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Lewis PJ, Morris EJA, Chan CSK, Darley K, Sebag-Montefiore D, Evans M. COVID RT - Assessing the Impact of COVID-19 on Radiotherapy in the UK. A National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group Initiative in Partnership with the Royal College of Radiologists, the Society of Radiographers and the Institute of Physics and Engineering in Medicine. Clin Oncol (R Coll Radiol) 2021; 33:e69-e72. [PMID: 32950351 PMCID: PMC7467021 DOI: 10.1016/j.clon.2020.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022]
Affiliation(s)
- P J Lewis
- NHS England; Royal College of Radiologists, London, UK.
| | - E J A Morris
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - C S K Chan
- National Cancer Research Institute, London, UK
| | - K Darley
- Royal College of Radiologists, London, UK
| | | | - M Evans
- Velindre University NHS Trust, Cardiff, UK
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Fountain DM, Piper RJ, Poon MTC, Solomou G, Brennan PM, Chowdhury YA, Colombo F, Elmoslemany T, Ewbank FG, Grundy PL, Hasan MT, Hilling M, Hutchinson PJ, Karabatsou K, Kolias AG, McSorley NJ, Millward CP, Phang I, Plaha P, Price SJ, Rominiyi O, Sage W, Shumon S, Silva IL, Smith SJ, Surash S, Thomson S, Lau JY, Watts C, Jenkinson MD. CovidNeuroOnc: A UK multicenter, prospective cohort study of the impact of the COVID-19 pandemic on the neuro-oncology service. Neurooncol Adv 2021; 3:vdab014. [PMID: 34056602 PMCID: PMC7928638 DOI: 10.1093/noajnl/vdab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly affected cancer services. Our objective was to determine the effect of the COVID-19 pandemic on decision making and the resulting outcomes for patients with newly diagnosed or recurrent intracranial tumors. METHODS We performed a multicenter prospective study of all adult patients discussed in weekly neuro-oncology and skull base multidisciplinary team meetings who had a newly diagnosed or recurrent intracranial (excluding pituitary) tumor between 01 April and 31 May 2020. All patients had at least 30-day follow-up data. Descriptive statistical reporting was used. RESULTS There were 1357 referrals for newly diagnosed or recurrent intracranial tumors across 15 neuro-oncology centers. Of centers with all intracranial tumors, a change in initial management was reported in 8.6% of cases (n = 104/1210). Decisions to change the management plan reduced over time from a peak of 19% referrals at the start of the study to 0% by the end of the study period. Changes in management were reported in 16% (n = 75/466) of cases previously recommended for surgery and 28% of cases previously recommended for chemotherapy (n = 20/72). The reported SARS-CoV-2 infection rate was similar in surgical and non-surgical patients (2.6% vs. 2.4%, P > .9). CONCLUSIONS Disruption to neuro-oncology services in the UK caused by the COVID-19 pandemic was most marked in the first month, affecting all diagnoses. Patients considered for chemotherapy were most affected. In those recommended surgical treatment this was successfully completed. Longer-term outcome data will evaluate oncological treatments received by these patients and overall survival.
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Affiliation(s)
- Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Michael T C Poon
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Paul M Brennan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yasir A Chowdhury
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesca Colombo
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Tarek Elmoslemany
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - Frederick G Ewbank
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul L Grundy
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Md T Hasan
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Molly Hilling
- Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Konstantina Karabatsou
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | | | | | - Isaac Phang
- Department of Neurosurgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Stephen J Price
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Ola Rominiyi
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - William Sage
- Department of Neurosurgery, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Syed Shumon
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Ines L Silva
- Department of Neurosurgery, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Stuart J Smith
- Department of Neurosurgery, School of Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Surash Surash
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Simon Thomson
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Jun Y Lau
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Colin Watts
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genome Sciences, University of Birmingham, Birmingham, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
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303
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Pathak S, Narurkar R, Khan MH, Jiang B, Soe MNC, Hwang C, Muppidi M, Aronow WS. Continuing cancer care delivery during the peak of COVID-19 in the Bronx, New York: experience from a public teaching hospital. Arch Med Sci 2021; 17:1109-1113. [PMID: 34336039 PMCID: PMC8314406 DOI: 10.5114/aoms/136299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We report our experience with cancer care delivery during the peak of COVID-19 pandemic in New York City. METHODS Retrospective analysis of the patients treated from the 1st of March, 2020 to the 8th of May, 2020. RESULTS Team huddles, infection screening and patient selection strategies were implemented. One hundred and seventy patients were treated in 576 visits. Six developed severe COVID-19 requiring hospitalization, two died. Their median Charlson Comorbidity Index was 9, higher than the rest of the cohort. CONCLUSIONS Cancer care delivery is safe and feasible using an approach focused on careful patient selection, team communication and infection control.
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Affiliation(s)
- Surabhi Pathak
- Division of Hematology-Oncology, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Roshni Narurkar
- Division of Hematology-Oncology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Mohammed Hasan Khan
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Bei Jiang
- Department of Internal Medicine, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - May Nyein Chann Soe
- Department of Internal Medicine, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Caroline Hwang
- Division of Hematology-Oncology, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Monica Muppidi
- Division of Hematology-Oncology, New York City Health and Hospital Corporation/Lincoln Medical and Mental Health Center, the Bronx, New York, USA
| | - Wilbert S. Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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304
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Araujo SEA, Leal A, Centrone AFY, Teich VD, Malheiro DT, Cypriano AS, Cendoroglo Neto M, Klajner S. Impact of COVID-19 pandemic on care of oncological patients: experience of a cancer center in a Latin American pandemic epicenter. EINSTEIN-SAO PAULO 2020; 19:eAO6282. [PMID: 33338192 PMCID: PMC7793126 DOI: 10.31744/einstein_journal/2021ao6282] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022] Open
Abstract
Objective Since the rising of coronavirus disease 2019 (COVID-19) pandemic, there is uncertainty regarding the impact of transmission to cancer patients. Evidence on increased severity for patients undergoing antineoplastic treatment is posed against deferring oncologic treatment. We aimed to evaluate the impact of COVID-19 pandemic on patient volumes in a cancer center in an epicenter of the pandemic. Methods Outpatient and inpatient volumes were extracted from electronic health record database. Two intervals were compared: pre-COVID-19 (March to May 2019) and COVID-19 pandemic (March to May 2020) periods. Results The total number of medical appointments declined by 45% in the COVID-19 period, including a 56.2% decrease in new visits. There was a 27.5% reduction in the number of patients undergoing intravenous systemic treatment and a 57.4% decline in initiation of new treatments. Conversely, there was an increase by 309% in new patients undergoing oral chemotherapy regimens and a 5.9% rise in new patients submitted to radiation therapy in the COVID-19 period. There was a 51.2% decline in length of stay and a 60% reduction in the volume of surgical cases during COVID-19. In the stem cell transplant unit, we observed a reduction by 36.5% in length of stay and a 62.5% drop in stem cell transplants. Conclusion A significant decrease in the number of patients undergoing cancer treatment was observed after COVID-19 pandemic. Although this may be partially overcome by alternative therapeutic options, avoiding timely health care due to fear of getting COVID-19 infection might impact on clinical outcomes. Our findings may help support immediate actions to mitigate this hypothesis.
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Affiliation(s)
| | | | | | | | | | | | | | - Sidney Klajner
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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305
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Wu JTY, Kwon DH, Glover MJ, Henry S, Wood D, Rubin DL, Koshkin VS, Schapira L, Shah SA. Changes in Cancer Management due to COVID-19 Illness in Patients with Cancer in Northern California. JCO Oncol Pract 2020; 17:e377-e385. [PMID: 33332170 PMCID: PMC8462649 DOI: 10.1200/op.20.00790] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The response to the COVID-19 pandemic has affected the management of patients with cancer. In this pooled retrospective analysis, we describe changes in management patterns for patients with cancer diagnosed with COVID-19 in two academic institutions in the San Francisco Bay Area. MATERIALS AND METHODS Adult and pediatric patients diagnosed with COVID-19 with a current or historical diagnosis of malignancy were identified from the electronic medical record at the University of California, San Francisco, and Stanford University. The proportion of patients undergoing active cancer management whose care was affected was quantified and analyzed for significant differences with regard to management type, treatment intent, and the time of COVID-19 diagnosis. The duration and characteristics of such changes were compared across subgroups. RESULTS A total of 131 patients were included, of whom 55 were undergoing active cancer management. Of these, 35 of 55 (64%) had significant changes in management that consisted primarily of delays. An additional three patients not undergoing active cancer management experienced a delay in management after being diagnosed with COVID-19. The decision to change management was correlated with the time of COVID-19 diagnosis, with more delays identified in patients treated with palliative intent earlier in the course of the pandemic (March/April 2020) compared with later (May/June 2020) (OR, 4.2; 95% CI, 1.03 to 17.3; P = .0497). This difference was not seen among patients treated with curative intent during the same timeframe. CONCLUSION We found significant changes in the management of cancer patients with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.
