Risk of death of cancer patients presenting with severe symptoms of infection, with or without documented COVID-19

We would like to thank Dr van Dam and colleagues (1) for their letter and the careful attention they dedicated to our work (2).We want first to express our full agreement to their conclusion stating that cancer patients must « have maximal access to (adapted) treatment and if necessary maximal supportive care in times of SARS-CoV-2 pandemic ». Indeed, the COVID-19 epidemic is affecting deeply the care of patients with cancer for at least three reasons. The first one is the delay to treatment that had to be given at the spike of the COVID-19 outbreak (in our case in the period of March to April 2020). These delays were requested 1) to cope with the concentration of healthcare resources on the epidemic, and 2) also often at patient request who feared to come to the health care services. Reports of delayed treatments were issued in many countries from known cancer patients already followed by multidisciplinary services (3). In the period reported in our work, this effect was of limited magnitude in the center from which the patients were recruited. An increase in the number of patients receving cancer treatment at home (+452%, n=181 vs n=40 as compared to the 8 previous weeks of 2020), with an increase of teleconsultations (+24550%, n=5886 vs n=24 in the previous 8 weeks of 2020). The access to ICU for cancer patients was never limited in our region, in contrast with other region in our country our in Europe. Although a longer follow-up will be needed to investigate the long term outcome of cancer patients in this time period, such delays are unlikely to have affected the survival of the patients in our series. The second one, delays to the access to initial diagnosis and initial treatment, reported also in several countries, are associated with a maximal risk of increased deaths for curable patients. While the magnitude of increased risk of deaths varies considerably across cancer types, an 6 to 15% increase risk of death related delay to diagnosis and treatment suggested by recent studies (3,4). In 9 centres of the French Unicancer Federation (Ms in preparation), a mean reduction of 36% of new incident cancer diagnosis was observed in this period of 8 weeks leading to estimates similar to those in the work of Maringe et al (3). Here again, the impact on the long term outcome of cancer patients will require additional years of follow-up. (…)

European Journal of Cancer , article en libre accès, 2019

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