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van Vuren RMG, Janssen YF, Hogenbirk RNM, de Graaff MR, van den Hoek R, Kruijff S, Heineman DJ, van der Plas WY, Wouters MWJM. The Impact of the COVID-19 Pandemic on Time to Treatment in Surgical Oncology: A National Registry Study in The Netherlands. Cancers (Basel) 2024; 16:1738. [PMID: 38730690 PMCID: PMC11083561 DOI: 10.3390/cancers16091738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
To avoid delay in oncological treatment, a 6-weeks norm for time to treatment has been agreed on in The Netherlands. However, the impact of the COVID-19 pandemic on health systems resulted in reduced capacity for regular surgical care. In this study, we investigated the impact of the COVID-19 pandemic on time to treatment in surgical oncology in The Netherlands. METHODS A population-based analysis of data derived from five surgical audits, including patients who underwent surgery for lung cancer, colorectal cancer, upper gastro-intestinal, and hepato-pancreato-biliary (HPB) malignancies, was performed. The COVID-19 cohort of 2020 was compared to the historic cohorts of 2018 and 2019. Primary endpoints were time to treatment initiation and the proportion of patients whose treatment started within 6 weeks. The secondary objective was to evaluate the differences in characteristics and tumour stage distribution between patients treated before and during the COVID-19 pandemic. RESULTS A total of 14,567 surgical cancer patients were included in this study, of these 3292 treatments were started during the COVID-19 pandemic. The median time to treatment decreased during the pandemic (26 vs. 27 days, p < 0.001) and the proportion of patients whose treatment started within 6 weeks increased (76% vs. 73%, p < 0.001). In a multivariate logistic regression analysis, adjusting for patient characteristics, no significant difference in post-operative outcomes between patients who started treatment before or after 6 weeks was found. Overall, the number of procedures performed per week decreased by 8.1% during the pandemic. This reduction was most profound for patients with stage I lung carcinoma and colorectal carcinoma. There were fewer patients with pulmonary comorbidities in the pandemic cohort (11% vs. 13%, p = 0.003). CONCLUSIONS Despite pressure on the capacity of the healthcare system during the COVID-19 pandemic, a larger proportion of surgical oncological patients started treatment within six weeks, possibly due to prioritisation of cancer care and reductions in elective procedures. However, during the pandemic, a decrease in the number of surgical oncological procedures performed in The Netherlands was observed, especially for patients with stage I disease.
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Affiliation(s)
- Roos M. G. van Vuren
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Yester F. Janssen
- Department of Neurosurgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands;
- TRACER Europe B.V., Aarhusweg 2-1, 9723 JJ Groningen, The Netherlands
| | - Rianne N. M. Hogenbirk
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Michelle R. de Graaff
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
- Dutch Institute for Clinical Auditing, Scientific Bureau, 2333 AA Leiden, The Netherlands
| | - Rinske van den Hoek
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - David J. Heineman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.J.H.); (W.Y.v.d.P.)
| | - Willemijn Y. van der Plas
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.J.H.); (W.Y.v.d.P.)
| | - Michel W. J. M. Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, 2333 AA Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands
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Kim YK, Park SB, Lee M, Youn JY, Kwak MS, Cha JM. Impact of COVID-19 Pandemic on Performance of Gastrointestinal Endoscopy. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 82:239-247. [PMID: 37997220 DOI: 10.4166/kjg.2023.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/28/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
Background/Aims Non-time-sensitive gastrointestinal endoscopy was deferred because of the risk of exposure to coronavirus disease 2019 (COVID-19), but no population-based studies have quantified the adverse impact on gastrointestinal procedures. This study examined the impact of the COVID-19 pandemic on the performance of esophagogastroduodenoscopy (EGD), colonoscopy, ERCP, and abdominal ultrasonography (US) in South Korea. Methods This nationwide, population-based study compared the claim data of EGD, colonoscopy, ERCP, and abdominal US in 2020 and 2021 (COVID-19 era) with those in 2019 (before the COVID-19 era). Results During the first year (2020) of the COVID-19 pandemic, the annual claim data of EGD and colonoscopy were reduced by 6.3% and 6.9%, respectively, but those of ERCP and abdominal US were increased by 1.0% and 2.9%, compared to those in 2019. During the first surge (March and April 2020) of COVID-19, the monthly claim data of EGD, colonoscopy, ERCP, and abdominal US were reduced by 28.8%, 43.8%, 5.1%, and 21.6%, respectively, in March 2020, and also reduced by 17.2%, 32.8%, 4.4%, and 9.5%, respectively, in April 2020, compared to those in March and April 2019. During March and April 2020, the monthly claims of ERCP, compared with those in 2019, declined less significantly than those of EGD and colonoscopy (both p<0.001). Conclusions The claims of EGD and colonoscopy were reduced more significantly than those of ERCP and abdominal US during the COVID-19 pandemic because ERCPs are time-sensitive procedures and abdominal USs are non-aerosolized procedures.
