Factors Associated With Cancer Treatment Delay Among Patients Diagnosed With COVID-19

Safe prescribing in cancer patients during the COVID-19 pandemic and outcomes following restart of cancer care following SARS-CoV-2 infection: The COV-SPOT initiative

SARS-CoV-2 continues to spread across the world as a highly transmissible endemic disease. For many cancer patients, SARS-CoV-2 infection is unavoidable. It continues to disrupt cancer care, causing treatment delays and major psycho-socio-medical issues. At present, there is limited evidence on safe prescribing of anti-cancer therapy, and safe treatment restart following SARS-CoV-2 infection. We conducted a prospective cohort study involving 406 COVID-19-positive cancer patients across five UK cancer centres and collected data on delay durations, COVID-19 symptoms and mortality, to ascertain the effect of treatment interruptions. Patients were studied between May 2022 and March 2023, during which Omicron variants of SARS-CoV-2 were predominant. Mean treatment interruption was 12.7 days (standard deviation 47.3 days). Upon resuming anti-cancer therapy, 8.5% experienced COVID-19 symptom progression, and 1.2% succumbed to COVID-19-related mortality. Patients with haematological cancers had a 3.4-fold increased risk of severe symptoms at 4 weeks compared to solid tumour patients. Higher symptom burden at COVID-19 diagnosis was associated with a 3.0-fold increase in symptom severity at 4 weeks following treatment restart. At 8 weeks following restart, 2.1% had increased morbidity or mortality. We highlight the ongoing impact of COVID-19 on patients and cancer care, and the risk of resuming cancer treatments in patients with symptomatic COVID-19. Although the risk of mortality is relatively low upon treatment resumption, personalised approaches assessing cancer diagnosis and SARS-CoV-2 status are crucial. Treatments are also stopped due to other infectious conditions and our results could be reviewed in the context of yearly influenza pandemics.

Assessing the effect of the COVID-19 pandemic on 1-year cancer survival in the United States

The COVID-19 pandemic had a substantial impact on health-care delivery. We used the Surveillance, Epidemiology, and End Results (SEER) data to assess changes in 1-year relative survival and competing risk probabilities of cancer and non-cancer death for patients diagnosed in 2018 Q2 (pre-pandemic) and 2020 Q2 (pandemic). For all cancer sites combined, 1-year relative survival declined from 82.3% in 2018 Q2 to 77.5% in 2020 Q2, with the steepest declines seen in stomach, leukemia, and liver cancers. However, survival improved nearing pre-pandemic levels during 2020 Q3. Competing risk survival measures revealed that the decline in 1-year survival was driven by increases in both the probability of dying of cancer (rising from 15.4% to 19.2%) and of other causes, including COVID-19 (rising from 3.8% to 5.2%). The pandemic led to substantial declines in survival and increased mortality from both cancer and other causes for patients diagnosed in 2020 Q2.

Isolation precautions associated with COVID-19 infections among immunocompromised populations: A multicenter study of nine National Cancer Institute--designated Comprehensive Cancer Centers

BACKGROUND

Nine Comprehensive Cancer Centers sought to understand COVID-19 infection management experiences to improve future immunocompromised host guidelines.

METHODS

Volunteers from Comprehensive Cancer Center Infection Prevention and Control (C3IC) completed 2 surveys on COVID-19 practices from March 2020 to December 2023. Three reviewers independently validated qualitative analysis of findings. Virtual meetings were leveraged to discuss findings and identify themes.

RESULTS

100% (9/9) of respondents changed COVID-19-associated isolation discontinuation guidance at least once. All (9/9) included patient immune status as criterion. All (9/9) required clearance testing at some point in the pandemic, 6 of 9 (66%) continued to require clearance testing at the time of the survey. Only 1 of 9 (11%) allowed antigen testing to meet criteria. Seven isolation titles were noted across 9 institutions, despite near agreement on measures employed.

DISCUSSION

Variability existed in COVID-19 management among study participants, despite serving similar populations, which may stem from limited data supporting understanding of viral transmissibility in immunocompromised hosts.

CONCLUSIONS

Guideline development for immunocompromised hosts, potential drivers for viral evolution, can lack clarity for consistent management of the population. Engaging subject matters in specialty populations with future guideline development will improve infection prevention in health care settings.

Delays in chemotherapy and radiotherapy of breast cancer during COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, hospitals were overwhelmed with infected patients, leading to a disruption in the delivery of services. Patients with cancer, including breast cancer, rely on timely treatment, as delays can reduce survival rates. In this study, we investigated delays in treatment and the factors contributing to delays in chemotherapy and radiotherapy for these patients.

METHOD

All women with breast cancer who received chemotherapy or radiotherapy at academic hospitals of Iran University of Medical Sciences from February 20, 2020, to March 20, 2022, were included in our study. Age and metastasis status, including the presence of any metastasis, were also recorded. Delays were calculated for each chemotherapy session, as well as the total number of delays for each patient. For patients who received radiotherapy, delays in the whole course of radiotherapy were calculated. Logistic and Poisson regression with Incidence Rate Ratio (IRR) was used to analyze the number of delays and the impact of pandemic waves.

RESULTS

The results of the study showed an association between metastasis and delays in chemotherapy for breast cancer. Having metastatic breast cancer before the start of treatment was also associated with the increasing number of delays in the entire course of chemotherapy (IRR=1.44). Delays among radiotherapy patients weren't associated with age or metastasis of the disease. The first (IRR=2.74), second (IRR=2.64), third (IRR=1.26), and fourth (IRR=1.44) pandemic waves in chemotherapy and first (IRR=2.56), second (IRR=6.45), fifth (IRR=2.36), and sixth (IRR=2.13) waves in radiotherapy were associated with longer delays compared to plateau times of pandemic.

CONCLUSION

In this study, having metastatic breast cancer before the start of treatment was associated with higher rates of delays in chemotherapy. Also, COVID-19 pandemic waves, specifically the early waves, were associated with longer delays in both chemotherapy and radiotherapy. However, the impact of these delays on patient survival requires further study.

Impact of the COVID-19 Pandemic on the Treatment of Head and Neck Cancers

Background/Objectives: The COVID-19 pandemic led to unprecedented disruptions to cancer care, including the care of head and neck cancer. Given the necessity of timely treatment for mucosal cancers, it is important to understand how the pandemic affected the diagnosis, presentation, and treatment of mucosal head and neck cancer. Methods: The National Cancer Database was queried for patients with primary head and neck mucosal cancer. The number of annual diagnoses and the number of days between diagnosis and the start and end of any treatment were tracked over time from 2004 to 2020. Chi-square tests were used to compare differences in patient clinical and demographic characteristics in 2019 and 2020 to provide the most direct comparison. Multivariable linear regression and logic regression analyses were also used to compare three treatment quality measures between 2019 and 2020: number of days between diagnosis and start of treatment, number of days between surgery and start of postoperative radiation, and number of days between surgery and end of radiation. Results: The number of mucosal cancer diagnoses decreased (9.1%) during the early stages of the pandemic, with a larger decrease (12.4%) among patients receiving surgery. On multivariable analysis comparing 2020 to 2019, time to treatment was shorter (2.3 days; 95% CI, 1.69 to 2.85 days), and time from surgery to start of postoperative radiation was less likely to be delayed (OR, 0.91 of radiation greater than 42 days from surgery; 95% CI, 0.85 to 0.97). However, patients who were black, female, older, or uninsured were more likely to experience treatment delays. Conclusions: Overall, there were no treatment delays for patients with surgical head cancer and patients with neck cancer during the COVID-19 pandemic. However, vulnerable groups, such as patients who were black, female, older, and uninsured, were at higher risk of experiencing treatment delays.