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Affiliation(s)
- Julie Tsu-Yu Wu
- Department of Medical Oncology, Stanford University, Stanford, CA
| | - Daniel H Kwon
- Department of Medical Oncology, University of California, San Francisco, San Francisco, CA
| | - Michael J Glover
- Department of Internal Medicine, Stanford University, Stanford, CA
| | - Solomon Henry
- Department of Biomedical Data Science, Stanford University, Stanford, CA
| | - Douglas Wood
- Department of Biomedical Data Science, Stanford University, Stanford, CA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, CA
| | - Vadim S Koshkin
- Department of Medical Oncology, University of California, San Francisco, San Francisco, CA
| | - Lidia Schapira
- Department of Medical Oncology, Stanford University, Stanford, CA
| | - Sumit A Shah
- Department of Medical Oncology, Stanford University, Stanford, CA
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306
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Long-term Overall Survival Outcomes in Patients with Early Stage, Peripherally Located, Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiotherapy in a Non-academic Cancer Centre. Clin Oncol (R Coll Radiol) 2020; 33:283-291. [PMID: 33341333 DOI: 10.1016/j.clon.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/30/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
AIMS To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.
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307
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Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital. Eur Arch Otorhinolaryngol 2020; 278:3417-3423. [PMID: 33320294 PMCID: PMC7736669 DOI: 10.1007/s00405-020-06519-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/23/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has a major impact on the diagnosis and treatment of ENT patients. The aim of this study was to analyze the influence of the pandemic on the number of otolaryngological procedures, particularly for critical diagnoses with potential negative effects due to prolonged symptom duration. METHODS We evaluated 10,716 surgical procedures between January 1, 2018 and May 31, 2020, focusing on the 16-week period around March 16, 2020, which includes 1080 observations. We further analyzed subsets of critical procedures. RESULTS We found a decline in critical procedures by 43% although no critical procedures were postponed by the hospital. Meanwhile, the share of critical procedures increased up to 90% caused by the cancellation of elective surgery. Especially worrisome was that diagnostic procedures for suspected malignancies decreased by 41% during the pandemic. CONCLUSION The decline in critical procedures in otorhinolaryngology as collateral damage of the COVID-19 pandemic is considerable and therefore alarming.
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308
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Leong TL. Delayed access to lung cancer screening and treatment during the COVID-19 pandemic: Are we headed for a lung cancer pandemic? Respirology 2020; 26:145-146. [PMID: 33325075 DOI: 10.1111/resp.13996] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Tracy L Leong
- Department of Respiratory Medicine, Austin Health, Melbourne, VIC, Australia.,Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
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309
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Zhang JT, Zhong WZ, Wu YL. Cancer treatment in the coronavirus disease pandemic. Lung Cancer 2020; 152:98-103. [PMID: 33373838 PMCID: PMC7832712 DOI: 10.1016/j.lungcan.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022]
Abstract
COVID-19 patients with cancer had increased risk of death and severe outcomes compared to those without cancer. There is no conclusive evidence indicating that antineoplastic treatment aggravates COVID-19 disease There was no significant difference in COVID-19 severity regardless of PD-1 blockade exposure.
Half a year after its emergence, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has resulted in a pandemic, with cases continuing to increase in nearly every country. Surges in coronavirus disease of 2019 (COVID-19) cases have clearly had profound effects on current cancer treatment paradigms. Considering the effect of antineoplastic treatment and the immunosuppressive properties of cancer itself, cancer patients are deemed to be more vulnerable to SARS-CoV-2. Hence, the specific risk of SARS-CoV-2 must be carefully weighed against the benefit of antineoplastic treatment for cancer patients in the COVID-19 era. In this review, we discuss the current evidence in this important field, and in particular, the effect of SARS-CoV-2 on antineoplastic treatment.
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Affiliation(s)
- Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China.
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310
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Patel NG, Reissis D, Mair M, Hart A, Ragbir M, Giele H, Mosahebi A, Ramakrishnan V. Safety of major reconstructive surgery during the peak of the COVID-19 pandemic in the United Kingdom and Ireland - multicentre national cohort study. J Plast Reconstr Aesthet Surg 2020; 74:1161-1172. [PMID: 33402316 PMCID: PMC7733685 DOI: 10.1016/j.bjps.2020.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
Background The safety of surgery during and after the coronavirus disease-2019 (COVID-19) pandemic is paramount. Early reports of excessive perioperative mortality in COVID-positive patients promoted the widespread avoidance of operations. However, cancelling or delaying operations for cancer, trauma, or functional restitution has resulted in increased morbidity and mortality. Methods A national multicentre cohort study of all major reconstructive operations carried out over a 12-week period of the ‘COVID-19 surge’ in the United Kingdom and Ireland was performed. Primary outcome was 30-day mortality and secondary outcome measures were major complications (Clavien-Dindo grade ≥3) and COVID-19 status of patients and healthcare professionals before and after surgery. Results A total of 418 patients underwent major reconstructive surgery with a mean operating time of 7.5 hours and 12 days’ inpatient stay. Cancer (59.8%) and trauma (29.4%) were the most common indications. COVID-19 infection was present in 4.5% of patients. The 30-day post-operative mortality was 0.2%, reflecting the death of one patient who was COVID-negative. Overall complication rate was 20.8%. COVID status did not correlate with major or minor complications. Eight healthcare professionals developed post-operative COVID-19 infection, seven of which occurred within the first three weeks. Conclusions Major reconstructive operations performed during the COVID-19 crisis have been mostly urgent cases involving all surgical specialties. This cohort is a surrogate for all major operations across all surgical specialties. Patient safety and surgical outcomes have been the same as in the pre-COVID era. With adequate precautions, major reconstructive surgery is safe for patients and staff. This study helps counsel patients of COVID-19 risks in the perioperative period.
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Affiliation(s)
- N G Patel
- Consultant Plastic and Reconstructive Surgeon, University Hospitals of Leicester, UK; University of Manitoba, Winnipeg, Canada; Department of Plastic and Reconstructive Surgery, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK.
| | - D Reissis
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK.
| | - M Mair
- Department of Otorhinolaryngology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary Hospital, Infirmary Square, Leicester, LE1 5WW UK
| | - A Hart
- Canniesburn Plastic Surgery Unit, NHS Greater Glasgow & Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF UK.
| | - M Ragbir
- Department of Plastic and Reconstructive Surgery, Newcastle Upon Tyne Hospitals NHS Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK.
| | - H Giele
- Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU UK.
| | - A Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK.
| | - V Ramakrishnan
- Anglia Ruskin University, Chelmsford UK; St Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospital Services NHS Trust, Broomfield Hospital, Court Road, Chelmsford, Essex, CM1 7ET UK.
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311
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How GY, Pua U. Trends of interventional radiology procedures during the COVID-19 pandemic: the first 27 weeks in the eye of the storm. Insights Imaging 2020; 11:131. [PMID: 33296046 PMCID: PMC7724451 DOI: 10.1186/s13244-020-00938-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023] Open
Abstract
Objectives While the Novel Coronavirus (COVID-19) pandemic looks to persist, institutions promote delaying procedures. Understanding trends and demands of interventional radiology (IR) procedures in the infected and COVID-free populations are needed in long-term planning. We detail IR procedure trends in the first 27 weeks of the pandemic and compare with the pre-pandemic era. Methods In this IRB approved retrospective electronic case review, all IR patients in our institution from 1 January to 9 July 2020, the same period in 2019 pre-pandemic and the Severe Acute Respiratory Syndrome (SARS-CoV) outbreak were included. IR procedures were classified using Interventional Radiology—Procedure Acuity Scale (IR-PAS) and category of IR procedures. Along with descriptive frequencies, the Mann–Whitney U test and Chi-square test of independence were performed. Results During the pandemic, 3655 IR procedures were performed compared to 3851 procedures pre-pandemic. No statistically significant difference in weekly IR caseloads across IR-PAS tiers between both periods (p = .088) and category of procedure (p = .054) were noted. General intervention procedures remained the largest proportion and musculoskeletal procedures the minority, in both periods. More general intervention radiology and oncology procedures were performed during the COVID-19 pandemic compared to the SARS-CoV outbreak. Thirty-four (0.93%) IR procedures were performed on 30 COVID-19 patients. There was no IR procedure-related COVID-19 cross-transmission. Conclusions Demand for IR procedures among COVID-free patients remains high, and IR procedures involving COVID-19 represents a fraction of the IR caseload. A sustainable model in providing timely IR services to COVID-free patients needs to be considered.
