Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

Karlijn de Joode; Jolien Tol; Paul Hamberg; Marissa Cloos; Elisabeth A. Kastelijn; Jessica S. W. Borgers; Veerle J. A. A. Nuij; Yarne Klaver; Gerarda J. M. Herder; Pim G. N. J. Mutsaers; Daphne W. Dumoulin; Esther Oomen-de Hoop; Nico G. J. van Diemen; Eduard J. Libourel; Erica J. Geraedts; Gerben P. Bootsma; Cor H. van der Leest; Anne L. Peerdeman; Karin H. Herbschleb; Otto J. Visser; Haiko J. Bloemendal; Hanneke W. M. van Laarhoven; Elisabeth G. E. de Vries; Lizza E. L. Hendriks; Laurens V. Beerepoot; Hans M. Westgeest; Franchette W. P. J. van den Berkmortel; John B. A. G. Haanen; Anne-Marie C. Dingemans; Astrid A. M. van der Veldt; A. Becker-Commissaris; F. Terheggen; B. E. E. M. van den Borne; L. J. C. van Warmerdam; L. van Leeuwen; F. S. van der Meer; M. A. Tiemessen; D. M. van Diepen; L. Strobbe; J. A. F. Koekkoek; P. Brocken; J. C. Drooger; R. Heller; J. W. B. de Groot; J. A. Stigt; C. C. M. Pitz; M. Slingerland; F. J. Borm; B. C. M. Haberkorn; S. C. van 't Westeinde; M. J. B. Aarts; J. W. G. van Putten; M. Youssef; G. A. Cirkel; C. R. van Rooijen; E. Citgez; N. P. Barlo; B. M. J. Scholtes; R. H. T. Koornstra; N. J. M. Claessens; L. M. Faber; C. H. Rikers; R. A. W. van de Wetering; G. L. Veurink; B. W. Bouter; I. Houtenbos; M. P. L. Bard; G. Douma; M. Jalving; T. J. N. Hiltermann; O. C. J. Schuurbiers-Siebers; K. P. M. Suijkerbuijk; A. S. R. van Lindert; A. J. van de Wouw; V. E. M. van den Boogaart; S. D. Bakker; E. Looysen; W. K. de Jong; E. J. M. Siemerink; A. J. Staal; B. Franken; W. H. van Geffen

doi:https://doi.org/10.1016/j.ejca.2021.10.009

Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

Karlijn de Joode, Jolien Tol, Paul Hamberg, Marissa Cloos, Elisabeth A. Kastelijn, Jessica S. W. Borgers, Veerle J. A. A. Nuij, Yarne Klaver, Gerarda J. M. Herder, Pim G. N. J. Mutsaers, Daphne W. Dumoulin, Esther Oomen-de Hoop, Nico G. J. van Diemen, Eduard J. Libourel, Erica J. Geraedts, Gerben P. Bootsma, Cor H. van der Leest, Anne L. Peerdeman, Karin H. Herbschleb, Otto J. VisserHaiko J. Bloemendal, Hanneke W. M. van Laarhoven, Elisabeth G. E. de Vries, Lizza E. L. Hendriks, Laurens V. Beerepoot, Hans M. Westgeest, Franchette W. P. J. van den Berkmortel, John B. A. G. Haanen, Anne-Marie C. Dingemans, Astrid A. M. van der Veldt, A. Becker-Commissaris, F. Terheggen, B. E. E. M. van den Borne, L. J. C. van Warmerdam, L. van Leeuwen, F. S. van der Meer, M. A. Tiemessen, D. M. van Diepen, L. Strobbe, J. A. F. Koekkoek, P. Brocken, J. C. Drooger, R. Heller, J. W. B. de Groot, J. A. Stigt, C. C. M. Pitz, M. Slingerland, F. J. Borm, B. C. M. Haberkorn, S. C. van 't Westeinde, M. J. B. Aarts, J. W. G. van Putten, M. Youssef, G. A. Cirkel, C. R. van Rooijen, E. Citgez, N. P. Barlo, B. M. J. Scholtes, R. H. T. Koornstra, N. J. M. Claessens, L. M. Faber, C. H. Rikers, R. A. W. van de Wetering, G. L. Veurink, B. W. Bouter, I. Houtenbos, M. P. L. Bard, G. Douma, M. Jalving, T. J. N. Hiltermann, O. C. J. Schuurbiers-Siebers, K. P. M. Suijkerbuijk, A. S. R. van Lindert, A. J. van de Wouw, V. E. M. van den Boogaart, S. D. Bakker, E. Looysen, W. K. de Jong, E. J. M. Siemerink, A. J. Staal, B. Franken, W. H. van Geffen

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Aim of the study: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do-not-resuscitate codes), were studied in patients with cancer and COVID-19. Methods: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID-19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account. Results: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life-prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome. Conclusion: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic.