Factors Associated with Self-reported COVID-19 Infection and Hospitalization among Patients Seeking Care at a Comprehensive Cancer Center

BACKGROUND

COVID-19 infection severity differs by race and ethnicity, but its long-term effect on cancer-related outcomes is unknown. Therefore, information on COVID-19 history is critical to ascertain among new cancer patients in order to advance research on its impact on cancer outcomes and potentially related health disparities.

METHODS

A cross-sectional study was conducted among 16,025 new patients seeking care at Moffitt Cancer Center (MCC) between 2021 and 2022. Patient self-reported histories of COVID-19 infection and other pre-existing health conditions were obtained from electronic questionnaires administered to all new MCC patients. Associations between demographics and COVID-19 infection and hospitalization were examined.

RESULTS

A total of 1,971 patients (12.3%) reported ever having COVID-19. Self-reported COVID-19 history was significantly more prevalent in Hispanic vs. non-Hispanic patients (OR = 1.24, 1.05-1.45) and less prevalent in Asian versus White patients (OR = 0.49, 95% 0.33-0.70). Among patients who ever had COVID-19, 10.6% reported a COVID-19-related hospitalization. Males had higher odds of a COVID-19 related hospitalization than females (OR = 1.50, 95% CI = 1.09-2.05), as did Black/African American patients (OR = 2.11, 95% CI = 1.18-3.60) and patients of races other than Black/African American and Asian (OR = 2.61, 95% CI = 1.43-4.54) compared to White patients. Hispanic patients also experienced higher odds of hospitalization (OR = 2.06, 95% CI-1.29- 3.23) compared with non-Hispanic patients of all races in a sensitivity analysis that combined race/ethnicity. Pre-existing lung and breathing problems were associated with higher odds of being hospitalized with COVID-19 (OR = 2.38, 95% CI = 1.61-3.48), but these and other health conditions did not explain the observed associations between race and COVID-19 hospitalization.

CONCLUSIONS

Higher rates of COVID-19 hospitalization were observed among patients identifying as Black/African American or Hispanic independent of pre-existing health conditions. Future studies evaluating long-term effects of COVID-19 should carefully examine potential racial/ethnic disparities in cancer outcomes.

An approach to COVID‑19 and oncology: From impact, staging and management to vaccine outcomes in cancer patients: A systematic review and meta‑analysis

The COVID-19 pandemic has had a global impact, with >771 million confirmed cases and 6 million deaths reported by October 2023. Cancer patients, due to their immunosuppressed status, face an increased infection risk and higher COVID-19 complications. The present study aimed to assess clinical outcomes in COVID-19-infected cancer patients, focusing on mortality rates and other aspects, providing valuable insight for better protection and outcomes. This systematic review was conducted by searching the PubMed, Cochrane and Embase databases from August 2023 following the PRISMA guidelines. Studies from 2020 to 2023 pertaining to the impact of COVID-19 on patients previously diagnosed with malignancies were considered. Inclusion criteria entailed a pre-existing malignancy diagnosis, confirmed COVID-19 infection and an impact of COVID-19 on any aspect of the patient's cancer management. Studies written in English were exclusively reviewed. Post-COVID-19 malignancy diagnoses, case reports, review articles and data-insufficient studies were excluded. Screening and consensus on eligibility were carried out by a team of four authors, with disputes resolved by a non-screening author. Data extraction was performed by a five-author team, detailing study and population characteristics, as well as cancer patient outcomes related to COVID-19. Cross-checking was conducted by the same team, with conflicts resolved by a third author. The review of 27 studies explored COVID-19's impact on oncology, revealing diverse sample sizes (1,807,559 to 177 participants). Studies spanned various cancer types, including gastric adenocarcinoma, breast, lung, gynecologic, colorectal and non-melanoma skin cancer. Mortality rates were higher among cancer patients with COVID-19 compared to those without. Gastric adenocarcinoma exhibited a 5.9% mortality rate. Thoracic cancer patients faced elevated mortality and gastrectomies decreased. A meta-analysis (10 studies, 5,151 patients) showed a 19.1% mortality rate for COVID-19-infected cancer patients, contrasting with 1% for non-COVID-19 cancer patients (5 studies, 54,528 patients). The odds ratio for mortality in non-COVID-19 vs. COVID-19 cancer patients was 0.1036 (3 studies, 3,496 patients). Cancer patients consistently faced elevated mortality during the pandemic, with specific cancers showing unique impacts. Gastric adenocarcinoma exhibited a significant COVID-19 mortality rate. Patients with thoracic cancer faced increased risks, influencing surgical trends. Meta-analysis revealed an overall elevated mortality rate among COVID-19-infected cancer patients compared to non-COVID-19 counterparts.

COVID-19 in patients receiving treatment at an outpatient chemotherapy unit

During the COVID-19 pandemic period, many patients who required outpatient chemotherapy developed COVID-19, requiring chemotherapy interruption. However, there are no clear guidelines regarding the safe timing for restarting chemotherapy. We conducted a retrospective study to assess when such patients can safely recommence chemotherapy. Of the 40 patients included in this study, 34 restarted anticancer drug therapy after COVID-19 infection. Six patients, four with multiple myeloma, and one each with follicular lymphoma and glioma, remained SARS-CoV-2 antigen positive >20 days after COVID-19 onset. Multiple myeloma patients recorded significantly higher frequencies of SARS-CoV-2 antigen positivity >20 days after COVID-19 onset compared with solid tumor patients, with no significant differences in the frequency of SARS-CoV-2 positivity during 5-20 days from COVID-19 onset between them. According to our data, most solid tumor patients achieved SARS-CoV-2 antigen negativity after 20 days from COVID-19 onset. On the other hand, multiple myeloma patients might need serial antigen tests before restarting anticancer therapy in the outpatient chemotherapy setting.

Access to timely cancer treatment initiation in India: extent, determinants and trends

Background

Treatment delays are significantly associated with advanced stage, poor response to treatment, increased mortality risk, poor health outcomes, increased healthcare expenditures among cancer patients. However, factors associated with these delays have not yet been robustly evaluated. In order to bridge this gap, we determined the delayed time to treatment initiation (TTI) among cancer patients in India, ascertained its determinants, and assessed the trends of delayed TTI.

Methods

We analysed data collected from 6695 cancer patients seeking outpatient/daycare treatment, recruited at purposively selected seven healthcare facilities across six states of India. Data on socio-demographic and clinical characteristics including date of cancer diagnosis, date of treatment initiation, cancer site, stage and type of treatment were collected to determine the median TTI and ascertain its determinants among cancer patients in India. Time to treatment initiation was calculated as the duration (days) between diagnosis of cancer (histologically/clinically) and date of initiation of treatment. Multi-variable logistic regression was employed to analyse the relationship between the outcome variable (TTI) and each explanatory variable. A Cox Proportional Hazard (CPH) model was used to conduct time-to-event analysis, and to assess the impact of government-funded health insurance on timely cancer treatment initiation.

