Dutch Oncology COVID-19 consortium:Outcome of COVID-19 in patients with cancer in a nationwide cohort study

Aim of the study: Patients with cancer might have an increased risk for severe outcome of coronavirus disease 2019 (COVID-19). To identify risk factors associated with a worse outcome of COVID-19, a nationwide registry was developed for patients with cancer and COVID-19. Methods: This observational cohort study has been designed as a quality of care registry and is executed by the Dutch Oncology COVID-19 Consortium (DOCC), a nationwide collaboration of oncology physicians in the Netherlands. A questionnaire has been developed to collect pseudonymised patient data on patients' characteristics, cancer diagnosis and treatment. All patients with COVID-19 and a cancer diagnosis or treatment in the past 5 years are eligible. Results: Between March 27th and May 4th, 442 patients were registered. For this first analysis, 351 patients were included of whom 114 patients died. In multivariable analyses, age ≥65 years (p < 0.001), male gender (p = 0.035), prior or other malignancy (p = 0.045) and active diagnosis of haematological malignancy (p = 0.046) or lung cancer (p = 0.003) were independent risk factors for a fatal outcome of COVID-19. In a subgroup analysis of patients with active malignancy, the risk for a fatal outcome was mainly determined by tumour type (haematological malignancy or lung cancer) and age (≥65 years). Conclusion: The findings in this registry indicate that patients with a haematological malignancy or lung cancer have an increased risk of a worse outcome of COVID-19. During the ongoing COVID-19 pandemic, these vulnerable patients should avoid exposure to severe acute respiratory syndrome coronavirus 2, whereas treatment adjustments and prioritising vaccination, when available, should also be considered

Neoadjuvant chemoradiotherapy plus surgery versus active surveillance for oesophageal cancer: A stepped-wedge cluster randomised trial

Background: Neoadjuvant chemoradiotherapy (nCRT) plus surgery is a standard treatment for locally advanced oesophageal cancer. With this treatment, 29% of patients have a pathologically complete response in the resection specimen. This provides the rationale for investigating an active surveillance approach. The aim of this study is to assess the (cost-)effectiveness of active surveillance vs. standard oesophagectomy after nCRT for oesophageal cancer. Methods: This is a phase-III multi-centre, stepped-wedge cluster randomised controlled trial. A total of 300 patients with clinically complete response (cCR, i.e. no local or disseminated disease proven by histology) after nCRT will be randomised to show non-inferiority of active surveillance to standard oesophagectomy (non-inferiority margin 15%, intra-correlation coefficient 0.02, power 80%, 2-sided α 0.05, 12% drop-out). Patients will undergo a first clinical response evaluation (CRE-I) 4-6 weeks after nCRT, consisting of endoscopy with bite-on-bite biopsies of the primary tumour site and other suspected lesions. Clinically complete responders will undergo a second CRE (CRE-II), 6-8 weeks after CRE-I. CRE-II will include 18F-FDG-PET-CT, followed by endoscopy with bite-on-bite biopsies and ultra-endosonography plus fine needle aspiration of suspected lymph nodes and/or PET- positive lesions. Patients with cCR at CRE-II will be assigned to oesophagectomy (first phase) or active surveillance (second phase of the study). The duration of the first phase is determined randomly over the 12 centres, i.e., stepped-wedge cluster design. Patients in the active surveillance arm will undergo diagnostic evaluations similar to CRE-II at 6/9/12/16/20/24/30/36/48 and 60 months after nCRT. In this arm, oesophagectomy will be offered only to patients in whom locoregional regrowth is highly suspected or proven, without distant dissemination. The main study parameter is overall survival; secondary endpoints include percentage of patients who do not undergo surgery, quality of life, clinical irresectability (cT4b) rate, radical resection rate, postoperative complications, progression-free survival, distant dissemination rate, and cost-effectiveness. We hypothesise that active surveillance leads to non-inferior survival, improved quality of life and a reduction in costs, compared to standard oesophagectomy. Discussion: If active surveillance and surgery as needed after nCRT leads to non-inferior survival compared to standard oesophagectomy, this organ-sparing approach can be implemented as a standard of care

Changes in body weight in patients with colorectal cancer treated with surgery and adjuvant chemotherapy: An observational study

Background and objectives Prevalence of overweight and obesity is high among colorectal cancer patients upon diagnosis. Body weight may change substantially during treatment for colorectal cancer. In this study, we describe changes in body weight in colorectal cancer patients during three periods: the period of surgery, during adjuvant chemotherapy and during oncological follow-up; in addition, we assess which clinical/personal factors were associated with weight change. Subject/Methods 485 stage II/III colorectal cancer patients diagnosed between 2007 and 2012 and treated with surgery and adjuvant chemotherapy in three hospitals in the Netherlands were identified through the Netherlands Cancer Registry. Data on changes in body weight were retrieved from medical records. Results Over the period of surgery, patients on average lost weight (mean −1.9 kg, SD 4.6 kg) (n=357). Weight increased during chemotherapy (2.9 kg, SD 5.8 kg) (n=291) and increased during oncological follow-up (2.2 kg, SD 6.6 kg) (n=242). Mean weight change over the total period was +2.0 kg (SD 6.8 kg) (n=283). Factors univariately associated with weight gain were normal BMI (vs a BMI of 25–30), open surgery (vs laparoscopic surgery) and Capecitabine monotherapy (vs Capecitabine plus Oxaliplatin). In a multivariate model, factors were no longer associated with weight gain. Conclusions Body weight generally decreased during surgery and increased during and after chemotherapy. During oncological follow-up, body weight generally was higher than upon diagnosis. Studies among other patient groups suggest that weight changes may primarily affect muscle mass, and may lead to e.g. sarcopenic obesity. Future prospective studies are needed to explore this in colorectal cancer patients

Changes in body weight in patients with colorectal cancer treated with surgery and adjuvant chemotherapy: An observational study

Background and objectives Prevalence of overweight and obesity is high among colorectal cancer patients upon diagnosis. Body weight may change substantially during treatment for colorectal cancer. In this study, we describe changes in body weight in colorectal cancer patients during three periods: the period of surgery, during adjuvant chemotherapy and during oncological follow-up; in addition, we assess which clinical/personal factors were associated with weight change. Subject/Methods 485 stage II/III colorectal cancer patients diagnosed between 2007 and 2012 and treated with surgery and adjuvant chemotherapy in three hospitals in the Netherlands were identified through the Netherlands Cancer Registry. Data on changes in body weight were retrieved from medical records. Results Over the period of surgery, patients on average lost weight (mean −1.9 kg, SD 4.6 kg) (n=357). Weight increased during chemotherapy (2.9 kg, SD 5.8 kg) (n=291) and increased during oncological follow-up (2.2 kg, SD 6.6 kg) (n=242). Mean weight change over the total period was +2.0 kg (SD 6.8 kg) (n=283). Factors univariately associated with weight gain were normal BMI (vs a BMI of 25–30), open surgery (vs laparoscopic surgery) and Capecitabine monotherapy (vs Capecitabine plus Oxaliplatin). In a multivariate model, factors were no longer associated with weight gain. Conclusions Body weight generally decreased during surgery and increased during and after chemotherapy. During oncological follow-up, body weight generally was higher than upon diagnosis. Studies among other patient groups suggest that weight changes may primarily affect muscle mass, and may lead to e.g. sarcopenic obesity. Future prospective studies are needed to explore this in colorectal cancer patients.</p