1457P The end-of-life experiences for cancer patients with COVID-19 across the two peak pandemic waves

Abstract

Background: The COVID-19 (C-19) pandemic has seen much research scrutinising the impact of C-19 on cancer patients, focusing on understanding the impact of a cancer diagnosis and anti-cancer treatments on mortality. Yet there is paucity of work regarding the end-of-life care (EOLC) for cancer patients dying with C-19. Methods: Retrospective record review of all non-ventilated patients who died in a tertiary referral UK cancer centre with known or suspected C-19 across the 2 peak pandemic waves from 25/03/20 – 01/05/20 and 05/12/20 – 01/03/21. Demographics and risk factors for severe C-19 were described. EOLC assessment considered palliative care (PC) needs, medications prescribed and advance care plans including Treatment Escalation Plans (TEP) and Do Not Attempt Resuscitation (DNAR) orders. Results: 34 patients were included. Most patients were female (18) and White British (19), mean age was 69 (45-82). 8 patients had recognised cardiovascular risk factors;11 patients had no comorbidities additional to cancer. 26 patient had metastatic disease, 30 were receiving palliative treatment. Most patients were referred to PC for symptom control (20), 8 were referred for EOLC. All patients had DNAR orders and TEPs. The median number of PC reviews was 5 (range 1-24). Integrated Palliative Outcome Scale (IPOS) (a holistic assessment tool used in clinical care) scores on first assessment (n=24) recorded the main symptoms as weakness, lacking peace and anxiety. Family anxiety was the highest scoring aspect. Medical management at the end-of-life was, however, generally uncomplicated;total opioid (oral morphine equivalent) and benzodiazepine doses administered in last 24 hours before death were relatively low, median dose (range) 30mg (5-180 mg) and 10mg (0-30mg) respectively. Conclusions: With prompt recognition and access to standard EOLC, the symptom management of cancer patients dying from C-19 is relatively uncomplicated. As a transmissible disease, associated with social anxiety and restrictions, death from C-19 is, however, undeniably complicated. Timely acknowledgment of the vulnerability of patients with advanced cancer and C-19 is essential to facilitate early communication about patients’ priorities and wishes, and enhance family support. Legal entity responsible for the study: The Royal Marsden NHS Foundation Trust. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.