Findings

The median (IQR) overall TTI was 20 (7-39) days, with a mean of 53.7 days (SD, 192.9). The TTI was higher for those having head and neck cancer (median TTI: 29 days, IQR: 10.5-55.5) and those receiving radiotherapy as initial treatment (27.5 days, IQR: 10-49.5). Younger patients, those educated up to graduation level and males had significantly lower odds of delayed TTI. As compared to patients who were diagnosed between 1995 and 2017, those diagnosed after 2018 had a 36% (26-46%) higher odds of timely initiation of treatment within 30 days. Upon stratifying by enrolment under PMJAY, we found that while the access for timely treatment initiation increased by 33% for those who were not enrolled, vs. 90% among those enrolled under PM-JAY. Overall, this shows significant improvement in timely initiation of cancer treatment as a result of introduction of PM-JAY.

Interpretation

The study highlights the positive impact of government-funded health insurance schemes on the timely access to cancer treatment in India. Our study recommends expanding AB PM-JAY cancer packages to include cost-effective treatments, increasing population coverage under screening programs and promoting e-RUPI to reduce financial constraints associated with diagnostic services to address delayed treatment initiation due to unknown cancer stages.

Funding

Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India.

Urban and Rural Differences in Cancer Treatment Disruption Among Patients With COVID-19: An Analysis of the US ASCO COVID-19 in Oncology Registry

INTRODUCTION

Cancer patients in rural areas experience greater barriers to treatment access compared with patients in urban areas. There is limited research on how the COVID-19 pandemic affected cancer treatment delivery for rural patients who were also diagnosed with COVID-19. This study has two objectives: to assess (1) the urban-rural differences in cancer care and (2) the predictors of cancer treatment delay or discontinuation (TDD) among patients diagnosed with COVID-19.

METHODS

We used data from the American Society of Clinical Oncology Survey on COVID-19 in Oncology Registry (March 2020-September 2022), which included cancer patients with test-confirmed SARS-CoV-2 infection (N = 3797). Data included patient sociodemographic characteristics, COVID-19 diagnosis information, cancer clinical characteristics, and changes to cancer treatment. Cancer TDD was defined as any scheduled treatment by more than 2 weeks. Rurality was examined through both patient residence and oncology practice. We computed adjusted prevalence ratios (aPRs) using multivariable Poisson regressions to assess predictors of cancer TDD in urban and rural areas.

RESULTS

During the study period, 44.1% of patients with COVID-19 experienced either cancer treatment delay or discontinuation and 5.7% experienced cancer treatment discontinuation. Controlling for other factors, receiving care in a rural oncology practice was associated with cancer TDD (aPR: 1.25, 95% CI: 1.01-1.55). Differences in cancer TDD were not found across rurality of patient residence. Among rural patients (N = 582), Hispanic/Latinx cancer patients had greater prevalence of cancer TDD (aPR: 1.55, 95% CI: 1.04-2.33) compared with non-Hispanic White cancer patients.

CONCLUSION

Our findings can be used to inform programs and policies to minimize the impact of future public health emergencies on cancer care delivery in rural areas. Additional research is needed to explore potential differences in cancer care delivery across urban and rural oncology practices and patients.

Prevention is better than cure: immunocompromised people need COVID-19 prevention therapies now

Immunocompromised people are facing ongoing inequality in health outcomes because of COVID-19. Let's remain ambitious and improve availability and access to COVID-19 prevention therapies that protect patients and aid management. This article brings together opinions from four experts based in the United Kingdom who specialise in immunology, solid organ transplantation, respiratory medicine and critical care, oncology and haematology. In this article, they communicate the impact of SARS-CoV-2 infection on vulnerable patients with underlying conditions and the need for immediate policies to protect vulnerable people from COVID-19.

Comparison of facilities with and without additional medical fees for nutrition support team activity during the COVID-19 pandemic

BACKGROUND

This study aimed to clarify the effectiveness of nutrition support team (NST) facilities for preventing central line-associated bloodstream infection (CLABSI).

METHODS

We retrospectively analyzed the incidence of CLABSI as well as the presence or absence of additional medical fees for NST activity between 2019 and 2021, including the period before and after the COVID-19 pandemic. Subsequently, we performed between-group comparisons of the CLABSI incidence. CLABSI rates were compared based on cumulative per 1000 catheter uses during the relevant period.

RESULTS

Among 47 facilities that were registered for participation, there were 34 and 13 facilities with and without additional medical fees for NST activity (NST and non-NST groups, respectively). The CLABSI incidence rate was significantly lower in the NST group 0.96 [0.28-1.73] than in the non-NST group 1.25 [075-6.10] (p < 0.05). Before the pandemic, the NST group had a lower CLABSI rate per 1000 catheter uses than the non-NST group 2019: 0.70 [0.12-1.26] vs 2.10 [0.62-5.97]. During the pandemic, the CLABSI incidence showed no significant between-group difference 2020: 0.99 [0.51-1.61] vs 1.01 [0.80-4.16]; 2021: 1.24 [0.44-2.35] vs 1.96 [1.23-5.31]; however, the CLABSI rates in the NST group remained low.

CONCLUSION

During the COVID-19 pandemic, the incidence of CLABSI was lower in the NST group than in the non-NST group, indicating the effectiveness of NST in preventing the occurrence of CLABSI.

Chemotherapy delays among cancer patients in Iran during COVID-19 pandemic

BACKGROUND AND OBJECTIVES

Following the outbreak of COVID-19, a set of restrictions, health advice, and limitations were put in place to reduce the spread of the virus. These restrictions, together with fear and anxiety of the population, limited people's access to public services such as health care services. Cancer patients during this era are a significant concern due to being at high risk for COVID-19 infection and also being exposed to delays in their diagnosis, treatment, and follow-ups. Delays in the treatment of cancer could lead to a poorer prognosis. In this study, we attempted to determine the magnitude of delays in chemotherapy and factors associated with delays during the COVID-19 pandemic.

METHOD

All patients diagnosed with colorectal, lung, gastric cancer, and lymphoma who had chemotherapy at teaching hospitals of Iran University of Medical Sciences (IUMS) between February 20, 2020, and March 20, 2022, were included. Age, gender, cancer type, having metastatic cancer, and date of each chemotherapy session were included for each patient individually. Every session with delays longer than two days was recorded. A three to six-day delay was considered a moderate delay, and a seven-day or longer delay was considered a severe delay in receiving each chemotherapy session. Additionally, each patient's total number of delays in the entire course was calculated. Logistic regression was used to examine the impact of pandemic waves on delays. On the other hand, Poisson regression was used to evaluate the number of delays in the entire course of chemotherapy.

RESULTS

The research findings indicated an association between the male gender and having metastasis with a higher likelihood of a moderate delay in the treatment regimen. Regarding cancer type, colorectal cancer was associated with higher rates of moderate delays (IRR = 1.88, P < 0.001), but gastric (IRR = 0.75, P = 0.001) and lung cancer (IRR = 0.59, P = 0.002) were associated with reduced rates of severe and moderate delays, respectively. Compared to the COVID-19 pandemic plateau periods, the first (OR = 2.08, P < 0.001), third, and fifth waves of the pandemic were associated with increased delays.