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Affiliation(s)
- Guo Yuan How
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Uei Pua
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
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312
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Grant JM, Schwartz IS, Laupland KB. Stockholm Syndrome: How to come to peace with our captor. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:209-213. [PMID: 36340055 PMCID: PMC9602877 DOI: 10.3138/jammi-2020-10-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Jennifer M Grant
- Divisions of Medical Microbiology and Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin B Laupland
- Intensive Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
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313
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Ioannidis JPA. Global perspective of COVID-19 epidemiology for a full-cycle pandemic. Eur J Clin Invest 2020; 50:e13423. [PMID: 33026101 PMCID: PMC7646031 DOI: 10.1111/eci.13423] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022]
Abstract
As of October 2020, there are >1 million documented deaths with COVID-19. Excess deaths can be caused by both COVID-19 and the measures taken. COVID-19 shows extremely strong risk stratification across age, socioeconomic factors, and clinical factors. Calculation of years-of-life-lost from COVID-19 is methodologically challenging and can yield misleading over-estimates. Many early deaths may have been due to suboptimal management, malfunctional health systems, hydroxychloroquine, sending COVID-19 patients to nursing homes, and nosocomial infections; such deaths are partially avoidable moving forward. About 10% of the global population may be infected by October 2020. Global infection fatality rate is 0.15-0.20% (0.03-0.04% in those <70 years), with large variability across locations with different age-structure, institutionalization rates, socioeconomic inequalities, population-level clinical risk profile, public health measures, and health care. There is debate on whether at least 60% of the global population must be infected for herd immunity, or, conversely, mixing heterogeneity and pre-existing cross-immunity may allow substantially lower thresholds. Simulations are presented with a total of 1.58-8.76 million COVID-19 deaths over 5-years (1/2020-12/2024) globally (0.5-2.9% of total global deaths). The most favorable figures in that range would be feasible if high risk groups can be preferentially protected with lower infection rates than the remaining population. Death toll may also be further affected by potential availability of effective vaccines and treatments, optimal management and measures taken, COVID-19 interplay with influenza and other health problems, reinfection potential, and any chronic COVID-19 consequences. Targeted, precise management of the pandemic and avoiding past mistakes would help minimize mortality.
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Affiliation(s)
- John P. A. Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta‐Research Innovation Center at Stanford (METRICS)Stanford UniversityStanfordCAUSA
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314
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Shioda K, Weinberger DM, Mori M. Navigating Through Health Care Data Disrupted by the COVID-19 Pandemic. JAMA Intern Med 2020; 180:1569-1570. [PMID: 33044501 DOI: 10.1001/jamainternmed.2020.5542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kayoko Shioda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Makoto Mori
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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315
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Affiliation(s)
- Rosanna Tarricone
- Department of Social and Political Science, Bocconi University
- CERGAS, SDA Bocconi School of Management
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316
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Nunoo-Mensah JW, Giordano P, Chung-Faye G. COVID-19: An Opportunity to Reimagine Colorectal Cancer Diagnostic Testing-A New Paradigm Shift. Clin Colorectal Cancer 2020; 19:227-230. [PMID: 32921580 PMCID: PMC7395219 DOI: 10.1016/j.clcc.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph W Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK; Cleveland Clinic London, London, UK.
| | - Pasquale Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, London, UK
| | - Guy Chung-Faye
- Department of Gastroenterology, King's College Hospital Foundation NHS Trust, London, UK
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317
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Mazzini C, Pieretti G, Vicini G, Nicolosi C, Giattini D, Calamita R, Santoro N, Giansanti F. Ocular oncology service during the COVID-19 outbreak in Florence (Italy): Practical considerations for the management of patients. Eur J Ophthalmol 2020; 31:NP4-NP7. [PMID: 33238727 DOI: 10.1177/1120672120976031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Coronavirus disease 2019 (COVID-19) outbreak has imposed the adoption of strategies to limit the risk of contagion for cancer patients without compromising their healthcare. As well as cancers of other sites, the treatment of certain ocular and periocular malignancies is considered non-deferrable and should proceed despite the pandemic. Delays in treatment of these patients may result in negative outcomes. Herein, we provide some practical considerations deriving from our experience at the Ocular Oncology Unit of Careggi University Hospital (Florence, Italy).
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Affiliation(s)
- Cinzia Mazzini
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Giulia Pieretti
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Giulio Vicini
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Cristina Nicolosi
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Dario Giattini
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Roberto Calamita
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Nicola Santoro
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Fabrizio Giansanti
- Ocular Oncology Unit, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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318
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Gundavda MK, Gundavda KK. Cancer or COVID-19? A Review of Guidelines for Safe Cancer Care in the Wake of the Pandemic. ACTA ACUST UNITED AC 2020; 2:2691-2701. [PMID: 33251481 PMCID: PMC7679239 DOI: 10.1007/s42399-020-00632-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
In the wake of the COVID-19 pandemic, due to reasons beyond control, health care workers have struggled to deliver treatment for the patients with cancer. The concern for otherwise healthy patients with curable cancers that require timely intervention or therapy is the risk of contracting COVID-19 may outweigh the benefits of cancer treatment. Lack of international guidelines leaves health care providers with a case-to-case approach for delivering optimal cancer care in the wake of the pandemic. Transition to telemedicine has somewhat bridged the gap for in-office visits, but there is a continuing challenge of delays in cancer screening or significant decline of new diagnoses of cancers due to the pandemic. We aim to propose a balance in risk from treatment delay versus risks from COVID-19 with emphasis on treatment modality (surgery, radiation, and systemic therapy) as well as supportive care for cancer patients, and therefore have reviewed the publications and recommendations from international societies and study groups available as of October 2020.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Andheri West, Mumbai, Maharashtra 400053 India
| | - Kaival K Gundavda
- Department of Surgical Oncology, Tata Memorial hospital, 93, Ground floor, Main Building, Mumbai, Maharashrta 400012 India
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319
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Fowler A, Abbott TEF, Pearse RM. Can we safely continue to offer surgical treatments during the COVID-19 pandemic? BMJ Qual Saf 2020; 30:268-270. [DOI: 10.1136/bmjqs-2020-012544] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/22/2022]
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320
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Gultekin M, Ak S, Ayhan A, Strojna A, Pletnev A, Fagotti A, Perrone AM, Erzeneoglu BE, Temiz BE, Lemley B, Soyak B, Hughes C, Cibula D, Haidopoulos D, Brennan D, Cola E, van der Steen-Banasik E, Urkmez E, Akilli H, Zapardiel I, Tóth I, Sehouli J, Zalewski K, Bahremand K, Chiva L, Mirza MR, Papageorgiou M, Zoltan N, Adámková P, Morice P, Garrido-Mallach S, Akgor U, Theodoulidis V, Arik Z, Steffensen KD, Fotopoulou C. Perspectives, fears and expectations of patients with gynaecological cancers during the COVID-19 pandemic: A Pan-European study of the European Network of Gynaecological Cancer Advocacy Groups (ENGAGe). Cancer Med 2020; 10:208-219. [PMID: 33205595 PMCID: PMC7753798 DOI: 10.1002/cam4.3605] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background The impact of the COVID‐19 pandemic on European gynaecological cancer patients under active treatment or follow‐up has not been documented. We sought to capture the patient perceptions of the COVID‐19 implications and the worldwide imposed treatment modifications. Methods A patient survey was conducted in 16 European countries, using a new COVID‐19‐related questionnaire, developed by ENGAGe and the Hospital Anxiety & Depression Scale questionnaire (HADS). The survey was promoted by national patient advocacy groups and charitable organisations. Findings We collected 1388 forms; 592 online and 796 hard‐copy (May, 2020). We excluded 137 due to missing data. Median patients’ age was 55 years (range: 18–89), 54.7% had ovarian cancer and 15.5% were preoperative. Even though 73.2% of patients named cancer as a risk factor for COVID‐19, only 17.5% were more afraid of COVID‐19 than their cancer condition, with advanced age (>70 years) as the only significant risk factor for that. Overall, 71% were concerned about cancer progression if their treatment/follow‐up was cancelled/postponed. Most patients (64%) had their care continued as planned, but 72.3% (n = 892) said that they received no information around overall COVID‐19 infection rates of patients and staff, testing or measures taken in their treating hospital. Mean HADS Anxiety and Depression Scores were 8.8 (range: 5.3–12) and 8.1 (range: 3.8–13.4), respectively. Multivariate analysis identified high HADS‐depression scores, having experienced modifications of care due to the pandemic and concern about not being able to visit their doctor as independent predictors of patients’ anxiety. Interpretation Gynaecological cancer patients expressed significant anxiety about progression of their disease due to modifications of care related to the COVID‐19 pandemic and wished to pursue their treatment as planned despite the associated risks. Healthcare professionals should take this into consideration when making decisions that impact patients care in times of crisis and to develop initiatives to improve patients’ communication and education.