Original language	English
Pages (from-to)	261-272
Number of pages	12
Journal	European Journal of Cancer
Volume	160
Early online date	2021
DOIs	https://doi.org/10.1016/j.ejca.2021.10.009
Publication status	Published - Jan 2022

Keywords

Advanced care planning
COVID-19
Cancer
Cancer treatment
Treatment restrictions

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https://doi.org/10.1016/j.ejca.2021.10.009

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de Joode, K., Tol, J., Hamberg, P., Cloos, M., Kastelijn, E. A., Borgers, J. S. W., Nuij, V. J. A. A., Klaver, Y., Herder, G. J. M., Mutsaers, P. G. N. J., Dumoulin, D. W., Oomen-de Hoop, E., van Diemen, N. G. J., Libourel, E. J., Geraedts, E. J., Bootsma, G. P., van der Leest, C. H., Peerdeman, A. L., Herbschleb, K. H., ... van Geffen, W. H. (2022). Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium. European Journal of Cancer, 160, 261-272. https://doi.org/10.1016/j.ejca.2021.10.009

@article{a9542ba45af94385a74bb1867a9d7359,

title = "Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium",

abstract = "Aim of the study: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do-not-resuscitate codes), were studied in patients with cancer and COVID-19. Methods: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID-19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account. Results: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life-prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome. Conclusion: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic.",

keywords = "Advanced care planning, COVID-19, Cancer, Cancer treatment, Treatment restrictions",

author = "{de Joode}, Karlijn and Jolien Tol and Paul Hamberg and Marissa Cloos and Kastelijn, {Elisabeth A.} and Borgers, {Jessica S. W.} and Nuij, {Veerle J. A. A.} and Yarne Klaver and Herder, {Gerarda J. M.} and Mutsaers, {Pim G. N. J.} and Dumoulin, {Daphne W.} and {Oomen-de Hoop}, Esther and {van Diemen}, {Nico G. J.} and Libourel, {Eduard J.} and Geraedts, {Erica J.} and Bootsma, {Gerben P.} and {van der Leest}, {Cor H.} and Peerdeman, {Anne L.} and Herbschleb, {Karin H.} and Visser, {Otto J.} and Bloemendal, {Haiko J.} and {van Laarhoven}, {Hanneke W. M.} and {de Vries}, {Elisabeth G. E.} and Hendriks, {Lizza E. L.} and Beerepoot, {Laurens V.} and Westgeest, {Hans M.} and {van den Berkmortel}, {Franchette W. P. J.} and Haanen, {John B. A. G.} and Dingemans, {Anne-Marie C.} and {van der Veldt}, {Astrid A. M.} and A. Becker-Commissaris and F. Terheggen and {van den Borne}, {B. E. E. M.} and {van Warmerdam}, {L. J. C.} and {van Leeuwen}, L. and {van der Meer}, {F. S.} and Tiemessen, {M. A.} and {van Diepen}, {D. M.} and L. Strobbe and Koekkoek, {J. A. F.} and P. Brocken and Drooger, {J. C.} and R. Heller and {de Groot}, {J. W. B.} and Stigt, {J. A.} and Pitz, {C. C. M.} and M. Slingerland and Borm, {F. J.} and Haberkorn, {B. C. M.} and {van 't Westeinde}, {S. C.} and Aarts, {M. J. B.} and {van Putten}, {J. W. G.} and M. Youssef and Cirkel, {G. A.} and {van Rooijen}, {C. R.} and E. Citgez and Barlo, {N. P.} and Scholtes, {B. M. J.} and Koornstra, {R. H. T.} and Claessens, {N. J. M.} and Faber, {L. M.} and Rikers, {C. H.} and {van de Wetering}, {R. A. W.} and Veurink, {G. L.} and Bouter, {B. W.} and I. Houtenbos and Bard, {M. P. L.} and G. Douma and M. Jalving and Hiltermann, {T. J. N.} and Schuurbiers-Siebers, {O. C. J.} and Suijkerbuijk, {K. P. M.} and {van Lindert}, {A. S. R.} and {van de Wouw}, {A. J.} and {van den Boogaart}, {V. E. M.} and Bakker, {S. D.} and E. Looysen and {de Jong}, {W. K.} and Siemerink, {E. J. M.} and Staal, {A. J.} and B. Franken and {van Geffen}, {W. H.}",