CONCLUSION

We found an association between the male gender, colorectal cancer, metastatic disease and higher rates of moderate delays. The initial COVID-19 pandemic wave was associated with increased severe delays in the chemotherapy course. According to the findings of this study, male cancer patients and those with metastatic cancer are at risk of poorer prognosis due to lower adherence to treatment. These findings can assist policymakers in developing targeted strategies to lessen the delay rates in the more vulnerable population.

Health Equity and Access to COVID-19 Treatments Available through Emergency Use Authorizations

Understanding and evaluating equity in access to care is a critical component to ensuring health equity for all individuals. During the COVID-19 pandemic, the U.S. Food and Drug Administration made unprecedented use of its regulatory authority by authorizing the use of unapproved products through Emergency Use Authorizations (EUAs). We use data from the U.S. National COVID Cohort Collaborative (N3C) to understand how access to therapeutic products authorized under EUAs has varied across COVID-19 patients and over time. We find that Black patients were more likely to receive early EUA drugs while White patients were more likely to receive monoclonal antibodies. Male patients were more likely to receive any EUA drug than Female patients. Patients in Metropolitan areas were more likely to receive EUA drugs than patients in other regions. Additionally, differences in the rates of exposure to EUA drugs by gender, rural-urban classification, and length of stay decreased over time while differences by race and ethnicity have generally persisted. Our project identifies inequities in the rate of access to EUA drugs across patient groups that can inform policy makers in future planning and decision making.

Patient perspectives on cancer care during COVID-19: A qualitative study

PURPOSE

The COVID-19 pandemic posed unique challenges to cancer-related care as health systems balanced competing risks of timely delivery of care and minimizing exposure to infection in a high-risk, immunocompromised patient population. This study aimed to better understand how pandemic-related factors affected the patient experience of cancer care during this time.

METHODS

We conducted fifteen semi-structured interviews with adults from rural counties in Maryland who were diagnosed with and/or actively treated for cancer at the TidalHealth healthcare network between January 2020 and October 2022.

RESULTS

Interviews from fifteen participants were analyzed. Two major themes emerged including COVID Impact on Care, and COVID Impact on Mental Health. Subthemes under COVID Impact on Care include Staffing Shortages, Hospital Regulations, Visitation, Importance of Advocacy, and Telehealth Utilization, and subthemes under COVID Impact on Mental Health include Loneliness, Support Networks, and Perceptions of COVID and Personal Protection. Overall, participants described positive care experiences despite notable delays, disruptions to continuity of care, difficult transitions to telemedicine, visitation policies that limited patient support, increased mental health struggles related to social distancing measures, and greater desire for patient advocacy.

CONCLUSION

Our findings reveal significant impacts of the COVID-19 pandemic on experiences of cancer treatment and survivorship in a more vulnerable, rural patient population with lower healthcare access and income level. Our findings suggest areas for targeted interventions to limit disruptions to quality care in future public health emergencies.

Loneliness and Crowded Living Predicted Poor Health in a Sample of Cancer Patients During COVID-19 Pandemic

We investigated the influence of social determinants of health (SDOH), healthcare services, and health behaviors on mental and physical health outcomes of cancer patients between the first winter and the following post-vaccine summer of the COVID-19 pandemic. A three-wave online survey of individuals diagnosed with incident cancer between January 2019 and January 2020 was conducted between November of 2020 and August of 2021 in northeast Ohio. Descriptive analysis and mixed-effect regression analyses were performed. A total of 322 newly diagnosed cancer patients, with 40 African Americans and 282 Whites (215 from metropolitan areas and 67 nonmetropolitan) responded to the survey questions. In Wave 3 ending in August 2021, the survey respondents reported significantly reduced depression (p = .019) on the Hamilton Depression Rating Scale and improved global health (p = .036) on PROMIS. With age, comorbidity, and other demographic and medical variables controlled in the analyses, the feeling of loneliness (p < .001) and crowded living space (p = .001, p = .015) were the two most prominent factors associated with depression, irritability, and poor global health at baseline, with the lowest p values and persistent effect. Self-efficacy of taking preventive measures was associated with reduced depression (p = .001) and improved global health (p = .029). Increasing access to medicine (p < .01) and satisfaction with telehealth appointments (p < .01) were significantly associated with better global health and reduced irritability. Respondents who had private health insurance reported better health than those that had Medicare coverage only (p < .05). This longitudinal, observational study demonstrated the impact of SDOH on health outcomes of cancer patients. Substandard living conditions resulting in loneliness and crowdedness, quality of medical care (e.g., quality telehealth and access to medicine), and personal behaviors (e.g., self-efficacy) were significantly associated with health outcomes in newly diagnosed cancer patients during the pandemic and should be given adequate consideration for the purpose of improving clinical care.

Characterization of time toxicity in older patients with metastatic breast cancer

PURPOSE

Recognizing that receiving healthcare can be time intensive and burdensome, time toxicity has been conceptualized as the time spent by patients seeking healthcare. This study investigates the association between age at diagnosis and time toxicity for patients with Metastatic Breast Cancer (MBC) and identifies major components of care that confer the greatest time toxicity.

METHODS

We conducted a retrospective cohort study among patients with MBC aged 67 or older using the SEER-Medicare database. We assessed time toxicity using the number of encounter days patients interacted with the healthcare system per 100 days, within the first year of starting cancer treatment. We used a Poisson model to analyze the association between age and encounter days, adjusting for clinical and sociodemographic factors. We stratified the mean encounter days for each age cohort by treatment types.

FINDINGS

The final sample included 2949 patients; 51.4% were between 70 and 79 years old, and 81.3% were white. Although unadjusted analysis showed an association between older age and more encounter days (Rate Ratio (RR) 1.12; 95% CI 1.02, 1.22), there was no significant association after adjusting for comorbidities and treatment type. Patients with more than three comorbidities had significantly higher encounter days compared to those without comorbidities [RR 1.36 (95% CI 1.26, 1.46)]. Receipt of radiotherapy [RR: 1.45 95% CI (1.37, 1.54)] was associated with more encounter days compared to not receiving radiotherapy, while receipt of bone-modifying agents was associated with fewer encounter days compared to not using Bone modifying agents [RR 0.75 (95% CI 0.70, 0.79)].

CONCLUSION

Our study identified comorbidities and cancer treatment modality, including radiotherapy, as the factors affecting time toxicity in older patients with MBC. Assessment of an individual's comorbid medical conditions and types of treatment planned are crucial to understanding age-related impacts on encounter days and to support shared decision making in older patients.

Sex Difference in Characteristics and Predictors of In-Hospital Mortality among Patients with COVID-19

INTRODUCTION

With a surge in the prevalence of coronavirus disease-2019 (COVID-19) in Beijing starting in October 2022, hospitalisation rates increased markedly. This study aimed to evaluate factors associated with in-hospital mortality in patients with COVID-19.