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Affiliation(s)
- Youn Kyung Kim
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Su Bee Park
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Moonhyung Lee
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin Young Youn
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2023; 30:5495-5505. [PMID: 37017832 PMCID: PMC10075171 DOI: 10.1245/s10434-023-13339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. PATIENTS AND METHODS We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0-III colon cancer receiving surgery at ≥ 60 days versus 30-59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors. RESULTS Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01-1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09-1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01-1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17-1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04-1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20-1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17-1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22-1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02-1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36-1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. CONCLUSIONS Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.
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Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Suh MA, Park SB, Kwak MS, Yoon JY, Cha JM. Impact of the COVID-19 Pandemic on Esophagogastroduodenoscopy and Gastric Cancer Claims in South Korea: A Nationwide, Population-Based Study. Yonsei Med J 2023; 64:549-557. [PMID: 37634631 PMCID: PMC10462811 DOI: 10.3349/ymj.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/14/2023] [Accepted: 07/09/2023] [Indexed: 08/29/2023] Open
Abstract
PURPOSE There has been little information about the impact of coronavirus disease 2019 (COVID-19) pandemic on esophagogastroduodenoscopy (EGD) and gastric cancer claims. This study aimed to measure the impact of COVID-19 pandemic on EGD and gastric cancer claims in South Korea. MATERIALS AND METHODS This nationwide, population-based study compared the claims data of EGD, gastric cancer, early gastric cancer (EGC), advanced gastric cancer (AGC) and gastric cancer operation in 2020 and 2021 (COVID-19 era) to those in 2019 (before COVID-19 pandemic). RESULTS The annual claims of EGD, gastric cancer, EGC, and AGC were reduced by 6.3%, 5.0%, 4.7%, and 3.6% in 2020 and by 2.2%, 1.0%, 0.6%, and 1.9% in 2021, respectively, compared to 2019. The amount of annual claims of gastric cancer operation was reduced by 8.8% in 2020, but increased by 0.9% in 2021, compared to those in 2019. The monthly claims of EGD, gastric cancer, EGC, AGC, and gastric cancer operation were mainly reduced in the first epidemic wave of COVID-19, but decreased in the 2nd to 4th epidemic wave. Compared to 2019, the monthly claim of EGD, gastric cancer, EGC, AGC, and gastric cancer operation were reduced by 28.8%, 14.3%, 18.1%, 9.2%, and 5.8% in March 2020 and by 17.2%, 10.8%, 10.3%, 7.2%, and 35.4% in April 2020, respectively. CONCLUSION Negative impact of the COVID-19 pandemic on EGD, gastric cancer, EGC, AGC, and gastric cancer operation was worst during the first surge of COVID-19, but decreased in the 2nd to 4th epidemic wave of the disease in 2020 and 2021.
