The impact of COVID-19 on the delivery of systemic anti-cancer treatment at Guy's Cancer Centre

Background: Early reports in the COVID-19 pandemic suggested higher mortality for cancer patients. The impact of potentially immunosuppressive systemic anti-cancer treatments (SACT) was unknown. This study analysed the delivery of SACT for patients with solid malignancies during the COVID-19 outbreak in 2020 compared to the same period in 2019 to inform future clinical decision-making. Methods: All patients receiving at least one SACT at Guy's comprehensive Cancer Centre during the COVID-19 outbreak for solid tumours (1st March- 31st May 2020) were compared to the same period in 2019. SARS-CoV2 infection was by positive RT-PCR test. Data collected: demographics, tumour type/stage and treatment (chemotherapy, immunotherapy (IO), biological-targeted (BT)). Results: 2125 patients received SACT in 2020, compared to 2450 in 2019 (13% decrease). Demographics were comparable with mean age of 62. 56% females in 2020 vs 54% in 2019, 85% vs 83% in the low socio-economic category, 63% vs 73% PS 0-1;30% vs 29% uro-gynaecological, 27% vs 24% breast and 20% vs 23% GI tumours. In 2020 compared to 2019, there was an increase in metastatic disease (71% vs 62%), decrease in CT (34% vs 42%), increase in IO (10% vs 6%), but similar rates of BT treatments (38% vs 37%). Treatment paradigms were similar in 2020 and 2019: neo/adjuvant (28% vs 29%), radical (4% vs 5%) and palliative (69% vs 67%). Earlier palliative treatments were prioritised in 2020 with significant increase in treatments in 1st-2nd line (72% vs 67%;p=0.02) and reduction in > 3rd line (12% vs 27%;p<0.05). 42 of 2125 patients (2%) developed SARS-CoV2 infections;38% GI, 26% breast with 69% on CT. Of 42 patients with COVID-19, 24 (57%) had severe infections and 6 (14%) resulted in COVID-related death. Conclusions: These data suggest that SACT does not put solid tumour patients at much a higher additional risk from COVID-19. Despite a 13% decline in treatment rates, radical and early palliative treatment were prioritised. There was a low frequency (2%) of SARS-CoV-2 infection;comparable to the 1.4% point prevalence rate in our cancer population. However, this was during national lockdown with limited COVID-19 testing. The next steps are to evaluate the impact of new variant strains and COVID vaccination programme. Legal entity responsible for the study: Guy's Real-World Evidence. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.