METHODS

Using data from hospitalised patients, sex-based differences in clinical characteristics, in-hospital management, and in-hospital mortality among patients diagnosed with COVID-19 were evaluated. Predictive factors associated with mortality in 1,091 patients admitted to the Beijing Anzhen Hospital (Beijing, China) for COVID-19 between October 2022 and January 2023 were also evaluated.

RESULTS

Data from 1,091 patients hospitalised with COVID-19 were included in the analysis. In-hospital mortality rates for male and female patients were 14.9% and 10.4%, respectively. Multifactorial logistic analysis indicated that lymphocyte percentage (LYM%) (odds ratio [OR] 0.863, 95% confidence interval [CI] 0.805-0.925; p < 0.001), uric acid (OR 1.004, 95% CI: 1.002-1.006; p = 0.001), and high-sensitivity C-reactive protein (OR 1.094, 95% CI: 1.012-1.183; p = 0.024) levels were independently associated with COVID-19-related in-hospital mortality. Among female patients, multifactorial analysis revealed that LYM% (OR 0.856, 95% CI: 0.796-0.920; p < 0.001), older age (OR 1.061, 95% CI: 1.020-1.103; p = 0.003), obesity (OR 2.590, 95% CI: 1.131-5.931; p = 0.024), and a high high-sensitivity troponin I level (OR 2.602, 95% CI: 1.157-5.853; p = 0.021) were risk factors for in-hospital mortality. Receiver operating characteristic (ROC) curve analysis, including area under the ROC curve, showed that the efficacy of LYM% in predicting in-hospital death was 0.800 (sensitivity, 63.2%; specificity, 83.2%) in male patients and 0.815 (sensitivity, 87.5%; specificity, 64.4%) in female patients.

CONCLUSION

LYM% is a consistent predictor of in-hospital mortality for both sexes. Older age and markers of systemic inflammation, myocardial injury, and metabolic dysregulation are also associated with a high mortality risk. These findings may help identify patients who require closer monitoring and tailored interventions to improve outcomes.

Survival Among Patients With High-Risk Gastrointestinal Cancers During the COVID-19 Pandemic

Importance

Prior reports demonstrated that patients with cancer experienced worse outcomes from pandemic-related stressors and COVID-19 infection. Patients with certain malignant neoplasms, such as high-risk gastrointestinal (HRGI) cancers, may have been particularly affected.

Objective

To evaluate disruptions in care and outcomes among patients with HRGI cancers during the COVID-19 pandemic, assessing for signs of long-term changes in populations and survival.

Design, Setting, and Participants

This retrospective cohort study used data from the National Cancer Database to identify patients with HRGI cancer (esophageal, gastric, primary liver, or pancreatic) diagnosed between January 1, 2018, and December 31, 2020. Data were analyzed between August 23 and September 4, 2023.

Main Outcome and Measures

Trends in monthly new cases and proportions by stage in 2020 were compared with the prior 2 years. Kaplan-Meier curves and Cox regression were used to assess 1-year mortality in 2020 compared with 2018 to 2019. Proportional monthly trends and multivariable logistic regression were used to evaluate 30-day and 90-day mortality in 2020 compared with prior years.

Results

Of the 156 937 patients included in this study, 54 994 (35.0%) were aged 60 to 69 years and 100 050 (63.8%) were men. There was a substantial decrease in newly diagnosed HRGI cancers in March to May 2020, which returned to prepandemic levels by July 2020. For stage, there was a proportional decrease in the diagnosis of stage I (-3.9%) and stage II (-2.3%) disease, with an increase in stage IV disease (7.1%) during the early months of the pandemic. Despite a slight decrease in 1-year survival rates in 2020 (50.7% in 2018 and 2019 vs 47.4% in 2020), survival curves remained unchanged between years (all P > .05). After adjusting for confounders, diagnosis in 2020 was not associated with increased 1-year mortality compared with 2018 to 2019 (hazard ratio, 0.99; 95% CI, 0.97-1.01). The rates of 30-day (2.1% in 2018, 2.0% in 2019, and 2.1% in 2020) and 90-day (4.3% in 2018, 4.4% in 2019, and 4.6% in 2020) operative mortality also remained similar.

Conclusions and Relevance

In this retrospective cohort study, a period of underdiagnosis and increase in stage IV disease was observed for HRGI cancers during the pandemic; however, there was no change in 1-year survival or operative mortality. These results demonstrate the risks associated with gaps in care and the tremendous efforts of the cancer community to ensure quality care delivery during the pandemic. Future research should investigate long-term survival changes among all cancer types as additional follow-up data are accrued.

Housing Insecurity and Asthma Outcomes

Asthma is a chronic respiratory disease with widespread prevalence that affects children, adolescents, and adults. Asthma morbidity and mortality can be exacerbated in the setting of housing insecurity. In this Grand Rounds Review article, we present a case and discuss the implications that housing insecurity has on asthma outcomes in the United States. We then highlight ways in which providers can advocate for patients with asthma and housing insecurity.

The impact of the pandemic on the presentation and treatment of head and neck squamous cell carcinoma at a county hospital

INTRODUCTION

In March 2020, the World Health Organization declared COVID-19 a pandemic, initiating stay-at-home orders which delayed cancer care and screening. The impact on head and neck cancer care in populations at risk has yet to be elucidated. The objective of this investigation is to evaluate how the presentation, diagnosis, and treatment of head and neck squamous cell carcinoma cancer patients at a county hospital were affected by the pandemic.

METHODS

A retrospective review of patients with head and neck squamous cell carcinoma that were diagnosed at a county hospital 365 days before and after stay-at-home orders were initiated. The primary outcomes were duration between diagnosis from imaging and initiation of treatment. Secondary outcomes included mortality, stage, nodal status, and distant metastasis at presentation.

RESULTS

There was a total of 105 diagnoses. Sixty-five (62 %) head and neck squamous cell carcinoma diagnoses were diagnosed before the stay-at-home orders were initiated, and 40 (38 %) after. Eighty percent (32/40) of diagnoses presenting after had stage IV disease compared to 58 % (38/65) in those before (p < 0.05). A higher percentage of patients who presented later had a >30-day delay to biopsy (43 % v. 20 %, OR: 3.0, p < 0.05). This difference was exacerbated by those with laryngeal, oral cavity, or oropharyngeal cancer (45 % v. 15 %, OR: 4.5, p < 0.05). There was a larger delay from diagnosis to treatment after the orders were initiated (68 v. 53, p < 0.05) however there was no difference in one-year mortality (25 % v. 23 %, p > 0.05). This investigation found a 14 % loss to follow-up.

CONCLUSIONS AND RELEVANCE

In this cohort of head and neck squamous cell carcinoma diagnoses at a county hospital, those diagnosed after the stay-at-home orders were initiated presented with more advanced disease. They also had more delays in diagnosis and initiation of treatment. There was no difference in one-year mortality rates between the two groups however there was a significant loss to follow-up, limiting prognostication. These findings serve to better prepare healthcare providers to implement optimized care during future shutdowns related to public health crises.

LEVEL OF EVIDENCE

III.

Avoidance of medical care among American Indians with a history of cancer during the coronavirus pandemic

Objectives

Assess the percentage of cancer-related appointment delays, cancelations, and the unavailability of medications experienced by American Indian participants during the COVID-19 pandemic.