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Affiliation(s)
- Min Ah Suh
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Su Bee Park
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
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Mareschal J, Hemmer A, Douissard J, Dupertuis YM, Collet TH, Koessler T, Toso C, Ris F, Genton L. Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies-A Systematic Review. Cancers (Basel) 2023; 15:cancers15061881. [PMID: 36980767 PMCID: PMC10047365 DOI: 10.3390/cancers15061881] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/02/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
The advantages of prehabilitation in surgical oncology are unclear. This systematic review aims to (1) evaluate the latest evidence of preoperative prehabilitation interventions on postoperative outcomes after gastrointestinal (GI) cancer surgery and (2) discuss new potential therapeutic targets as part of prehabilitation. Randomized controlled trials published between January 2017 and August 2022 were identified through Medline. The population of interest was oncological patients undergoing GI surgery. Trials were considered if they evaluated prehabilitation interventions (nutrition, physical activity, probiotics and symbiotics, fecal microbiota transplantation, and ghrelin receptor agonists), alone or combined, on postoperative outcomes. Out of 1180 records initially identified, 15 studies were retained. Evidence for the benefits of unimodal interventions was limited. Preoperative multimodal programs, including nutrition and physical activity with or without psychological support, showed improvement in postoperative physical performance, muscle strength, and quality of life in patients with esophagogastric and colorectal cancers. However, there was no benefit for postoperative complications, hospital length of stay, hospital readmissions, and mortality. No trial evaluated the impact of fecal microbiota transplantation or oral ghrelin receptor agonists. Further studies are needed to confirm our findings, identify patients who are more likely to benefit from surgical prehabilitation, and harmonize interventions.
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Affiliation(s)
- Julie Mareschal
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Alexandra Hemmer
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Jonathan Douissard
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- Department of Colorectal Surgery, Freeman Hospital-Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Yves Marc Dupertuis
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Tinh-Hai Collet
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Diabetes Centre, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Thibaud Koessler
- Department of Oncology, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Frédéric Ris
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Laurence Genton
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Diabetes Centre, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
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Liu Z, Zhang Z, Liu H, Chen J. Time to surgery does not affect oncologic outcomes in locally advanced gastric cancer after neoadjuvant chemotherapy: a meta-analysis. Future Oncol 2023; 19:397-408. [PMID: 36919890 DOI: 10.2217/fon-2022-1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Aim: The authors conducted a meta-analysis to determine the association between time-to-surgery (TTS) after neoadjuvant chemotherapy and patient outcomes in locally advanced gastric cancer. Methods: Electronic databases were searched to identify potential studies, in which the authors compared patient outcomes between those with TTS within 4 (and 6) weeks of completion of neoadjuvant chemotherapy and those after 4 (and 6) weeks. Results: Six studies, including 1238 patients, were eligible for inclusion. Pooled data showed no significant differences in rates of pathological complete response, major pathological response, ypN0, complications, R0 resection and operative time between groups of longer TTS and shorter TTS. Conclusion: There was no statistically advantageous impact of prolonged TTS on pathological and surgical outcomes. Large, population-based studies are warranted.
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Affiliation(s)
- Zining Liu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhening Zhang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis & Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hua Liu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis & Translational Research, Peking University Cancer Hospital & Institute, Beijing, China
| | - Junbing Chen
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
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Effects of the COVID-19 pandemic on colorectal cancer surgery. JOURNAL OF SURGERY AND MEDICINE 2023. [DOI: 10.28982/josam.7739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Background/Aim: In accordance with the guidelines published during the COVID-19 pandemic, cancer operations, except for emergencies, were postponed. However, the effect of postponed surgical treatment on the outcomes of cancer cases has not yet been determined. Therefore, this study aimed to compare the clinical data and outcomes of patients who underwent surgery for colorectal cancer before and during the pandemic.
Methods: This retrospective cohort study was conducted in the Department of General Surgery. Patients who underwent surgery for colorectal cancer during the pre-pandemic period (February 1, 2019-December 31, 2019) and pandemic period (August 1, 2020-June 30, 2021) were included. The patients’ demographic data, clinical and laboratory findings, clinical presentation, operation type, complications, and pathology results were retrospectively obtained by screening the patient files.
Results: The study included a total of 183 patients, 91 in the pre-pandemic period and 92 in the pandemic period. During the pandemic period, the length of hospital stay was significantly shorter, but the rate of readmission after discharge was significantly higher (P<0.001, P=0.04). There was no significant difference between the two periods in terms of disease stage. During the pandemic period, the number of cases that underwent emergency surgery was significantly higher. The rates of mortality and postoperative complication rates were also significantly higher (P=0.04, P<0.001).
Conclusion: The pandemic had serious effects on colorectal cancer cases. There was an increase in mortality and morbidity due to the increase in complicated cases.