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Affiliation(s)
- Murat Gultekin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey.,European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic
| | - Sertac Ak
- Stress Assesment and Research Center (STAR, Hacettepe University, Ankara, Turkey.,Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - Ali Ayhan
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Baskent University, Ankara, Turkey
| | - Aleksandra Strojna
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Andrei Pletnev
- Department of Gynecologic Oncology, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Belarus
| | - Anna Fagotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | | | - B Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - B Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Birthe Lemley
- European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,KIU - Patient Organisation for Women with Gynaecological Cancer, Copenhagen, Denmark
| | - Burcu Soyak
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Cathy Hughes
- Ovacome - Ovarian Cancer Support Charity, London, UK.,Department of Gynecology, Imperial College London, NHS Trust London, London, UK
| | - David Cibula
- Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dimitrios Haidopoulos
- Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greece
| | - Donal Brennan
- Department of Gynaecological Oncology, University College Dublin (UCD) School of Medicine, Catherine McAuley Research Centre, Mater University Hospital, Dublin, Ireland
| | - Edoardo Cola
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Esra Urkmez
- European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,Dance With Cancer Society, Ankara, Turkey
| | - Huseyin Akilli
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Baskent University, Ankara, Turkey
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Icó Tóth
- European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,Mallow Flower Foundation, Budapest, Hungary
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-University Hospital, Berlin, Germany
| | - Kamil Zalewski
- European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,Department of Gynecological Oncology, Hollycross Cancer Center, Kielce, Poland.,Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK
| | - Kiarash Bahremand
- Department of Gynaecology, National Institute of Oncology, Budapest, Hungary
| | - Luis Chiva
- Clinica Universidad de Navarra, Madrid, Spain
| | - Mansoor Raza Mirza
- Department of Oncology, The Finsen Centre, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Papageorgiou
- European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,K.E.F.I. Cancer Society, Athens, Greece
| | - Novak Zoltan
- Department of Gynaecology, National Institute of Oncology, Budapest, Hungary
| | - Petra Adámková
- European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,Onko Unie Cancer Society, Prague, Czech Republic
| | - Philippe Morice
- Department of Surgery, Institute Gustave Roussy, Villejuif, France
| | | | - Utku Akgor
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Vasilis Theodoulidis
- Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greece
| | - Zafer Arik
- Faculty of Medicine, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Karina D Steffensen
- European Society of Gynaecological Oncoloy (ESGO, European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,Department of Oncology, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Center for Shared Decision Making, Lillebaelt Hospital-University Hospital of Southern Denmark, Vejle, Denmark
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321
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Lai AG, Pasea L, Banerjee A, Hall G, Denaxas S, Chang WH, Katsoulis M, Williams B, Pillay D, Noursadeghi M, Linch D, Hughes D, Forster MD, Turnbull C, Fitzpatrick NK, Boyd K, Foster GR, Enver T, Nafilyan V, Humberstone B, Neal RD, Cooper M, Jones M, Pritchard-Jones K, Sullivan R, Davie C, Lawler M, Hemingway H. Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study. BMJ Open 2020; 10:e043828. [PMID: 33203640 PMCID: PMC7674020 DOI: 10.1136/bmjopen-2020-043828] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer. METHODS We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England. RESULTS Declines in urgent referrals (median=-70.4%) and chemotherapy attendances (median=-41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=-44.5%) and chemotherapy attendances (median=-31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity. CONCLUSIONS Dramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.
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Affiliation(s)
- Alvina G Lai
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Rd, London, UK
| | - Geoff Hall
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
- The Alan Turing Institute, London, UK
| | - Wai Hoong Chang
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Michail Katsoulis
- Institute of Health Informatics, University College London, London, UK
| | - Bryan Williams
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - David Linch
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
- Department of Hematology, University College London Cancer Institute, London, UK
| | - Derralynn Hughes
- University College London Cancer Institute, London, UK
- Royal Free NHS Foundation Trust, London, UK
| | - Martin D Forster
- University College London Hospitals NHS Trust, London, UK
- University College London Cancer Institute, London, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Kathryn Boyd
- Northern Ireland Cancer Network, Northern Ireland, UK
| | - Graham R Foster
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Tariq Enver
- University College London Cancer Institute, London, UK
| | | | | | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matt Cooper
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Monica Jones
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Kathy Pritchard-Jones
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- UCLPartners Academic Health Science Partnership, London, UK
- Centre for Cancer Outcomes, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Richard Sullivan
- Conflict and Health Research Group, Institute of Cancer Policy, King's College London, London, UK
| | - Charlie Davie
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Royal Free NHS Foundation Trust, London, UK
- UCLPartners Academic Health Science Partnership, London, UK
| | - Mark Lawler
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
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322
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Nabhen JJ, Ostroski TKD, Kozonoe MM, Orlandi D, Tormen T, Ioshii SO. Impact of the COVID-19 pandemic in patient admission to a high-complexity cancer center in Southern Brasil. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2020; 66:1361-1365. [PMID: 33174927 DOI: 10.1590/1806-9282.66.10.1361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of our study was to investigate whether there has been a reduction in patient admission to a high-complexity cancer care center in Brasil during the COVID-19 pandemic, similar to what was reported in Europe. METHODS We reviewed the cancer tracking database of the largest cancer center in southern Brasil and performed statistical tests to compare first-time appointments from the onset of the outbreak until the end of June to those of the equivalent period in 2019. RESULTS We observed a dramatic reduction (-42%) in first-time appointments during the pandemic compared to the same period in the previous year (P <0.001). This reduction was observed among all medical specialties (P <0.001). CONCLUSION The onset of COVID-19 was correlated with a reduction in admission to a high-complexity cancer care center in Brasil. Since a delay in diagnosis and treatment may influence prognosis, it is important that cancer centers and public health strategies reinforce care for non-COVID-19 patients to prevent potentially unnecessary deaths.
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Affiliation(s)
- Jacqueline Justino Nabhen
- Hospital de Clínicas da Universidade Federal do Paraná, Faculdade de Medicina, Curitiba, PR, Brasil.,Hospital Erasto Gaertner, Departamento de Anatomia Patológica, Curitiba, PR, Brasil
| | - Tayza Katelline Danilau Ostroski
- Hospital Erasto Gaertner, Departamento de Anatomia Patológica, Curitiba, PR, Brasil.,Hospital de Clínicas da Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
| | - Milena Massumi Kozonoe
- Hospital Erasto Gaertner, Departamento de Anatomia Patológica, Curitiba, PR, Brasil.,Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação de Tecnologia em Saúde, Curitiba, PR, Brasil
| | - Dinarte Orlandi
- Diretor Técnico, Hospital Erasto Gaertner, Curitiba, PR, Brasil
| | - Tiago Tormen
- Diretor Técnico, Hospital Erasto Gaertner, Curitiba, PR, Brasil
| | - Sérgio Ossamu Ioshii
- Hospital Erasto Gaertner, Departamento de Anatomia Patológica, Curitiba, PR, Brasil.,Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação de Tecnologia em Saúde, Curitiba, PR, Brasil.,Diretor Clínico, Hospital Erasto Gaertner, Curitiba, PR, Brasil
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323
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Bakouny Z, Hawley JE, Choueiri TK, Peters S, Rini BI, Warner JL, Painter CA. COVID-19 and Cancer: Current Challenges and Perspectives. Cancer Cell 2020; 38:629-646. [PMID: 33049215 PMCID: PMC7528740 DOI: 10.1016/j.ccell.2020.09.018] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
Patients with cancer have been disproportionately affected by the COVID-19 pandemic. This effect has included the adverse outcomes in patients with cancer who develop COVID-19, the impact of the COVID-19 pandemic on the delivery of cancer care, and the severe disruption to cancer research. However, patients with cancer are a heterogeneous population, and recent studies have now documented factors that allow risk stratification of patients with cancer in order to optimize care. In this review, we highlight data at the intersection of COVID-19 and cancer, including the biological interplay between the two diseases and practical recommendations for the treatment of patients with cancer during the pandemic. We additionally discuss the potential long-lasting impact of the pandemic on cancer care due to its deleterious effect on cancer research, as well as biological insights from the cancer research community that could help develop novel therapies for all patients with COVID-19.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jessica E Hawley
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Brian I Rini
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy L Warner
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Corrie A Painter
- Cancer Program, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
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324
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Affiliation(s)
- Ambica Parmar
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room T2-058, Toronto, ON M4N 3M5, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room T2-058, Toronto, ON M4N 3M5, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
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325
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Affiliation(s)
- Itai Bavli
- Harvard Department of the History of Science, Cambridge, MA, USA
- Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Brent Sutton
- Department of Political Science, University of British Columbia Vancouver, BC, Canada
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326
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Boettcher AN, Hammoud DA, Weinberg JB, Agarwal P, Mendiratta-Lala M, Luker GD. Cancer Imaging and Patient Care during the COVID-19 Pandemic. Radiol Imaging Cancer 2020; 2:e200058. [PMID: 33778750 PMCID: PMC7706101 DOI: 10.1148/rycan.2020200058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Patients with cancer have been negatively impacted during the coronavirus disease 2019 (COVID-19) pandemic, as many of these individuals may be immunosuppressed and of older age. Additionally, cancer follow-up or imaging appointments have been delayed in many clinics around the world. Postponement of routine screening exams will result in delays in new cancer diagnoses. Clinics are continuing to monitor and adapt their appointment schedules based on local outbreaks of COVID-19. Studies on COVID-19 in patients with cancer are limited, but consistently indicate that this population is at risk for more severe COVID-19 illness. Data from recent studies also suggest that pediatric patients with cancer have a lower risk of severe COVID-19 illness compared to adults. Certain features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected by lung, brain, and gastrointestinal imaging may confound radiologists' interpretation of cancer diagnosis, staging, and treatment response. Lastly, as clinics begin to re-open for routine appointments, protocols have been put in place to reduce SARS-CoV-2 exposure to patients during their visits. This review details different perspectives on the impact of the COVID-19 pandemic on patients with cancer and on cancer imaging. Keywords: Abdomen/GI, Cardiac, Infection, Nervous-Peripheral.