Methods

This cross-sectional survey study was completed between October 2020 and July 2021 by 360 individuals with cancer who lived in California and Oklahoma. Binary and multivariate logistic regression analysis was completed in SAS 9.4.

Results

During the initial Covid-19 pandemic, almost one-third (30%) of respondents delayed cancer-related appointments, 42% canceled cancer-related appointments, and one-quarter (24%) were unable to access prescription medications or over-the-counter medications (27%) due to COVID-19. People who underwent testing for COVID-19 were five times more likely to delay a medical appointment [adjusted odds ratio (aOR) = 5.3, 95% CI:2.4, 11.7] and people who followed three or more social distancing measures were more than six times more likely to cancel medical appointments (aOR:6.3, 95% CI:2.9, 13.9).

Conclusion

This study identifies delays, cancelations, and medication inaccessibility people identifying as American Indian faced during the coronavirus pandemic. Disparities in healthcare delivery could contribute to increased morbidity and mortality rates of cancer.

Time to treatment patterns of head and neck cancer patients before and during the Covid-19 pandemic

OBJECTIVES

The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020.

MATERIALS AND METHODS

Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020.

RESULTS

A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020.

CONCLUSIONS

TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020.

Alterations in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US

Importance

The COVID-19 pandemic created challenges to the evaluation and treatment of cancer, and abrupt resource diversion toward patients with COVID-19 put cancer treatment on hold for many patients. Previous reports have shown substantial declines in cancer screening and diagnoses in 2020; however, the extent to which the delivery of cancer care was altered remains unclear.

Objective

To assess alterations in cancer treatment in the US during the first year of the COVID-19 pandemic.

Design, Setting, and Participants

This retrospective cohort study used data from the National Cancer Database (NCDB) on patients older than 18 years with newly diagnosed cancer from January 1, 2018, to December 31, 2020.

Main Outcomes and Measures

The main outcomes were accessibility (time to treatment, travel distance, and multi-institutional care), availability (proportional changes in cancer treatment between years), and utilization (reductions by treatment modality, hospital type) of cancer treatment in 2020 compared with 2018 to 2019. Autoregressive models forecasted expected findings for 2020 based on observations from prior years.

Results

Of 1 229 654 patients identified in the NCDB in 2020, 1 074 225 were treated for cancer, representing a 16.8% reduction from what was expected. Patients were predominately female (53.8%), with a median age of 66 years (IQR, 57-74 years), similar to demographics in 2018 and 2019. Median time between diagnosis and treatment was 26 days (IQR, 0-36 days) in 2020, and median travel distance for care was 11.1 miles (IQR, 5.0-25.3 miles), similar to 2018 and 2019. In 2020, fewer patients traveled longer distances (20.2% reduction of patients traveling >35 miles). The proportions of patients treated with chemotherapy (32.0%), radiation (29.5%), and surgery (57.1%) were similar to those in 2018 and 2019. Overall, 146 805 fewer patients than expected underwent surgery, 80 480 fewer received radiation, and 68 014 fewer received chemotherapy. Academic hospitals experienced the greatest reduction in cancer surgery and treatment, with a decrease of approximately 484 patients (-19.0%) per hospital compared with 99 patients (-12.6%) at community hospitals and 110 patients (-12.8%) at integrated networks.

Conclusions and Relevance

This study found that among patients diagnosed with cancer in 2020, access and availability of treatment remained intact; however, reductions in treated patients varied across treatment modalities and were greater at academic hospitals than at community hospitals and integrated networks compared with expected values. These results suggest the resilience of cancer service lines and frame the economic losses from reductions in cancer treatment during the pandemic.

Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19

Patients with cancer have many comorbidities that increase their risk of death from Coronavirus disease 2019 (COVID-19). Anti-spike monoclonal antibodies (mAbs) reduce the risk of hospitalization or death from COVID-19 in the general population. To our knowledge, no studies have focused on the clinical efficacy of mAbs compared to no outpatient treatment exclusively among patients with solid tumors and hematologic malignancies, who are often excluded from clinical trials. We studied patients with cancer who had COVID-19 between 11.9.2020 and 7.21.2022 and received mAbs in an outpatient setting. We compared hospitalization and mortality rates to those of patients with cancer concurrently diagnosed with COVID-19, who were eligible for mAbs, but did not receive any outpatient treatment. 63 patients received mAbs and 89 no outpatient treatment. Administration of mAbs was associated with lower 90-day hospitalization (20.6% vs. 60.7%, p <0.001), all-cause (6.3% vs. 19.1%, p 0.025) and COVID-19-attributed (3.2% vs. 14.6%, p 0.019) mortality rates, and lower peak O2 requirements (ordinal Odds Ratio [OR] = 0.33, 95% Confidence Intervals [CI] = 0.20-0.53). Administration of mAbs (aHR 0.21, p <0.001), age (≥ 60 years, adjusted Hazard Ratio [aHR] 1.86, p=0.033), and metastases (aHR 0.41, p 0.007) were independently associated with hospitalization. mAb treatment remained significantly associated with all-cause (aHR 0.27, p 0.019) and COVID-19-attributed (aHR 0.19, p 0.031) mortality, after adjustment for other factors. mAb administration was associated with improved clinical outcomes among vulnerable patients with cancer and COVID-19. With no mAbs approved currently for treatment against the prevalent circulating variants, the development of new mAbs should be a research priority.

Therapy delay due to COVID-19 pandemic among European women with breast cancer: prevalence and associated factors

PURPOSE

This study investigates the impact of the COVID-19 pandemic on breast cancer (BC) care, analyzing treatment delays and factors associated with them.

METHODS

This retrospective cross-sectional study analyzed data from the Oncology Dynamics (OD) database. Surveys of 26,933 women with BC performed between January 2021 and December 2022 in Germany, France, Italy, the United Kingdom, and Spain were examined. The study focused on determining the prevalence of treatment delays due to the COVID-19 pandemic, considering factors such as country, age group, treating facility, hormone receptor status, tumor stage, site of metastases, and Eastern Cooperative Oncology Group (ECOG) status. Baseline and clinical characteristics were compared for patients with and without therapy delay using chi-squared tests, and a multivariable logistic regression analysis was conducted to explore the association between demographic and clinical variables and therapy delay.

RESULTS

The present study found that most therapy delays lasted less than 3 months (2.4%). Factors associated with higher risk of delay included being bedridden (OR 3.62; 95% CI 2.51-5.21), receiving neoadjuvant therapy (OR 1.79; 95% CI 1.43-2.24) compared to adjuvant therapy, being treated in Italy (OR 1.58; 95% CI 1.17-2.15) compared to Germany or treatment in general hospitals and non-academic cancer facilities (OR 1.66, 95% CI 1.13-2.44 and OR 1.54; 95% CI 1.14-2.09, respectively) compared to treatment by office-based physicians.

CONCLUSION

Addressing factors associated with therapy delays, such as patient performance status, treatment settings, and geographic location, can help guide strategies for improved BC care delivery in the future.