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Correia de Sá T, Rocha M. The Pancreas in Coronavirus Disease 2019 Infection. Gastroenterol Clin North Am 2023; 52:37-48. [PMID: 36813429 PMCID: PMC9744682 DOI: 10.1016/j.gtc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An association between acute pancreatitis (AP) and coronavirus disease 2019 (COVID-19) has been proposed but the mechanisms of pancreatic injury of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the implicative role on the development of AP are not yet fully understood. COVID-19 also imposed major challenges on pancreatic cancer management. We conducted an analysis on the mechanisms of pancreatic injury by SARS-CoV-2 and reviewed published case reports of AP attributed to COVID-19. We also examined the pandemic effect on pancreatic cancer diagnosis and management, including pancreatic surgery.
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Affiliation(s)
- Tiago Correia de Sá
- General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007 Penafiel, Portugal.
| | - Mónica Rocha
- Hepato-Pancreato-Biliary Unit, General Surgery Department, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, 4564-007 Penafiel, Portugal
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9
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Ram A, Pagès A, Cubilier E, Daoudi N, Vandergheynst F, Scotte F, Antoun S, Merad M. COVID-19 impact on an oncologic emergency department visits: observational study. BMJ Support Palliat Care 2023:spcare-2023-004184. [PMID: 36813536 DOI: 10.1136/spcare-2023-004184] [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: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study aimed at evaluating the impact of COVID-19 on emergency department (ED) visits in a tertiary cancer centre and providing information on the features of the unplanned events during the first wave of COVID-19 pandemic. METHODS This retrospective observational study based on data from ED reports was divided into three periods of 2 months each around the first lockdown announcement of 17 March 2020: pre-lockdown, lockdown and post-lockdown. RESULTS A total of 903 ED visits were included in the analyses. The mean (±SD) daily number of ED visits did not change during the lockdown period (14.6±5.5) when compared with the periods before (13.6±4.5) and after lockdown (13.7±4.4) (p=0.78). The proportion of ED visits for fever and respiratory disorders increased significantly to 29.5% and 28.5%, respectively (p<0.01) during lockdown. Pain, the third most frequent motive, remained stable with 18.2% (p=0.83) throughout the three periods. Symptom severity also showed no significant differences in the three periods (p=0.31). CONCLUSION Our study shows that ED visits during the first wave of the COVID-19 pandemic remained stable for our patients regardless of the symptom's severity. The fear of an in-hospital viral contamination appears weaker than the need for pain management or for the treatment of cancer-related complications. This study highlights the positive impact of cancer ED in the first-line treatment and supportive care of patients with cancer.
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Affiliation(s)
- Aurélie Ram
- Internal medicine, Hôpital Erasme, Brussels, Belgium
| | - Arnaud Pagès
- Biostatistics, Gustave Roussy Institute, Villejuif, Île de France, France
| | - Edouard Cubilier
- Internal medicine, Brugmann University Hospital, Brussels, Belgium
| | - Nesrine Daoudi
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | | | - Florian Scotte
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Sami Antoun
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Mansouriah Merad
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
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Vogel MME, Wagner A, Gempt J, Krenzlin H, Zeyen T, Drexler R, Voss M, Nettekoven C, Abboud T, Mielke D, Rohde V, Timmer M, Goldbrunner R, Steinbach JP, Dührsen L, Westphal M, Herrlinger U, Ringel F, Meyer B, Combs SE. Impact of the SARS-CoV-2 pandemic on the survival of patients with high-grade glioma and best practice recommendations. Sci Rep 2023; 13:2766. [PMID: 36797335 PMCID: PMC9933015 DOI: 10.1038/s41598-023-29790-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has changed the clinical day-to-day practice. The aim of this study was to evaluate the impact of the pandemic on patients with high-grade glioma (HGG) as well as to derive best practice recommendations. We compared a multi-institutional cohort with HGG (n = 251) from 03/2020 to 05/2020 (n = 119) to a historical cohort from 03/2019 to 05/2019 (n = 132). The endpoints were outcome (progression-free survival (PFS) and overall survival (OS)) as well as patterns of care and time intervals between treatment steps. The median OS for WHO grade 4 gliomas was 12 months in 2019 (95% Confidence Interval 9.7-14.3 months), and not reached in 2020 (p = .026). There were no other significant differences in the Kaplan-Meier estimates for OS and PFS between cohorts of 2019 and 2020, neither did stratification by WHO grade reveal any significant differences for OS, PFS or for patterns of care. The time interval between cranial magnetic resonance imaging (cMRI) and biopsy was significantly longer in 2020 cohort (11 versus 21 days, p = .031). Median follow-up was 10 months (range 0-30 months). Despite necessary disease containment policies, it is crucial to ensure that patients with HGG are treated in line with the recent guidelines and standard of care (SOC) algorithms. Therefore, we strongly suggest pursuing no changes to SOC treatment, a timely diagnosis and treatment with short time intervals between first symptoms, initial diagnosis, and treatment, as well as a guideline-based cMRI follow-up.
