Background The COVID-19 pandemic has seen a wealth of research examining the features of the disease. While large multicentre studies have detailed the implications of a cancer diagnosis and systemic anti-cancer therapy on mortality, little has been published regarding the end-of-life experiences for cancer patients dying COVID-19.
Aims To review the end-of-life care (EOLC) for patients with COVID-19 at 2 UK cancer centres.
Methods Prescriptions of anticipatory medications, opioids and continuous subcutaneous infusions of all non-ventilated inpatient deaths, n=28.
Results The mean age was 67 (45–89), most patients were male and white British (18). 10 patients had recognised risk factors of cardiovascular disease and diabetes. 18 patients had metastatic disease and 23 were receiving palliative treatment. The most commonly recorded tumour type was GI (8). 12 patients were referred to palliative care (PC) for symptom control, while 10 were referred for EOLC. The mean number of PC reviews was 3.29 (range 0–10). Baseline IPOS scores on initial assessment at one centre (N=15), recorded the main symptoms as breathlessness, weakness and anxiety. Family anxiety was the highest scoring aspect of the IPOS. The medical management at the end-of-life was, however, generally uncomplicated; the total opioid (oral morphine equivalent) and benzodiazepine doses administered in last 24 hours before death were relatively low, median dose(range) 31.25 mg (5–160 mg) and 15 mg (0–30 mg) respectively.
Conclusions Should a further surge of COVID-19 cases occur, many cancer patients dying with COVID-19 could be appropriately managed by non-specialist physicians supported by comprehensive guidelines, ward-based teaching and specialist palliative care input for more complex cases. High levels of family anxiety could be improved by enhanced family support and communication about end-of-life wishes and priorities; healthcare services should have a particular focus on supporting the shadow pandemic of loss.
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