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Affiliation(s)
- Adeline N. Boettcher
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Dima A. Hammoud
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Jason B. Weinberg
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Prachi Agarwal
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Mishal Mendiratta-Lala
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Gary D. Luker
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
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327
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Assaad S, Fuhrmann C, Avrillon V, Ray-Coquard I, Blay JY. Risk of death of patients with cancer presenting with severe symptoms of infection, with or without documented COVID-19: In reply to van Dam et al. Eur J Cancer 2020; 139:68-69. [PMID: 32977222 PMCID: PMC7474920 DOI: 10.1016/j.ejca.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Isabelle Ray-Coquard
- Centre Leon Berard, Lyon, France; Universite de Lyon, Lyon, France; Unicancer, Paris, France
| | - Jean-Yves Blay
- Centre Leon Berard, Lyon, France; Universite de Lyon, Lyon, France; Unicancer, Paris, France.
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328
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Collateral effects of the coronavirus disease 2019 pandemic on lung cancer diagnosis in Korea. BMC Cancer 2020; 20:1040. [PMID: 33121456 PMCID: PMC7594984 DOI: 10.1186/s12885-020-07544-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022] Open
Abstract
Background The COVID-19 pandemic is predicted to significantly affect patients with lung cancer, owing to its rapid progression and high mortality. Studies on lung cancer diagnosis and treatment during an epidemic are lacking. We analyzed the impact of COVID-19 on lung cancer diagnosis in Korea, where lung cancer incidence continues to rise. Methods The number of newly diagnosed lung cancer cases in three university-affiliated hospitals during the pandemic and their clinical features were compared with lung cancer cases diagnosed during the same period in the past 3 years. The effectiveness of measures taken by the study hospitals to prevent nosocomial transmission was reviewed. Results A total of 612 patients were diagnosed with lung cancer from February through June, 2017–2020. During the pandemic, the number of patients who sought consultation at the division of pulmonology of study hospitals dropped by 16% from the previous year. Responding to the pandemic, the involved hospitals created physically isolated triage areas for patients with acute respiratory infection symptoms. Wide-range screening and preventive measures were implemented, thus minimizing the delay in lung cancer diagnosis. No patient acquired COVID-19 due to hospital exposure. The proportion of patients with stage III–IV non-small-cell lung cancer (NSCLC) significantly increased (2020: 74.7% vs. 2017: 57.9%, 2018: 66.7%, 2019: 62.7%, p = 0.011). The number of lung cancers diagnosed during this period and the previous year remained the same. Conclusions The proportion of patients with advanced NSCLC increased during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07544-3.
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329
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Kasivisvanathan V, Lindsay J, Rakshani-Moghadam S, Elhamshary A, Kapriniotis K, Kazantzis G, Syed B, Hines J, Bex A, Ho DH, Hayward M, Bhan C, MacDonald N, Clarke S, Walker D, Bellingan G, Moore J, Rohn J, Muneer A, Roberts L, Haddad F, Kelly JD. A cohort study of 30 day mortality after NON-EMERGENCY surgery in a COVID-19 cold site. Int J Surg 2020; 84:57-65. [PMID: 33122153 PMCID: PMC7584883 DOI: 10.1016/j.ijsu.2020.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022]
Abstract
Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Methods During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. Results 500 patients underwent surgery with median age 62.5 (IQR 51–71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. Conclusion It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration. Priority surgeries are being cancelled every week due to the COVID-19 pandemic. A multicentre surgical referral network was set up as part of an NHS England approach to continuing safe surgery The referral network consisted of 14 NHS trusts and surgery was performed at a single COVID-19 ‘cold site’. After 500 surgeries performed, there was a 0% 30-day mortality from COVID-19. It is safe to continue cancer and priority surgery during the COVID-19 pandemic with appropriate service reconfiguration.
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Affiliation(s)
- Veeru Kasivisvanathan
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Jamie Lindsay
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Sara Rakshani-Moghadam
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Ahmed Elhamshary
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | | | - Georgios Kazantzis
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Bilal Syed
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - John Hines
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Axel Bex
- Department of Urology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Daniel Heffernan Ho
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Chetan Bhan
- Department of General Surgery, Whittington Health NHS Trust, London, UK
| | - Nicola MacDonald
- Department of Gynaecology, University College London Hospital NHS Foundation Trust, London, UK
| | - Simon Clarke
- Department of Anaesthetics, University College London Hospital NHS Foundation Trust, London, UK
| | - David Walker
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - Geoff Bellingan
- Department of Intensive Care, University College London Hospital NHS Foundation Trust, London, UK
| | - James Moore
- NHS England and NHS Improvement, England, UK
| | - Jennifer Rohn
- Centre for Urological Biology, Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | - Asif Muneer
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; National Institute for Health and Research Biomedical Research Centre, University College London Hospital, London, UK
| | - Lois Roberts
- Division of Surgery, University College London Hospital NHS Foundation Trust, London, UK
| | - Fares Haddad
- Division of Surgery and Interventional Science, University College London, London, UK
| | - John D Kelly
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
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330
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Araujo-Filho JDAB, Normando PG, Melo MDTD, Costa AN, Terra RM. Lung cancer in the era of COVID-19: what can we expect? J Bras Pneumol 2020; 46:e20200398. [PMID: 33111754 PMCID: PMC7910004 DOI: 10.36416/1806-3756/e20200398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- Jose de Arimateia Batista Araujo-Filho
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - André Nathan Costa
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ricardo Mingarini Terra
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Instituto do Câncer do Estado de São Paulo - ICESP - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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331
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Groen MT, Derks MEW, Kuijpers CCHJ, Nagtegaal ID, Hoentjen F. Reduction of IBD healthcare during the COVID-19 pandemic: a nationwide retrospective cohort study. Gastroenterology 2020; 160:S0016-5085(20)35321-X. [PMID: 34756842 PMCID: PMC7581342 DOI: 10.1053/j.gastro.2020.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Maarten Te Groen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Monica E W Derks
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chantal C H J Kuijpers
- PALGA Foundation (The Nationwide Network and Registry of Histo- and Cytopathology), Houten, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
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332
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Schmitz KH, Stout NL, Maitin-Shepard M, Campbell A, Schwartz AL, Grimmett C, Meyerhardt JA, Sokolof JM. Moving through cancer: Setting the agenda to make exercise standard in oncology practice. Cancer 2020; 127:476-484. [PMID: 33090477 DOI: 10.1002/cncr.33245] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023]
Abstract
LAY SUMMARY International evidence-based guidelines support the prescription of exercise for all individuals living with and beyond cancer. This article describes the agenda of the newly formed Moving Through Cancer initiative, which has a primary objective of making exercise standard practice in oncology by 2029.
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Affiliation(s)
- Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Nicole L Stout
- Section of Hematology/Oncology, Department of Medicine, West Virginia University Cancer Institute, Morgantown, West Virginia
| | | | - Anna Campbell
- School of Applied Science, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | - Chloe Grimmett
- Department of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jeffrey A Meyerhardt
- Division of Gastrointestinal Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jonas M Sokolof
- Department of Physical Medicine and Rehabilitation, New York University Grossman School of Medicine, New York, New York
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333
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Srivastava A, Patel HV, Kim S, Shinder B, Sterling J, Tabakin AL, Polotti CF, Saraiya B, Mayer T, Kim IY, Ghodoussipour S, Patel HD, Jang TL, Singer EA. Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: Oncologic implications in the COVID-19 era and beyond. Urol Oncol 2020; 39:247-257. [PMID: 33223368 PMCID: PMC7574787 DOI: 10.1016/j.urolonc.2020.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/10/2020] [Accepted: 10/17/2020] [Indexed: 01/01/2023]
Abstract
Purpose During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival. Materials and methods We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1–3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival. Results A total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77–1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69–1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62–1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1–3, 3–6, and >6 months, also showed no increase in upstaging risk. Conclusion Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.
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Affiliation(s)
- Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Biometrics Shared Resource, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexandra L Tabakin
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Charles F Polotti
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tina Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Hiten D Patel
- The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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334
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Suárez J, Mata E, Guerra A, Jiménez G, Montes M, Arias F, Ciga MA, Ursúa E, Ederra M, Arín B, Laiglesia M, Sanz A, Vera R. Impact of the COVID-19 pandemic during Spain's state of emergency on the diagnosis of colorectal cancer. J Surg Oncol 2020; 123:32-36. [PMID: 33078425 DOI: 10.1002/jso.26263] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION We evaluate the impact of COVID-epidemic in colorectal cancer (CRC) diagnosis during Spain's state of emergency. METHODS We compared newly diagnosed patients with patients diagnosed in the same period of 2019. RESULTS A new diagnosis of CRC decreased 48% with a higher rate of patients diagnosed in the emergency setting (12.1% vs. 3.6%; p = .048) and a lower rate diagnosed in the screening program (5.2% vs. 33.3%; p = .000). CONCLUSIONS Fewer patients have been diagnosed with CRC, with a higher rate of patients diagnosed in an emergency setting.