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Affiliation(s)
- Marco M. E. Vogel
- grid.6936.a0000000123222966Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675 Munich, Germany ,grid.4567.00000 0004 0483 2525Institute for Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany
| | - Arthur Wagner
- grid.6936.a0000000123222966Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675 Munich, Germany
| | - Jens Gempt
- grid.6936.a0000000123222966Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675 Munich, Germany
| | - Harald Krenzlin
- grid.410607.4Department of Neurosurgery, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Thomas Zeyen
- grid.10388.320000 0001 2240 3300Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University of Bonn, Venusberg-Campus 1, 53105 Bonn, Germany
| | - Richard Drexler
- grid.13648.380000 0001 2180 3484Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Universität Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Martin Voss
- grid.411088.40000 0004 0578 8220Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528 Frankfurt/Main, Germany
| | - Charlotte Nettekoven
- grid.411097.a0000 0000 8852 305XCenter for Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Tammam Abboud
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, University Medical Center Göttingen, University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Dorothee Mielke
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, University Medical Center Göttingen, University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Veit Rohde
- grid.411984.10000 0001 0482 5331Department of Neurosurgery, University Medical Center Göttingen, University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Marco Timmer
- grid.411097.a0000 0000 8852 305XCenter for Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Roland Goldbrunner
- grid.411097.a0000 0000 8852 305XCenter for Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
| | - Joachim P. Steinbach
- grid.411088.40000 0004 0578 8220Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528 Frankfurt/Main, Germany
| | - Lasse Dührsen
- grid.13648.380000 0001 2180 3484Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Universität Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Manfred Westphal
- grid.13648.380000 0001 2180 3484Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Universität Hamburg, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Herrlinger
- grid.10388.320000 0001 2240 3300Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University of Bonn, Venusberg-Campus 1, 53105 Bonn, Germany
| | - Florian Ringel
- grid.410607.4Department of Neurosurgery, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany
| | - Bernhard Meyer
- grid.6936.a0000000123222966Department of Neurosurgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675 Munich, Germany
| | - Stephanie E. Combs
- grid.6936.a0000000123222966Department of Radiation Oncology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich (TUM), Ismaninger Strasse 22, 81675 Munich, Germany ,grid.4567.00000 0004 0483 2525Institute for Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany ,grid.7497.d0000 0004 0492 0584Deutsches Konsortium Für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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11
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Chen SY, Radomski SN, Stem M, Papanikolaou A, Gabre-Kidan A, Atallah C, Efron JE, Safar B. Colorectal Surgery Outcomes in the United States During the COVID-19 Pandemic. J Surg Res 2023; 287:95-106. [PMID: 36893610 PMCID: PMC9868386 DOI: 10.1016/j.jss.2022.12.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/02/2022] [Accepted: 12/25/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The purpose of this study was to assess colorectal surgery outcomes, discharge destination, and readmission in the United States during the COVID-19 pandemic. METHODS Adult colorectal surgery patients in the American College of Surgeons National Surgical Quality Improvement Program database (2019-2020) and its colectomy and proctectomy procedure-targeted files were included. The prepandemic time period was defined from April 1, 2019 to December 31, 2019. The pandemic time period was defined from April 1, 2020 to December 31, 2020 in quarterly intervals (Q2 April-June; Q3 July-September; Q4 October-December). Factors associated with morbidity and in-hospital mortality were assessed using multivariable logistic regression. RESULTS Among 62,393 patients, 34,810 patients (55.8%) underwent colorectal surgery prepandemic and 27,583 (44.2%) during the pandemic. Patients who had surgery during the pandemic had higher American Society of Anesthesiologists class and presented more frequently with dependent functional status. The proportion of emergent surgeries increased (12.7% prepandemic versus 15.2% pandemic, P < 0.001), with less laparoscopic cases (54.0% versus 51.0%, P < 0.001). Higher rates of morbidity with a greater proportion of discharges to home and lesser proportion of discharges to skilled care facilities were observed with no considerable differences in length of stay or worsening readmission rates. Multivariable analysis demonstrated increased odds of overall and serious morbidity and in-hospital mortality, during Q3 and/or Q4 of the 2020 pandemic. CONCLUSIONS Differences in hospital presentation, inpatient care, and discharge disposition of colorectal surgery patients were observed during the COVID-19 pandemic. Pandemic responses should emphasize balancing resource allocation, educating patients and providers on timely medical workup and management, and optimizing discharge coordination pathways.