Experience with the safe admission of breast and thyroid cancer patients in non-endemic areas during an epidemic outbreak

Background

The outbreaks of infectious diseases, such as coronavirus disease 2019 (COVID-19), have seriously affected the normal work and life of the public, as well as the normal diagnosis and treatment of other diseases due to their strong infectivity, high population susceptibility, and diverse clinical manifestations. Breast and thyroid specialists in non-hotspot epidemic areas of COVID-19 must consider factors, including epidemic prevention and control, breast and thyroid cancers and diseases diagnosis and treatment, and access to medical resources to make a reasonable treatment choice and optimize the treatment process.

Methods

A cohort study was designed under our center's epidemic prevention and control strategy. The study was conducted between February 3 and April 19, 2020, to explore the safety of clinical diagnosis and treatment of breast and thyroid cancer patients during the epidemic. All the outpatients, inpatients, day-time chemotherapy patients, targeted therapy patients, and relevant medical staff in the observation period in the Department of Breast and Thyroid Surgery in Southwest Hospital in Chongqing municipality, China, were included to investigate the detection and infection rate of COVID-19 and suspected patients.

Results

During the observation period, 27,117 patients were admitted to the outpatient unit. We performed 394 inpatient surgeries and 411 day-time surgeries. In our center, 1,046 and 663 patients received day-time chemotherapy and targeted therapy, respectively. All the patients were diagnosed and treated promptly and safely. Three suspected COVID-19 patients were identified in the outpatient unit. Healthcare staff achieved a "zero" infection of COVID-19.

Conclusion

The spread and cross-infection of COVID-19 can be avoided in non-hotspot epidemic areas based on scientific prevention and control, and cancer patients can be diagnosed and treated on time. The prevention and control measure implemented in the COVID-19 epidemic for diagnosing and treating cancer patients was effective and can be referenced for other infectious disease outbreaks.

R0 surgical resection of giant dedifferentiated retroperitoneal liposarcomas in the COVID era with and without nephrectomy: A case report

Retroperitoneal sarcomas (RPSs) are rare findings that can grow into large masses without eliciting severe symptoms. At present, surgical resection is the only radical therapy, whenever it can be performed with the aim to achieve a complete removal of the tumor. The present report describes two consecutive cases of RPSs that resulted in dedifferentiated liposarcomas (DDLPSs) and these patients underwent R0 surgical resection with and without a nephron-sparing procedure. The diagnostic workup, the surgical approach, the impact of late surgical management due to the COVID pandemic and the latest literature on the topic are discussed and analyzed. The patients, who refused to undergo any medical examination during the prior 2 years due to the COVID pandemic, were admitted to Federico II University Hospital (Naples, Italy) complaining about weight loss and general abdominal discomfort. In the first case, a primitive giant abdominal right neoplasm of retroperitoneal origin enveloping and medializing the right kidney was observed. The second patient had a similar primitive retroperitoneal giant left neoplasm, which did not affect the kidney. Given the characteristics of the masses and the absence of distant metastases, after a multidisciplinary discussion, radical surgical removal was carried out for both patients. The lesions appeared well-defined from the surrounding tissues, and markedly compressed all the adjacent organs, without signs of infiltration. In the first patient, the right kidney was surrounded and undetachable from the tumor and it was removed en bloc with the mass. The second patient benefited from a nephron-sparing resection, due to the existence of a clear cleavage plane. The postoperative courses were uneventful. Both the histological examinations were oriented towards a DDLPS and both patients benefited from adjuvant chemotherapy. In conclusion, the treatment of giant RPS is still challenging and requires multidisciplinary treatment as well as, when possible, radical surgical removal. The lack of tissue infiltration and the avoidance of excision or reconstruction of major organs (including the kidney) could lead to an easier postoperative course and an improved prognosis. When possible, surgical management of recurrences or incompletely resected masses must be pursued. Since the COVID pandemic caused limited medicalization of a number of population groups and delayed diagnosis of other oncologic diseases, an increased number of DDLPSs could be expected in the near future.

Socioeconomic status and inequities in treatment initiation and survival among patients with cancer, 2011-2022

BACKGROUND

Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. Most studies examining cancer inequities across area-level socioeconomic status tend to use less granular or unidimensional measures and pre-date the COVID-19 pandemic. Here, we examined the association of area-level socioeconomic status on real-world treatment initiation and overall survival among adults with 20 common cancers.

METHODS

This retrospective cohort study used electronic health record-derived deidentified data (Flatiron Health Research Database, 2011-2022) linked to US Census Bureau data from the American Community Survey (2015-2019). Area-level socioeconomic status quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their mailing address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type.

RESULTS

This cohort included 291 419 patients (47.7% female; median age = 68 years). Patients from low-SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) than those in high-SES areas. Living in low-SES areas (vs high) was associated with lower treatment rates (hazard ratio = 0.94 [95% confidence interval = 0.93 to 0.95]) and reduced survival (median real-world overall survival = 21.4 vs 29.5 months, hazard ratio = 1.20 [95% confidence interval = 1.18 to 1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-level socioeconomic inequities in treatment and survival remained statistically significant in the COVID-19 era (after March 2020).

CONCLUSION

To reduce inequities in cancer outcomes, efforts that target marginalized, low-socioeconomic status neighborhoods are necessary.

"I Had to Do It All Alone": Hispanic Perspectives on Navigating Breast Cancer Treatment

Cancer patients are at a high risk for COVID infection and its corresponding impacts on treatment delay, social isolation, and psychological distress. Hispanic breast cancer patients may be more vulnerable due to a lack of resources and language barriers, widening disparities in cancer care. This qualitative study explored the challenges and obstacles to cancer care during the COVID pandemic among 27 Hispanic females from a United States-Mexico border region. Data were collected via individual in-depth interviews and analyzed using thematic analysis. The majority of the participants were interviewed in Spanish. More than half (55.6%, n = 15) were diagnosed with breast cancer within the prior year to the interview. One-third of the participants (33.3%, n = 9) reported that COVID somewhat to greatly impacted their cancer care. Study findings revealed potential barriers and challenges for cancer care at multiple levels (e.g., medical, psychosocial, financial level) during the COVID pandemic. Five major themes reported include: (1) delays in testing and access to care; (2) fear of COVID infection; (3) social isolation and reduced social support; (4) challenges in navigating treatments alone; and (5) financial hardships. Our findings highlight the importance for health care practitioners to understand various challenges encountered by underserved Hispanic breast cancer patients due to COVID. Screening for psychological distress and exploring approaches to expand social support to address these challenges are discussed.

Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19

BACKGROUND

Patients with cancer have many comorbidities that increase their risk of death from Coronavirus disease 2019 (COVID-19). Anti-spike monoclonal antibodies (mAbs) reduce the risk of hospitalization or death from COVID-19 in the general population. To our knowledge, no studies have focused on the clinical efficacy of mAbs compared to no outpatient treatment exclusively among patients with solid tumors and hematologic malignancies, who are often excluded from clinical trials.

METHODS

We studied patients with cancer who had COVID-19 between 11.9.2020 and 7.21.2022 and received mAbs in an outpatient setting. We compared hospitalization and mortality rates to those of patients with cancer concurrently diagnosed with COVID-19, who were eligible for mAbs, but did not receive any outpatient treatment.