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Affiliation(s)
- Javier Suárez
- Coloproctology Unit, Department of General Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain.,Nurse Navigator, Colorectal Cancer Multidisciplinary Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elena Mata
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Guerra
- Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Gloria Jiménez
- Department of Radiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marta Montes
- Department of Pathology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Fernando Arias
- Department of Radiotherapy, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Miguel A Ciga
- Coloproctology Unit, Department of General Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - María Ederra
- Navarra Public Health Institute, Pamplona, Spain
| | - Beñat Arín
- Department of General Surgery, Hospital García Orcoyen, Estella, Spain
| | | | - Asunción Sanz
- Nurse Navigator, Colorectal Cancer Multidisciplinary Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Vera
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
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Salmerón Jiménez M, Hermoso Alarza F, Martínez Serna I, Marrón Fernández C, Meneses Pardo JC, García Salcedo JA, Torres Serna A, Manama Gama MG, Colmenares Mendoza OE, Diaz-Hellín Gude V, Gamez García AP. Clinical features and outcomes of thoracic surgery patients during the COVID-19 pandemic. Eur J Cardiothorac Surg 2020; 58:738-744. [PMID: 32951033 PMCID: PMC7543325 DOI: 10.1093/ejcts/ezaa287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/15/2020] [Accepted: 06/27/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The goal of this study was to describe the clinical features and outcomes of thoracic surgery patients during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Thirty-five patients were treated at the 12 de Octubre University Hospital in Madrid between 1 March 2020 and 24 April 2020 during the COVID-19 pandemic. Patient demographics, surgical procedures, complications, COVID-19 symptoms and outcomes were recorded. A protocol was introduced to reduce the risk of operating on patients with COVID-19, including symptom screening, a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 and computed tomography scans of the chest. Surgical activity changed significantly during this time, from an initial period of near-normal activity, through an emergency-only period and finally a recovery period when some oncological surgical cases were restarted. Selection criteria for surgical patients are also described. RESULTS A total of 34 patients underwent surgery during the pandemic period. We performed 22 lung resections (11 lobectomies and 11 sublobar resections). No hospital deaths were recorded. An elective surgery patient and an emergency surgery patient were diagnosed with COVID-19 (5.88%). The former died within 30 days after surgery. CONCLUSIONS Severe acute respiratory syndrome coronavirus 2 represents a tremendous limitation for thoracic surgical practice. Preoperative practices to exclude asymptomatic cases infected with the virus allowed us to perform thoracic surgical procedures.
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Affiliation(s)
- María Salmerón Jiménez
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - Fátima Hermoso Alarza
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - Ivan Martínez Serna
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Marrón Fernández
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - José Carlos Meneses Pardo
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - José Alberto García Salcedo
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Torres Serna
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - Mario Gustavo Manama Gama
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Vicente Diaz-Hellín Gude
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Pablo Gamez García
- Department of Thoracic Surgery, 12 de Octubre University Hospital, Universidad Complutense de Madrid, Madrid, Spain
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336
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Pellisé M. The COVID-19 pandemic and colorectal cancer prevention: God tempers the wind to the shorn lamb. Endoscopy 2020; 52:877-878. [PMID: 32967017 PMCID: PMC7516359 DOI: 10.1055/a-1243-1372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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337
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Schippers MC. For the Greater Good? The Devastating Ripple Effects of the Covid-19 Crisis. Front Psychol 2020; 11:577740. [PMID: 33132987 PMCID: PMC7550468 DOI: 10.3389/fpsyg.2020.577740] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022] Open
Abstract
As the crisis around Covid-19 evolves, it becomes clear that there are numerous negative side-effects of the lockdown strategies implemented by many countries. Currently, more evidence becomes available that the lockdowns may have more negative effects than positive effects. For instance, many measures taken in a lockdown aimed at protecting human life may compromise the immune system, and purpose in life, especially of vulnerable groups. This leads to the paradoxical situation of compromising the immune system and physical and mental health of many people, including the ones we aim to protect. Also, it is expected that hundreds of millions of people will die from hunger and postponed medical treatments. Other side effects include financial insecurity of billions of people, physical and mental health problems, and increased inequalities. The economic and health repercussions of the crisis will be falling disproportionately on young workers, low-income families and women, and thus exacerbate existing inequalities. As the virus outbreak and media coverage spread fear and anxiety, superstition, cognitive dissonance reduction and conspiracy theories are ways to find meaning and reduce anxiety. These behavioral aspects may play a role in the continuance of lockdown decisions. Based on theories regarding agnotology (i.e., the ways ignorance or doubt about certain topics is created by means of withholding or presenting information in a certain way), social influence, superstition and stress and coping, I seek to explain the social and behavioral aspects of human behavior in times of crises. Both the Covid-19 crisis itself as well as the resulting economic and (mental) health crisis are global problems that may require global solutions. I present a model of drivers and outcomes of lockdown behaviors and offer suggestions and a tool to counteract the negative psychological effects by means of online life crafting therapeutic writing interventions.
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Affiliation(s)
- Michaéla C. Schippers
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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338
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O'Donohoe N, Jamal S, Cope J, Strom L, Ryan S, Nunoo-Mensah JW. COVID-19 recovery: tackling the 2-week wait colorectal pathway backlog by optimising CT colonography utilisation. Clin Radiol 2020; 76:117-121. [PMID: 33059853 PMCID: PMC7505548 DOI: 10.1016/j.crad.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
AIM To review the indications for computed tomography colonography (CTC) performed on patients referred via the 2-week wait colorectal pathway (2WWCP). MATERIALS AND METHODS A retrospective study was performed on all patients referred through the 2WWCP between October 2018 and September 2019. The referrals were audited against the National Institute for Health and Care Excellence (NICE) NG12/DG30 guidelines for referral to the 2WWCP, and against the Royal College of Radiologists (RCR) 2017 guidelines for CTC. RESULTS Over the study period, there were 1,707 2WWCP referrals, and 362 (21.2%) of these patients underwent CTC. The median age was 66 years, and 55% were female. Forty-six patients did not meet the NICE NG12/DG30 guidelines for referral to the 2WWCP, and a further 268, although meeting the NICE guidelines, did not meet the RCR 2017 guidelines for CTC. In total, only 13% of CTCs performed complied with both guidelines. CONCLUSION This audit demonstrated a significant opportunity to reallocate CTC resources in the recovery stage of the COVID-19 pandemic. To improve outcomes for colorectal cancer (CRC) in the UK, establishing a selective straight-to-test CTC 2WWCP should be considered. Documented consent detailing the risks and benefits of CTC versus colonoscopy should take place in order to assist the patient in making an informed choice.
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Affiliation(s)
- N O'Donohoe
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK
| | - S Jamal
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK
| | - J Cope
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK
| | - L Strom
- Department of Radiology, King's College Hospital Foundation NHS Trust, London, UK
| | - S Ryan
- Department of Radiology, King's College Hospital Foundation NHS Trust, London, UK
| | - J W Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK; Department of Colorectal Surgery, Cleveland Clinic London, UK.
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339
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Woodhouse F, Yeung T. Impact of COVID-19 on stoma care: the experience of one team in Oxford. ACTA ACUST UNITED AC 2020; 29:S4-S6. [PMID: 32901544 DOI: 10.12968/bjon.2020.29.16.s4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Trevor Yeung
- Specialist Registrar in Colorectal Surgery, Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust
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340
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Meyer M, Bindelglas E, Kupferman ME, Eggermont AM. The ongoing COVID-19 pandemic will create a disease surge among cancer patients. Ecancermedicalscience 2020; 14:ed105. [PMID: 33082857 PMCID: PMC7532024 DOI: 10.3332/ecancer.2020.ed105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
With major parts of the United States in lockdown, parts of Europe and the UK possibly going back on lockdown or expecting a second COVID-19 wave and rapidly rising rates elsewhere other than Asia, many people are forgoing regular cancer screenings and prevention services. More worrisome, some may be experiencing early signs or symptoms, yet they are not seeking evaluation, treatment or surveillance examinations. The long-term impact of this on patients, families and health care providers will be substantial. Not only will this strain sophisticated health systems in developed countries, but it will also overwhelm the health care infrastructure in developing countries. Health-care executives, cancer center directors, oncologists and policy experts should focus now on serving this potential “third wave” of sick patients who have delayed treatment. Stopping COVID-19 is critical. However, it’s also essential to plan for the coming wave of patients who have delayed seeking care or don’t have access.
