Explore the vast range of titles available.

IntroductionACP is a process of documenting a patient’s preferences and priorities for future care.1 ACPs reduce avoidable hospital admissions and improve patient and family satisfaction.2 3 The need for improved training in ACP and the importance of shared electronic records has been highlighted,4e.g. the Universal Care Plan (UCP).5 AimsEvaluate the prevalence of existing UCPs for patients with GI cancers who attend Medical Oncology clinics at Guy’s Cancer Centre to assess the prevalence of ACP discussions in these patients.MethodsA retrospective audit was conducted of 156 patients living in Greater London who attended GI Medical Oncology clinics week commencing 16/01/2023. Electronic hospital records and the OneLondon UCP portal were reviewed. A retrospective 6-month period was used for inpatient data.Results84% of patients were on active treatment. Of those, 73% were treated with palliative intent. 7% had ACP discussions in the oncology outpatient clinic, and all were treated with palliative intent. 14.7% patients had been admitted under Oncology at Guy’s in the preceding 6 months: 13% of these were involved in ACP discussions during the admission. 9.6% of patients were found to have an existing ACP documented on UCP. Palliative care specialists completed the majority of UCPs (≥60%). 40% of patients with an existing UCP were involved in ACP discussions during clinic appointments. Despite this, only one patient’s UCP was noted in clinic documentation.ConclusionThe majority of the patients sampled did not have an ACP discussion in clinic. Even amongst those with UCP in place, their wishes for ACP were not frequently reviewed.ImpactAwareness of the UCP platform, and how clinic staff can document and review ACP discussions here, is recommended. This audit informs an educational programme to encourage ACP discussions in oncology clinics.ReferencesUniversal Principles for Advance Care Planning (ACP) First published March 2022Abel J, et al. The impact of advance care planning of place of death, a hospice retrospective cohort study. 2013;3(2):168–73.Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. Bmj. 2010 Mar 24;340. Available at: https://doi.org/10.1136/bmj. c1345Marie Curie, The Better End of Life Report 2022. https://www.onelondon.online/urgent-care-plan/

The COVID-19 pandemic has led to a range of novel and adaptive research designs. In this perspective, we use our experience coordinating the National COVID Cancer Antibody Survey to demonstrate how a balance between speed and integrity can be achieved within a hyper-accelerated study design. Using the COVID-19 pandemic as an example, we show this approach is necessary in the face of uncertain and evolving situations wherein reliable information is needed in a timely fashion to guide policy. We identify streamlined participant involvement, healthcare systems integration, data architecture and real-world real-time analytics as key areas that differentiate this design from traditional cancer trials, and enable rapid results. Caution needs to be taken to avoid the exclusion of patient subgroups without digital access or literacy. We summarise the merits and defining features of hyper-accelerated cancer studies.

Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission.

An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.