Palliative care to cancer patients: how COVID-19 pandemic could affect quality of care

ABSTRACT Objective To evaluate the impact of COVID-19 pandemic on the care delivered to hospitalized cancer patients in end-of-life. Methods A retrospective analysis of data of hospitalized patients with advanced solid tumors, who died under exclusive palliative care during first wave (March 2020 to July 2020) compared with the period previous pandemic (January 2018 to February 2020). Results A total of 190 oncologic patients were included, 161 patients before the pandemic, and 29 in the period from March 2020 to July 2020. The average hospitalization was 497.2 patients per month, before the pandemic, and dropped to an average of 46.5 in the pandemic, whereas the death rate decreased from an average of 6.3 patients per month to 4.8. Considering the benchmarks for quality of care during end-of-life care, preferences on life assistance were discussed prior to hospitalization for 34.4%, before the pandemic, and 13.8% during the pandemic (p=0.0298); 9.3% received chemotherapy 15 days prior to the date of death, before the pandemic, and 20.7%, in the pandemic (p=0.1012). Conclusion Based on the present results, despite the decrease in oncology admissions, the advanced-stage cancer patients continued to seek hospital for end-of-life care. However, we could observe in our benchmarking analyses for palliative quality of care that talks about prognosis occurred less often during the pandemic.

摘要
研究目的：评估新型冠状病毒肺炎（COVID-19）疫情对住院晚期肿瘤患者临终关怀的影响。
研究方法：本研究对2020年3月至7月第一波疫情期间，仅接受姑息治疗（palliative care）后去世的晚期实体瘤住院患者的临床数据进行回顾性分析（retrospective analysis），并与疫情前期（2018年1月至2020年2月）的同类患者数据进行对照。
研究结果：本研究共纳入190例肿瘤患者，其中疫情前期161例，2020年3月至7月期间29例。疫情前期月均住院患者数为497.2例，疫情期间降至月均46.5例；而月均死亡数则从6.3例降至4.8例。参照临终关怀护理质量评价基准，疫情前期有34.4%的患者在住院前已讨论过生命支持意愿，疫情期间该比例仅为13.8%（p=0.0298）；疫情前期有9.3%的患者在死亡前15天内接受了化疗，疫情期间该比例升至20.7%（p=0.1012）。
研究结论：基于本研究结果，尽管肿瘤收治入院人数有所下降，但晚期肿瘤患者仍会前往医院寻求临终关怀服务。然而，通过姑息治疗护理质量基准分析可见，疫情期间关于预后的沟通频次有所减少。