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Affiliation(s)
- Michael Meyer
- Meyer Consulting, 5665 N Scottsdale Road, Suite 110 Scottsdale, AZ 85250, USA
| | - Ethan Bindelglas
- Meyer Consulting, 5665 N Scottsdale Road, Suite 110 Scottsdale, AZ 85250, USA
| | - Michael E Kupferman
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Alexander Mm Eggermont
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
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341
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Ioannidis JPA, Axfors C, Contopoulos-Ioannidis DG. Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters. ENVIRONMENTAL RESEARCH 2020; 188:109890. [PMID: 32846654 DOI: 10.1101/2020.04.05.20054361] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To provide estimates of the relative rate of COVID-19 death in people <65 years old versus older individuals in the general population, the absolute risk of COVID-19 death at the population level during the first epidemic wave, and the proportion of COVID-19 deaths in non-elderly people without underlying diseases in epicenters of the pandemic. ELIGIBLE DATA Cross-sectional survey of countries and US states with at least 800 COVID-19 deaths as of April 24, 2020 and with information on the number of deaths in people with age <65. Data were available for 14 countries (Belgium, Canada, France, Germany, India, Ireland, Italy, Mexico, Netherlands, Portugal, Spain, Sweden, Switzerland, UK) and 13 US states (California, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, Pennsylvania). We also examined available data on COVID-19 deaths in people with age <65 and no underlying diseases. MAIN OUTCOME MEASURES Proportion of COVID-19 deaths in people <65 years old; relative mortality rate of COVID-19 death in people <65 versus ≥65 years old; absolute risk of COVID-19 death in people <65 and in those ≥80 years old in the general population as of June 17, 2020; absolute COVID-19 mortality rate expressed as equivalent of mortality rate from driving a motor vehicle. RESULTS Individuals with age <65 account for 4.5-11.2% of all COVID-19 deaths in European countries and Canada, 8.3-22.7% in the US locations, and were the majority in India and Mexico. People <65 years old had 30- to 100-fold lower risk of COVID-19 death than those ≥65 years old in 11 European countries and Canada, 16- to 52-fold lower risk in US locations, and less than 10-fold in India and Mexico. The absolute risk of COVID-19 death as of June 17, 2020 for people <65 years old in high-income countries ranged from 10 (Germany) to 349 per million (New Jersey) and it was 5 per million in India and 96 per million in Mexico. The absolute risk of COVID-19 death for people ≥80 years old ranged from 0.6 (Florida) to 17.5 per thousand (Connecticut). The COVID-19 mortality rate in people <65 years old during the period of fatalities from the epidemic was equivalent to the mortality rate from driving between 4 and 82 miles per day for 13 countries and 5 states, and was higher (equivalent to the mortality rate from driving 106-483 miles per day) for 8 other states and the UK. People <65 years old without underlying predisposing conditions accounted for only 0.7-3.6% of all COVID-19 deaths in France, Italy, Netherlands, Sweden, Georgia, and New York City and 17.7% in Mexico. CONCLUSIONS People <65 years old have very small risks of COVID-19 death even in pandemic epicenters and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic.
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Epidemiology and Population Health, Stanford University School of Medicine, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA.
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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342
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Jazieh AR, Chan SL, Curigliano G, Dickson N, Eaton V, Garcia-Foncillas J, Gilmore T, Horn L, Kerr DJ, Lee J, Mathias C, Nogueira-Rodrigues A, Pierce L, Rogado A, Schilsky RL, Soria JC, Warner JL, Yoshida K. Delivering Cancer Care During the COVID-19 Pandemic: Recommendations and Lessons Learned From ASCO Global Webinars. JCO Glob Oncol 2020; 6:1461-1471. [PMID: 32997537 PMCID: PMC7529523 DOI: 10.1200/go.20.00423] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE In response to the COVID-19 pandemic, the ASCO launched a Global Webinar Series to address various aspects of cancer care during the pandemic. Here we present the lessons learned and recommendations that have emerged from these webinars. METHODS Fifteen international health care experts from different global regions and oncology disciplines participated in one of the six 1-hour webinars to discuss the latest data, share their experiences, and provide recommendations to manage cancer care during the COVID-19 pandemic. These sessions include didactic presentations followed by a moderated discussion and questions from the audience. All recommendations have been transcribed, categorized, and reviewed by the experts, who have also approved the consensus recommendations. RESULTS The summary recommendations are divided into different categories, including risk minimization; care prioritization of patients; health care team management; virtual care; management of patients with cancer undergoing surgical, radiation, and systemic therapy; clinical research; and recovery plans. The recommendations emphasize the protection of patients and health care teams from infections, delivery of timely and appropriate care, reduction of harm from the interruption of care, and preparation to handle a surge of new COVID-19 cases, complications, or comorbidities thereof. CONCLUSION The recommendations from the ASCO Global Webinar Series may guide practicing oncologists to manage their patients during the ongoing pandemic and help organizations recover from the crisis. Implementation of these recommendations may improve understanding of how COVID-19 has affected cancer care and increase readiness to manage the current and any future outbreaks effectively.
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Affiliation(s)
- Abdul Rahman Jazieh
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Stephen L. Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS and University of Milano, Milano, Italy
| | | | | | - Jesus Garcia-Foncillas
- Department of Oncology, Oncohealth Institute, Fundacion Jimenez Diaz University Hospital, Autonomous University, Madrid, Spain
| | | | | | | | | | | | | | - Lori Pierce
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI
| | - Alvaro Rogado
- ECO Foundation for Excellence and Quality in Oncology, Madrid, Spain
| | | | | | | | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University, Graduate School of Medicine, Gifu, Japan
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343
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Soltany A, Hamouda M, Ghzawi A, Sharaqi A, Negida A, Soliman S, Benmelouka AY. A scoping review of the impact of COVID-19 pandemic on surgical practice. Ann Med Surg (Lond) 2020; 57:24-36. [PMID: 32704366 PMCID: PMC7347302 DOI: 10.1016/j.amsu.2020.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The current COVID-19 pandemic has challenged the infrastructure of the healthcare systems. To cope with the pandemic, substantial changes were introduced to surgical practice and education all over the world. METHODS A scoping search in PubMed and Google Scholar was done using the search terms: "Coronavirus," "COVID-19", "SARS-CoV-2", "nCoV-2019", and "surgery." They were either searched individually or in combination. All relevant articles of any study design (published within December 15, 2019, till the mid of June 2020), were included and narratively discussed in this review. RESULTS Sixty-six articles were reviewed in this article. Through these articles, we provide guidance and recommendations on the preoperative preparation and safety precautions, intraoperative precautions, postoperative precautions, postoperative complications (related to COVID-19), surgical scheduling, emergency surgeries, elective surgeries, cancer surgery, psychological impact on surgical teams, and surgical training during the COVID-19 pandemic. CONCLUSION COVID-19 pandemic has affected nearly all aspects of surgical procedures, scheduling, and staffing. Special precautions were taken before, during, or after surgeries. New treatment and teaching modalities emerged in response to the pandemic. Psychological support and training platforms are necessary for the surgical team.
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Affiliation(s)
- Amjad Soltany
- Department of Plastic and Reconstructive Surgery, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | | | - Ansam Ghzawi
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Ahmed Sharaqi
- Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Ahmed Negida
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
- UK and Faculty of Medicine and Zagazig University Hospitals, Zagazig University, Sharkia, Egypt
| | - Shaimaa Soliman
- Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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344
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SARS-CoV-2 and cancer: Are they really partners in crime? Cancer Treat Rev 2020; 89:102068. [PMID: 32731090 PMCID: PMC7351667 DOI: 10.1016/j.ctrv.2020.102068] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022]
Abstract
The outbreak of the SARS-CoV-2 pandemic has overwhelmed health care systems in many countries. The clinical presentation of the SARS-CoV-2 varies between a subclinical or flu-like syndrome to that of severe pneumonia with multi-organ failure and death. Initial reports have suggested that cancer patients may have a higher susceptibility to get infected by the SARS-CoV-2 virus but current evidence remains poor as it is biased by important confounders. Patients with ongoing or recent cancer treatment for advanced active disease, metastatic solid tumors and hematological malignancies are at higher risk of developing severe COVID-19 respiratory disease that requires hospitalization and have a poorer disease outcome compared to individuals without cancer. However it is not clear whether these are independent risk factors, or mainly driven by male gender, age, obesity, performance status, uncontrolled diabetes, cardiovascular disease and various other medical conditions. These often have a greater influence on the probability to die due to SARS-CoV-2 then cancer. Delayed diagnosis and suboptimal cancer management due to the pandemic results in disease upstaging and has considerable impact cancer on specific death rates. Surgery during the peak of the pandemic seems to increase mortality, but there is no convincing evidence that adjuvant systemic cancer therapy and radiotherapy are contraindicated, implicating that cancer treatment can be provided safely after individual risk/benefit assessment and some adaptive measures. Underlying immunosuppression, elevated cytokine levels, altered expression of the angiotensin converting enzyme (ACE-2) and TMPRSS2, and a prothrombotic status may fuel the effects of a SARS-CoV-2 in some cancer patients, but have the potential to be used as biomarkers for severe disease and therapeutic targets. The rapidly expanding literature on COVID-19 should be interpreted with care as it is often hampered by methodological and statistical flaws.