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Affiliation(s)
- Sophia Y Chen
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Shannon N Radomski
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Miloslawa Stem
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Angelos Papanikolaou
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Alodia Gabre-Kidan
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Chady Atallah
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland; Department of Surgery, NYU Langone Health, New York, New York
| | - Jonathan E Efron
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland; Department of Surgery, NYU Langone Health, New York, New York.
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12
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Abdel-Rahman O, Ghosh S. Impact of Time From Diagnosis to Treatment Start on the Outcomes of Patients With Nonmetastatic Anal Squamous Cell Carcinoma. Am J Clin Oncol 2023; 46:31-35. [PMID: 36453694 DOI: 10.1097/coc.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To assess the impact of time from diagnosis to treatment on the survival outcomes of patients with nonmetastatic anal squamous cell carcinoma, controlling for other clinicopathological features. METHODS Surveillance, Epidemiology, and End Results research plus database was accessed, and patients with nonmetastatic anal squamous cell carcinoma were reviewed. Factors associated with longer time to treatment were evaluated through multivariable logistic regression analysis. Kaplan-Meier survival estimates were used to examine survival differences according to time to treatment (≤2 vs. >2 mo), and multivariable Cox regression analysis was used to examine factors associated with worse overall and cancer-specific survival. RESULTS A total of 13,032 patients were considered eligible and they were included in this study. The following factors were associated with longer time to treatment (>2 mo): male sex (odds ratio [OR]: 1.503; 95% CI, 1.292 to 1.749), and non-White race (OR for Black vs. White patients: 1.846; 95% CI, 1.488 to 2.290; OR for American Indian vs. White patients: 2.414; 95% CI, 1.197 to 4.872; OR for Asian-Pacific Islanders vs. White patients: 2.182; 95% CI, 1.440 to 3.309). Using Kaplan-Meier survival estimates, longer time to treatment was associated with worse overall survival (median OS for >2 mo=109 mo; for ≤2 mo=164 mo P <0.0001). Using multivariable Cox regression analysis, the following factors were associated with worse overall survival: older age (hazard ratio [HR]: 1.037; 95% CI, 1.034 to 1.039), male sex (HR: 1.650; 95% CI, 1.548 to 1.758), Black race (HR: 1.341; 95% CI, 1.210 to 1.487), advanced stage (HR for regional vs. localized stage: 1.596; 95% CI, 1.500 to 1.698), and longer time to treatment (HR: 1.385; 95% CI, 1.222 to 1.571). CONCLUSIONS Time from diagnosis to treatment longer than 2 months is associated with worse survival outcomes among patients with nonmetastatic anal squamous cell carcinoma.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
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13
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Chavda VP, Ping FF, Chen ZS. An Impact of COVID-19 on Cancer Care: An Update. Vaccines (Basel) 2022; 10:vaccines10122072. [PMID: 36560482 PMCID: PMC9780966 DOI: 10.3390/vaccines10122072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/09/2022] Open
Abstract
The world has been affected socioeconomically for the last two years due to the emergence of different variants of the COVID-19 virus. Vaccination is the major and most efficient way to prevent the widening of this pandemic. Those who are having comorbidities are more vulnerable to serious infections due to their immunocompromised state. Additionally, cancer patients could be at significant risk for COVID-19. In this pandemic era, the diagnosis and treatment of cancer were significantly affected. Clinical trials at the initial stage were performed on healthy or COVID-19 infected patients. This produces a greater level of hesitancy in cancer patients. This review article provide an update regarding the vaccination and treatment for COVID-19 in patients with cancer and future directions.
