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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.

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Topic Significance & Study Purpose/Background/Rationale: BMT recipients aged 65 years or older comprise 30% of patients at this large academic health system. BMT protocols commonly use medications at standardized doses often bringing about the need for aggressive symptom management. Lorazepam, prochlorperazine, promethazine and diphenhydramine are frequently used to treat the nausea, vomiting and diarrhea which often follow BMT conditioning regimens. Literature indicates that geriatric individuals are at a greater risk for medication-related adverse events as described per BEERS and STOP/START criteria. The Silver Star initiative was established as a process for identifying patients and prompting discussion amongst the multidisciplinary team members with regards to the adjustment of medication dosages in an effort to minimize and/or prevent potential medication-related issues in the older transplant patient population. Methods, Intervention, & Analysis: The program entails: Identify patients 65 years of age or older by the use of a silver star on the unit census board and the patient room Provide written information regarding medications and Silver Star awareness to patients on initial encounter Review on admission and daily rounds scheduled and PRN medications to identify potential opportunities to minimize the risk of adverse events in the older population Prompt discussion among nursing staff, extenders, physicians and pharmacist, with emphasis concerning the use and doses of lorazepam, prochlorperazine, promethazine and diphenhydramine as well as other potential medications of concern

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