RESULTS

63 patients received mAbs and 89 no outpatient treatment. Administration of mAbs was associated with lower 90-day hospitalization (20.6% vs. 60.7%, p<0.001), all-cause (6.3% vs. 19.1%, p=0.025) and COVID-19-attributed (3.2% vs. 14.6%, p=0.019) mortality rates, and lower peak O2 requirements (ordinal Odds Ratio [OR]=0.33, 95%Confidence Intervals [CI]=0.20-0.53). Administration of mAbs (aHR 0.21, p<0.001), age (≥ 60 years, adjusted Hazard Ratio [aHR] 1.86, p=0.033), and metastases (aHR 0.41, p=0.007) were independently associated with hospitalization. mAb treatment remained significantly associated with all-cause (aHR 0.27, p=0.019) and COVID-19-attributed (aHR 0.19, p=0.031) mortality, after adjustment for other factors.

CONCLUSIONS

mAb administration was associated with improved clinical outcomes among vulnerable patients with cancer and COVID-19. With no mAbs approved currently for treatment against the prevalent circulating variants, the development of new mAbs should be a research priority.

The Effects of the COVID-19 Pandemic on Cancer Staging in Patients Diagnosed With Head and Neck Cancer

Purpose The healthcare system across the world was forced to implement new policies, guidelines, and procedures due to the coronavirus disease 2019 (COVID-19) pandemic, which led many patients to make an impossible choice about their health. For various reasons, many patients chose to remain at home and delay any interaction at medical facilities to protect themselves or others from the virus. Patients managing chronic diseases faced unprecedented challenges during this period, and the long-term effects on these patient populations remain unclear. Oncology patients, specifically those diagnosed with head and neck cancers, require prompt diagnosis and initiation of treatment for better outcomes. While the overall impact of how the pandemic has affected oncology patients is unknown, this retrospective study examined how the staging of head and neck tumors at our institution has been impacted since the beginning of the pandemic. Methods Available patient data (from August 1, 2019, through June 28, 2021) were collected from medical records and compared to determine statistical significance. Patients were categorized into a Pre-pandemic group, Pandemic group, and Vaccine-approved group, and patient and treatment characteristics were analyzed to look for patterns. The pre-pandemic period was defined as the period from August 1, 2019, to March 16, 2020, the pandemic period was defined as the period from March 17, 2020, to December 31, 2020, and the vaccine-approved period was defined as the period from January 1, 2021, to June 28, 2021.  Results Fisher's exact tests were used to compare tumor, node, metastasis (TNM) staging distributions between the three groups. In the Pre-pandemic group, out of 67 patients, 33 patients (55.0%) were diagnosed with a T stage of 0-2 and 27 patients (45.0%) were diagnosed with a T stage of 3-4. In the Pandemic and Vaccine-approved groups, out of 139 patients, 50 patients (39.1%) were diagnosed with a T stage of 0-2 and 78 patients (60.9%) were diagnosed with a T stage of 3-4; these differences were statistically significant (P-value = 0.0426). The Pre-pandemic group had 25 patients (41.7%) diagnosed with a group stage of 0-2 and 35 patients (58.3%) diagnosed with a group stage of 3-4. The Pandemic and Vaccine-approved groups had 36 patients (28.1%) diagnosed with a group stage of 0-2 and 92 patients (71.9%) diagnosed with a group stage of 3-4; these results trended to statistically significant (P-value = 0.0688). Conclusions Our findings suggest that there have been a higher number of patients with head and neck cancer diagnosed with a T stage of 3 or 4 since the start of the COVID-19 pandemic. The effects of the COVID-19 pandemic are ongoing and will need further evaluation to determine the overall effects on oncology patients. Increased morbidity and mortality rates may be a potential result in the years to come.

Reexamining Social Determinants of Health Data Collection in the COVID-19 Era

This Viewpoint describes the association of various factors, including demographic factors, disease-related factors, and social determinants of health, with cancer treatment delays among a cohort of patients across multiple sites who had all tested positive for SARS-CoV-2.

Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data

The COVID-19 pandemic has forced people to significantly change their lifestyles and attitudes, and has greatly burdened healthcare delivery systems worldwide. The redistribution of the medical delivery system to maintain normal medical care while responding generously to COVID-19 is a continuing challenge that weighs heavily on medical institutions. Among imaging modalities, chest X-rays and computed tomography (CT) examinations have clearly made a large contribution to treatment of COVID-19. In contrast, it is difficult to express the standpoint of nuclear medicine examinations in a straightforward manner, as the greatest emphasis in this modality has been on how necessary medical care can continue to be provided. Many clinical reports of nuclear medicine examinations related to COVID-19 have been published, and knowledge continues to accumulate. This review provides a summary of the current state of oncology and cardiology positron emission tomography (PET) examinations related to COVID-19, and includes preparation of the nuclear medicine department, trends in PET examinations, specific imaging findings on 18F-fluorodeoxyglucose (FDG) PET/CT, imaging of complications of COVID-19, PET tracers other than FDG, and the effects of vaccines on PET imaging findings.

Prevalence and Outcomes of COVID-19 among Hematology/Oncology Patients and Providers of a Community-Facing Health System during the B1.1.529 (“Omicron”) SARS-CoV-2 Variant Wave

Simple Summary

The COVID-19 pandemic continues, and cancer patients are at high risk for both contracting as well as dying from the infection. There is not as much data known about newer COVID-19 variants such as Omicron compared to earlier waves for patients with cancer. In this study, we retrospectively evaluated how COVID-19 positivity affected both patients and their providers in our community-facing cancer clinic. We found that 33.3% compared to 8.7% of cancer providers versus patients, respectively, tested positive for COVID-19 from December 2021 through April 2022 (p = 0.038). Furthermore, we saw that almost two-thirds of cancer patients experienced delays in receiving cancer treatments. Finally, over 10% of cancer patients (4 of 90) died during the Omicron wave. This study confirms that COVID-19 remains a formidable infection in terms of cancer patients’ treatment as well as livelihood, and continues to result in considerable health care disparities for disadvantaged populations.

Abstract

(1) Background: the SARS-CoV-2 (COVID-19) pandemic continues, and patients actively receiving chemotherapy are known to be at enhanced risk for developing symptomatic disease with poorer outcomes. Our study evaluated the prevalence of COVID-19 among patients and providers of our community-facing county health system during the B1.1.529 (“Omicron”) COVID-19 variant wave. (2) Methods: We retrospectively analyzed patients that received care and clinical providers whom worked at the Jackson Memorial Hospital Hematology/Oncology clinic in Miami, Florida, USA, from 1 December 2021 through 30 April 2022. We assessed demographic variables and quality outcomes among patients. (3) Results: 1031 patients and 18 providers were retrospectively analyzed. 90 patients tested positive for COVID-19 (8.73%), while 6 providers tested positive (33.3%) (p = 0.038). There were 4 (10.3%) COVID-19-related deaths (and another outside our study timeframe) and 39 non-COVID-19-related deaths (89.7%) in the patient population (p = 0.77). COVID-19 accounted for 4.44% of our clinic’s total mortality, and delayed care in 64.4% of patients. (4) Conclusions: The prevalence of COVID-19 positivity in our patient cohort mirrored local, state, and national trends, however a statistically significant greater proportion of our providers tested positive. Almost two-thirds of patients experienced a cancer treatment delay, significantly impacting oncologic care.