Dereddi Raja Reddy, MD, FACP FCCP
Assistant Professor, Program Director MS4 McGovern Medical School
MD Anderson Cancer Care Center
Houston, Texas
Disclosure information not submitted.
Mayoora Muthu, DO
Assistant Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
John Cuenca, MD (he/him/his)
Clinical Research Assistant
The University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Robert Wegner, MD, FASA
Assistant Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
John Crommett, MD
Associate Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
Cristina Gutierrez, MD
Associate Professor of Critical Care Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Sajid Haque, MD
Associate Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
Joshua Botdorf, DO
Assistant Professor
University of Texas MD Anderson Cancer Center, Texas, United States
Disclosure information not submitted.
Nisha Rathi, MD
Associate Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
Nirmala Manjappachar, MD
Internal Medicine Resident Physician
Anne Arundel Medical Center
Annapolis, MD
Disclosure information not submitted.
Bilja Sajith, MSN, PhD, APRN, (she/her/hers)
Nurse Practitioner - Acute Care Services
The University of Texas MD Anderson Cancer Center
Houston
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Joseph Nates, MBA, MD
Professor, Deputy Chair, Director ICUs
University of Texas MD Anderson Center
Bellaire, Texas, United States
Disclosure information not submitted.
Title: End of Life Care and Clinical Characteristics of Non-survivor Cancer Patients with COVID-19
INTRODUCTION/HYPOTHESIS: Data detailing the end-of-life care (EOL) in cancer patients with COVID-19 is scarce. We conducted an in-depth analysis to characterize the cancer patients with COVID-19 who died during their ICU admission.
Methods: Retrospective cohort of adult cancer non-survivor patients with confirmed SARS-CoV-2 admitted to the hospital between 03/2020-02/2021. We collected baseline demographic and clinical characteristics. We used descriptive statistics to synthesize the characteristics of the included patients.
Results: A total of 551 patients with COVID-19 were admitted to the hospital. Of them, 61 (11%) were non-survivors. The median age was 70 years old (61-76). Most of them were female (61%), white (59%), and had hematological malignancies (61%). Almost half (48%) of the patients had received chemotherapy three months before the admission. At hospital admission, 56% of patients had poor predicted 3-month cancer survival, and the treatment goal was predominantly for life prolongation (53%). During the hospitalization, most patients received corticosteroids (95%) and remdesivir (87%). Convalescent plasma was administered in 39% of patients, tocilizumab in 28%, and anakinra in 20%. Most patients required respiratory support by high-flow oxygen therapy (93%) and invasive mechanical ventilation (54%). Neuromuscular blockade was used in 26% of patients and anticoagulation in 25%. Most (57%) non-survivors required vasopressor therapy, and 18% continuous renal replacement therapy. Due to the baseline oncologic disease, none of the patients were eligible for extracorporeal membrane oxygenation. The median length of stay was 15 days (9-31). Most of the patients were full code (84%) at admission. However, 87% of the patients had active DNR orders at the time of death, and 80% were also transitioned to comfort care. Most of the deaths (89%) were considered a direct consequence of COVID-19.
Conclusions: We found a low in-patient mortality (11%) in this 1-year cohort of cancer patients with COVID-19. However, the EOL care played an important role in their management. Four out of every five non-survivors underwent comfort care before dying. Despite having advanced baseline malignancies, most patients received a trial of aggressive intensive care management with life support before considering any EOL measures.