note = "Funding Information: This study was supported by a grant from the Dutch Cancer Society , a non-profit organisation. The Dutch Cancer Society had no role in study design, data collection, data analysis, data interpretation or writing of the report. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = jan,

doi = "https://doi.org/10.1016/j.ejca.2021.10.009",

language = "English",

volume = "160",

pages = "261--272",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "Elsevier Limited",

}

de Joode, K, Tol, J, Hamberg, P, Cloos, M, Kastelijn, EA, Borgers, JSW, Nuij, VJAA, Klaver, Y, Herder, GJM, Mutsaers, PGNJ, Dumoulin, DW, Oomen-de Hoop, E, van Diemen, NGJ, Libourel, EJ, Geraedts, EJ, Bootsma, GP, van der Leest, CH, Peerdeman, AL, Herbschleb, KH, Visser, OJ, Bloemendal, HJ, van Laarhoven, HWM, de Vries, EGE, Hendriks, LEL, Beerepoot, LV, Westgeest, HM, van den Berkmortel, FWPJ, Haanen, JBAG, Dingemans, A-MC, van der Veldt, AAM, Becker-Commissaris, A, Terheggen, F, van den Borne, BEEM, van Warmerdam, LJC, van Leeuwen, L, van der Meer, FS, Tiemessen, MA, van Diepen, DM, Strobbe, L, Koekkoek, JAF, Brocken, P, Drooger, JC, Heller, R, de Groot, JWB, Stigt, JA, Pitz, CCM, Slingerland, M, Borm, FJ, Haberkorn, BCM, van 't Westeinde, SC, Aarts, MJB, van Putten, JWG, Youssef, M, Cirkel, GA, van Rooijen, CR, Citgez, E, Barlo, NP, Scholtes, BMJ, Koornstra, RHT, Claessens, NJM, Faber, LM, Rikers, CH, van de Wetering, RAW, Veurink, GL, Bouter, BW, Houtenbos, I, Bard, MPL, Douma, G, Jalving, M, Hiltermann, TJN, Schuurbiers-Siebers, OCJ, Suijkerbuijk, KPM, van Lindert, ASR, van de Wouw, AJ, van den Boogaart, VEM, Bakker, SD, Looysen, E, de Jong, WK, Siemerink, EJM, Staal, AJ, Franken, B & van Geffen, WH 2022, 'Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium', European Journal of Cancer, vol. 160, pp. 261-272. https://doi.org/10.1016/j.ejca.2021.10.009

TY - JOUR

T1 - Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19

T2 - an update from the Dutch Oncology COVID-19 Consortium

AU - de Joode, Karlijn

AU - Tol, Jolien

AU - Hamberg, Paul

AU - Cloos, Marissa

AU - Kastelijn, Elisabeth A.

AU - Borgers, Jessica S. W.

AU - Nuij, Veerle J. A. A.

AU - Klaver, Yarne

AU - Herder, Gerarda J. M.

AU - Mutsaers, Pim G. N. J.

AU - Dumoulin, Daphne W.

AU - Oomen-de Hoop, Esther

AU - van Diemen, Nico G. J.

AU - Libourel, Eduard J.

AU - Geraedts, Erica J.

AU - Bootsma, Gerben P.

AU - van der Leest, Cor H.

AU - Peerdeman, Anne L.

AU - Herbschleb, Karin H.

AU - Visser, Otto J.

AU - Bloemendal, Haiko J.

AU - van Laarhoven, Hanneke W. M.

AU - de Vries, Elisabeth G. E.

AU - Hendriks, Lizza E. L.

AU - Beerepoot, Laurens V.

AU - Westgeest, Hans M.

AU - van den Berkmortel, Franchette W. P. J.

AU - Haanen, John B. A. G.

AU - Dingemans, Anne-Marie C.

AU - van der Veldt, Astrid A. M.

AU - Becker-Commissaris, A.

AU - Terheggen, F.

AU - van den Borne, B. E. E. M.

AU - van Warmerdam, L. J. C.

AU - van Leeuwen, L.

AU - van der Meer, F. S.

AU - Tiemessen, M. A.

