefit from further hospital care. A previous study has also shown that lack of consultation of SPC in hospitals decreased the number of patients referred to EOL care in patients with COVID-19 and cancer, 19 and in our study, only 14% of patients received palliative consultation, which might have decreased referral to SPC.…”

“…Breathlessness was a common symptom in this study, which is in accordance with other studies among patients with COVID-19 6 , 10 and also among patients with COVID-19 and cancer during EOL. 19 More patients within the hospital group suffered from breathlessness, which indicates that they might have had more severe lung complications from COVID-19. A lower symptom burden during EOL among nursing-home residents with a COVID-19 infection compared to elderly patients in hospitals has previously been shown, which also is an indication that those with more severe COVID-19 have an increased probability of being hospitalized.…”

“…In concordance with our results, a previous study showed that patients with both cancer and COVID-19 dying in SPC had higher numbers of prescribed medications for symptom control compared to patients dying in hospitals, reflecting the need for palliative care knowledge and routines to control symptoms during EOL care. 19 …”

“…18 Only 1 study assessed patients with cancer and COVID-19 during EOL care, showing that these patients had a high symptom burden. 19 Thus, to maintain high-quality palliative care, structured assessments of pain and other symptoms are considered essential. 20 Unfortunately, adherence to these clinical routines has not met the usual standard during the COVID-19 pandemic, 21 and there are no studies addressing clinical routines in cancer patients during the pandemic.…”

Embracing Family Presence: Exploring the Reason of Family Decision Making Dependence on in-hospital Palliative Care for Cancer Patients

“…Following on the patient's readiness and autonomy, the palliative cancer patient care will be moved from the hospital to the community, as chosen by the patients. SPC has shown the impacts on improving the patient quality of life, reducing the stress of the patient and family, lowering the aggressive medical treatment and hence the hospital costs, and even on increasing patient life expectancy (32) The United Kingdom (UK) serves as a successful example of the well-developed Specialist Palliative Care (SPC) system that has signi cantly improved access to high-quality palliative care services. By 2005, the UK had established 361 hospitals offering SPC, along with 277 community palliative care nurses.…”