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345
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Ioannidis JPA, Axfors C, Contopoulos-Ioannidis DG. Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters. ENVIRONMENTAL RESEARCH 2020; 188:109890. [PMID: 32846654 PMCID: PMC7327471 DOI: 10.1016/j.envres.2020.109890] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To provide estimates of the relative rate of COVID-19 death in people <65 years old versus older individuals in the general population, the absolute risk of COVID-19 death at the population level during the first epidemic wave, and the proportion of COVID-19 deaths in non-elderly people without underlying diseases in epicenters of the pandemic. ELIGIBLE DATA Cross-sectional survey of countries and US states with at least 800 COVID-19 deaths as of April 24, 2020 and with information on the number of deaths in people with age <65. Data were available for 14 countries (Belgium, Canada, France, Germany, India, Ireland, Italy, Mexico, Netherlands, Portugal, Spain, Sweden, Switzerland, UK) and 13 US states (California, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, Pennsylvania). We also examined available data on COVID-19 deaths in people with age <65 and no underlying diseases. MAIN OUTCOME MEASURES Proportion of COVID-19 deaths in people <65 years old; relative mortality rate of COVID-19 death in people <65 versus ≥65 years old; absolute risk of COVID-19 death in people <65 and in those ≥80 years old in the general population as of June 17, 2020; absolute COVID-19 mortality rate expressed as equivalent of mortality rate from driving a motor vehicle. RESULTS Individuals with age <65 account for 4.5-11.2% of all COVID-19 deaths in European countries and Canada, 8.3-22.7% in the US locations, and were the majority in India and Mexico. People <65 years old had 30- to 100-fold lower risk of COVID-19 death than those ≥65 years old in 11 European countries and Canada, 16- to 52-fold lower risk in US locations, and less than 10-fold in India and Mexico. The absolute risk of COVID-19 death as of June 17, 2020 for people <65 years old in high-income countries ranged from 10 (Germany) to 349 per million (New Jersey) and it was 5 per million in India and 96 per million in Mexico. The absolute risk of COVID-19 death for people ≥80 years old ranged from 0.6 (Florida) to 17.5 per thousand (Connecticut). The COVID-19 mortality rate in people <65 years old during the period of fatalities from the epidemic was equivalent to the mortality rate from driving between 4 and 82 miles per day for 13 countries and 5 states, and was higher (equivalent to the mortality rate from driving 106-483 miles per day) for 8 other states and the UK. People <65 years old without underlying predisposing conditions accounted for only 0.7-3.6% of all COVID-19 deaths in France, Italy, Netherlands, Sweden, Georgia, and New York City and 17.7% in Mexico. CONCLUSIONS People <65 years old have very small risks of COVID-19 death even in pandemic epicenters and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic.
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Epidemiology and Population Health, Stanford University School of Medicine, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA.
| | - Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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346
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Gallo O, Locatello LG, Orlando P, Martelli F, Bruno C, Cilona M, Fancello G, Mani R, Vitali D, Bianco G, Trovati M, Tomaiuolo M, Maggiore G. The clinical consequences of the COVID-19 lockdown: A report from an Italian referral ENT department. Laryngoscope Investig Otolaryngol 2020; 5:824-831. [PMID: 32904910 PMCID: PMC7461474 DOI: 10.1002/lio2.446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives To evaluate the clinical effects of health care reorganization because of COVID-19, in a non-red zone Italian referral department of Otorhinolaryngology. Materials and Methods We retrospectively reviewed the statistics of admissions to the Emergency Department (ED) of the Careggi University Hospital, Florence, from January 1, 2020, to May 17, 2020. Data regarding elective and urgent head and neck disorders were reviewed and the most challenging cases were discussed. Results During the lockdown period, outpatient otolaryngological consultations and elective procedures decreased by 78% and 75% respectively, while emergency/urgency surgery increased by 128%. The five most emblematic clinical cases were thoroughly analyzed. Conclusion Our analysis shows how the profound rearrangement of clinical and surgical activities, along with the citizens' fear to seek medical care has probably exacerbated the management of many routine head and neck conditions. Level of Evidence 4.
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Affiliation(s)
- Oreste Gallo
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | | | - Pietro Orlando
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Federica Martelli
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Chiara Bruno
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Maria Cilona
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Giuseppe Fancello
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Riccardo Mani
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Daniele Vitali
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Giacomo Bianco
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Massimo Trovati
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | - Matteo Tomaiuolo
- Medical Management of Emergency Department Careggi University Hospital Florence Italy
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Analysis of worldwide surgical outcomes in COVID-19-infected patients: a gynecological oncology perspective. Future Sci OA 2020; 6:FS0629. [PMID: 33312692 PMCID: PMC7488719 DOI: 10.2144/fsoa-2020-0099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Coronavirus Disease 2019 (COVID-19) guidance limits all but the most urgent surgery in the United Kingdom. We review the literature and our experience in gynecology to assess perioperative outcomes. PubMed was searched with (surg*[Title])AND(COVID[Title]), (surg*[Title])AND(2019-nCoV[Title]), and (surg*[Title])AND(SARS-CoV-2[Title]), and 67 COVID-19-positive surgical patients across ten hospitals in four countries are included. Median mortality was 33%. Cardiac and pulmonary co-morbidities associated with higher risk of COVID-19-positive postoperative death. Mortality was high in neurosurgery (80%) and the lowest in gynecological oncology surgery (none). This analysis provides an evidence base on which to consider surgical risk assessment for different specialties. Risk of perioperative death needs to be assessed in the context of patients’ co-morbidities and surgical specialty. An individualized approach toward surgical decision making is imperative. Coronavirus Disease 2019 (COVID-19) has resulted in cancer patients receiving inferior surgical treatment compared with normal treatment plans. The risk of death after surgery, when infected with COVID-19, can be as high as 33%. For this reason, during the pandemic, guidelines were issued to protect healthcare services by prohibiting all but the most urgent surgery. This article shows that death rates vary by surgical specialty. The risk of dying within 30 days of surgery is particularly low in gynecological oncology patients. Guidelines should be tailored toward individuals’ needs rather than applying a blanket approach to all.
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348
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Tsang-Wright F, Tasoulis MK, Roche N, MacNeill F. Breast cancer surgery after the COVID-19 pandemic. Future Oncol 2020; 16:2687-2690. [PMID: 32815421 PMCID: PMC7439762 DOI: 10.2217/fon-2020-0619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Fiona Tsang-Wright
- Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust, Queen Alexandra Road, High Wycombe, HP11 2TT, UK
| | | | - Nicola Roche
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK
| | - Fiona MacNeill
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK
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349
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O'Brien CM, Jung K, Dang W, Jang HJ, Kielar AZ. Collateral Damage: The Impact of the COVID-19 Pandemic on Acute Abdominal Emergency Presentations. J Am Coll Radiol 2020; 17:1443-1449. [PMID: 32905786 PMCID: PMC7439814 DOI: 10.1016/j.jacr.2020.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/20/2022]
Abstract
Introduction In March 2020, the World Health Organization declared a pandemic caused by a novel coronavirus. Public information created awareness as well as concern in the general population. There has been a reported decrease in the number of patients attending emergency departments (ED) during the pandemic. This is the first study to determine differences in the types of presenting illnesses, severity, and rate of resultant surgical intervention during the pandemic. Methods and Materials We carried out a retrospective, observational cohort study comparing two groups of patients attending the ED at our tertiary-care academic hospital. A historical comparison cohort was obtained by reviewing the number of patients referred by the ED for abdominal CT between March 15 and April 15, 2020, compared with March 15 and April 15, 2019. CT reports were reviewed; primary pathologies, complications, and subsequent surgical intervention were documented and compared between the two groups. Results In all, 733 patients were included in the 2019 cohort, and 422 patients were included in the 2020 cohort. In 2019, 32.7% had positive CT findings, increasing to 50.5% in 2020. The number of complications increased from 7.9% to 19.7%. The rate requiring surgical intervention increased from 26.3% to 47.6% in 2020. Conclusion To date, there is little published data regarding the presentation and severity of illnesses during the coronavirus disease 2019 pandemic. This information has important public health implications, highlighting the need to educate patients to continue to present to hospital services during such crises, including if a purported second wave of COVID-19 arises.
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Affiliation(s)
- Ciara M O'Brien
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Katherine Jung
- Department of Physiology and Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Wilfred Dang
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hyun-Jung Jang
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ania Z Kielar
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
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350
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Broom A, Kenny K, Page A, Cort N, Lipp ES, Tan AC, Ashley DM, Walsh KM, Khasraw M. The Paradoxical Effects of COVID-19 on Cancer Care: Current Context and Potential Lasting Impacts. Clin Cancer Res 2020; 26:5809-5813. [PMID: 32816894 DOI: 10.1158/1078-0432.ccr-20-2989] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/03/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has fundamentally disrupted the practice of oncology, shifting care onto virtual platforms, rearranging the logistics and economics of running a successful clinical practice and research, and in some contexts, redefining what treatments patients with cancer should and can receive. Since the start of the pandemic in early 2020, there has been considerable emphasis placed on the implications for patients with cancer in terms of their vulnerability to the virus and potential exposure in healthcare settings. But little emphasis has been placed on the significant, and potentially enduring, consequences of COVID-19 for how cancer care is delivered. In this article, we outline the importance of a focus on the effects of COVID-19 for oncology practice during and potentially after the pandemic, focusing on key shifts that are already evident, including: the pivot to online consultations, shifts in access to clinical trial and definitions of "essential care," the changing economics of practice, and the potential legacy effects of rapidly implemented changes in cancer care. COVID-19 is reshaping oncology practice, clinical trials, and delivery of cancer care broadly, and these changes might endure well beyond the short- to mid-term of the active pandemic. Therefore, shifts in practice brought about by the pandemic must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support if they are to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care.
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Affiliation(s)
- Alex Broom
- The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Kenny
- The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Page
- The University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Cort
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Eric S Lipp
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Aaron C Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - David M Ashley
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Kyle M Walsh
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Mustafa Khasraw
- The University of Sydney, Sydney, New South Wales, Australia. .,Duke University Medical Center, Duke University, Durham, North Carolina
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