AU - van Diepen, D. M.

AU - Strobbe, L.

AU - Koekkoek, J. A. F.

AU - Brocken, P.

AU - Drooger, J. C.

AU - Heller, R.

AU - de Groot, J. W. B.

AU - Stigt, J. A.

AU - Pitz, C. C. M.

AU - Slingerland, M.

AU - Borm, F. J.

AU - Haberkorn, B. C. M.

AU - van 't Westeinde, S. C.

AU - Aarts, M. J. B.

AU - van Putten, J. W. G.

AU - Youssef, M.

AU - Cirkel, G. A.

AU - van Rooijen, C. R.

AU - Citgez, E.

AU - Barlo, N. P.

AU - Scholtes, B. M. J.

AU - Koornstra, R. H. T.

AU - Claessens, N. J. M.

AU - Faber, L. M.

AU - Rikers, C. H.

AU - van de Wetering, R. A. W.

AU - Veurink, G. L.

AU - Bouter, B. W.

AU - Houtenbos, I.

AU - Bard, M. P. L.

AU - Douma, G.

AU - Jalving, M.

AU - Hiltermann, T. J. N.

AU - Schuurbiers-Siebers, O. C. J.

AU - Suijkerbuijk, K. P. M.

AU - van Lindert, A. S. R.

AU - van de Wouw, A. J.

AU - van den Boogaart, V. E. M.

AU - Bakker, S. D.

AU - Looysen, E.

AU - de Jong, W. K.

AU - Siemerink, E. J. M.

AU - Staal, A. J.

AU - Franken, B.

AU - van Geffen, W. H.

N1 - Funding Information: This study was supported by a grant from the Dutch Cancer Society , a non-profit organisation. The Dutch Cancer Society had no role in study design, data collection, data analysis, data interpretation or writing of the report. Publisher Copyright: © 2021 The Authors

PY - 2022/1

Y1 - 2022/1

N2 - Aim of the study: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do-not-resuscitate codes), were studied in patients with cancer and COVID-19. Methods: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID-19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account. Results: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life-prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome. Conclusion: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic.

AB - Aim of the study: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted cancer care. In this study, clinical patient characteristics related to COVID-19 outcomes and advanced care planning, in terms of non-oncological treatment restrictions (e.g. do-not-resuscitate codes), were studied in patients with cancer and COVID-19. Methods: The Dutch Oncology COVID-19 Consortium registry was launched in March 2020 in 45 hospitals in the Netherlands, primarily to identify risk factors of a severe COVID-19 outcome in patients with cancer. Here, an updated analysis of the registry was performed, and treatment restrictions (e.g. do-not-intubate codes) were studied in relation to COVID-19 outcomes in patients with cancer. Oncological treatment restrictions were not taken into account. Results: Between 27th March 2020 and 4th February 2021, 1360 patients with cancer and COVID-19 were registered. Follow-up data of 830 patients could be validated for this analysis. Overall, 230 of 830 (27.7%) patients died of COVID-19, and 60% of the remaining 600 patients with resolved COVID-19 were admitted to the hospital. Patients with haematological malignancies or lung cancer had a higher risk of a fatal outcome than other solid tumours. No correlation between anticancer therapies and the risk of a fatal COVID-19 outcome was found. In terms of end-of-life communication, 50% of all patients had restrictions regarding life-prolonging treatment (e.g. do-not-intubate codes). Most identified patients with treatment restrictions had risk factors associated with fatal COVID-19 outcome. Conclusion: There was no evidence of a negative impact of anticancer therapies on COVID-19 outcomes. Timely end-of-life communication as part of advanced care planning could save patients from prolonged suffering and decrease burden in intensive care units. Early discussion of treatment restrictions should therefore be part of routine oncological care, especially during the COVID-19 pandemic.

KW - Advanced care planning

KW - COVID-19

KW - Cancer

KW - Cancer treatment

KW - Treatment restrictions

UR - http://www.scopus.com/inward/record.url?scp=85119334869&partnerID=8YFLogxK

U2 - https://doi.org/10.1016/j.ejca.2021.10.009

DO - https://doi.org/10.1016/j.ejca.2021.10.009

M3 - Article

C2 - 34799210

SN - 0959-8049

VL - 160

SP - 261

EP - 272

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

Life-prolonging treatment restrictions and outcomes in patients with cancer and COVID-19: an update from the Dutch Oncology COVID-19 Consortium

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