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Affiliation(s)
- Vivek P. Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L. M. College of Pharmacy, Ahmedabad 380009, India
| | - Feng-Feng Ping
- Department of Reproductive Medicine, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China
- Correspondence: (F.-F.P.); (Z.-S.C.)
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, Queens, New York, NY 11439, USA
- Correspondence: (F.-F.P.); (Z.-S.C.)
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14
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de Brito BB, Marques HS, Silva FAFD, Cordeiro Santos ML, Araújo GRL, Valente LDA, Freire de Melo F. Influence of the COVID-19 pandemic in the gastrointestinal oncology setting: An overview. World J Gastrointest Pathophysiol 2022; 13:157-169. [PMID: 36187602 PMCID: PMC9516457 DOI: 10.4291/wjgp.v13.i5.157] [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: 03/21/2022] [Revised: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 02/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been impacting healthcare in various ways worldwide and cancer patients are greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. The reorganization of the health facilities in order to supply the high demand resulting from the aforementioned infection as well as the social isolation measures led to impairments for the diagnosis and follow-up of patients with gastrointestinal cancers, which has had an impact on the prognosis of the oncologic patients. In that context, health authorities and organizations have elaborated new guidelines with specific recommendations for the management of individuals with gastrointestinal neoplasms during the pandemic. Of note, oncologic populations seem to be more susceptible to unfavorable outcomes when exposed to SARS-CoV-2 infection and some interactions involving virus, tumor, host immune system and anticancer therapies are probably related to the poorer prognosis observed in those COVID-19 patients. Moreover, vaccination stands out as the main prevention method against severe SARS-CoV-2 infection and some particularities have been observed regarding the seroconversion of vaccinated oncologic patients including those with gastrointestinal malignancies. In this minireview, we gather updated information regarding the influence of the pandemic in the diagnosis of gastrointestinal neoplasms, new recommendations for the management of gastrointestinal cancer patients, the occurrence of SARS-CoV-2 infection in those individuals and the scenario of the vaccination against the virus in that population.
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Affiliation(s)
- Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45055-380, Bahia, Brazil
| | | | - Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lara de Araujo Valente
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45055-380, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Brazil
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15
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Parray AM, Chaudhari VA, Bhandare MS, Madhabananda K, Muduly DK, Sudhindran S, Mathews J, Pradeep R, Thammineedi SR, Amal K, Chaudhary D, Jitender R, Pandey D, Amar P, Penumadu P, Kalayarasan R, Elamurugan TP, Kantharia C, Pujari S, Ramesh H, Somashekhar SP, Fernandes A, Sexena R, Singh RK, Lattoo MR, Shah OJ, Jeswanth S, Roy M, Thambudorai R, Shrikhande SV. Impact of Covid-19 on gastrointestinal cancer surgery: A National Survey. Langenbecks Arch Surg 2022; 407:3735-3745. [PMID: 36098808 PMCID: PMC9469820 DOI: 10.1007/s00423-022-02675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022]
Abstract
Purpose To understand the actual impact of the Covid-19 pandemic and frame the future strategies, we conducted a pan India survey to study the impact on the surgical management of gastrointestinal cancers. Methods A national multicentre survey in the form of a questionnaire from 16 tertiary care gastrointestinal oncology centres across India was conducted from January 2019 to June 2021 that was divided into a 15-month pre-Covid era and a similar period of active Covid pandemic era. Results There was significant disruption of services; 13 (81%) centres worked as dedicated Covid care centres and 43% reported suspension of essential care for more than 6 months. In active Covid phase, there was a 14.5% decrease in registrations and proportion of decrease was highest in the centres from South zone (22%). There was decrease in resections across all organ systems; maximum reduction was noted in hepatic resections (33%) followed by oesophageal and gastric resections (31 and 25% respectively). There was minimal decrease in colorectal resections (5%). A total of 584 (7.1%) patients had either active Covid-19 infection or developed infection in the post-operative period or had recovered from Covid-19 infection. Only 3 (18%) centres reported higher morbidity, while the rest of the centres reported similar or lower morbidity rates when compared to pre-Covid phase; however, 6 (37%) centres reported slightly higher mortality in the active Covid phase. Conclusion
Covid-19 pandemic resulted in significant reduction in new cancer registrations and elective gastrointestinal cancer surgeries. Perioperative morbidity remained similar despite 7.1% perioperative Covid 19 exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02675-6.
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Affiliation(s)
- Amir M Parray
- Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | | | | | - K Madhabananda
- All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Dilip K Muduly
- All India Institute of Medical Sciences, Bhubaneshwar, India
| | - S Sudhindran
- Amrita Institute of Medical Sciences and Research Institute, Kochi, India
| | - Johns Mathews
- Amrita Institute of Medical Sciences and Research Institute, Kochi, India
| | - R Pradeep
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | - K Amal
- Dr B Borooah Cancer Institute, Gauhati, India
| | | | - R Jitender
- Homi Bhabha Cancer Hospital (TMC), Sangrur, India
| | - Durgatosh Pandey
- Mahamana Pandit Madan Mohan Malaviya Cancer Centre & Homi Bhabha Cancer Hospital (TMC), Varanasi, India
| | - P Amar
- Mahamana Pandit Madan Mohan Malaviya Cancer Centre & Homi Bhabha Cancer Hospital (TMC), Varanasi, India
| | - Prasanth Penumadu
- Jawahar Lal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raja Kalayarasan
- Jawahar Lal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - T P Elamurugan
- Jawahar Lal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - H Ramesh
- Lakeshore Hospital and Research Centre, Kochi, India
| | | | | | - Rajan Sexena
- Sanjay Gandhi PGI of Medical Sciences, Lucknow, India
| | | | - Mohd R Lattoo
- Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Omar J Shah
- Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | | | | | - Shailesh V Shrikhande
- Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India. .,Department of Gastrointestinal and Hepato-Pancreato-Biliary, Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, Maharashtra, 400012, India.
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16
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Habbous S, Tai X, Beca JM, Arias J, Raphael MJ, Parmar A, Crespo A, Cheung MC, Eisen A, Eskander A, Singh S, Trudeau M, Gavura S, Dai WF, Irish J, Krzyzanowska M, Lapointe-Shaw L, Naipaul R, Peacock S, Yeung L, Forbes L, Chan KKW. Comparison of Use of Neoadjuvant Systemic Treatment for Breast Cancer and Short-term Outcomes Before vs During the COVID-19 Era in Ontario, Canada. JAMA Netw Open 2022; 5:e2225118. [PMID: 35917122 PMCID: PMC9346546 DOI: 10.1001/jamanetworkopen.2022.25118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE In response to an increase in COVID-19 infection rates in Ontario, several systemic treatment (ST) regimens delivered in the adjuvant setting for breast cancer were temporarily permitted for neoadjuvant-intent to defer nonurgent breast cancer surgical procedures. OBJECTIVE To examine the use and compare short-term outcomes of neoadjuvant-intent vs adjuvant ST in the COVID-19 era compared with the pre-COVID-19 era. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study in Ontario, Canada. Patients with cancer starting selected ST regimens in the COVID-19 era (March 11, 2020, to September 30, 2020) were compared to those in the pre-COVID-19 era (March 11, 2019, to March 10, 2020). Patients were diagnosed with breast cancer within 6 months of starting systemic therapy. MAIN OUTCOMES AND MEASURES Estimates were calculated for the use of neoadjuvant vs adjuvant ST, the likelihood of receiving a surgical procedure, the rate of emergency department visits, hospital admissions, COVID-19 infections, and all-cause mortality between treatment groups over time. RESULTS Among a total of 10 920 patients included, 7990 (73.2%) started treatment in the pre-COVID-19 era and 7344 (67.3%) received adjuvant ST; the mean (SD) age was 61.6 (13.1) years. Neoadjuvant-intent ST was more common in the COVID-19 era (1404 of 2930 patients [47.9%]) than the pre-COVID-19 era (2172 of 7990 patients [27.2%]), with an odds ratio of 2.46 (95% CI, 2.26-2.69; P < .001). This trend was consistent across a range of ST regimens, but differed according to patient age and geography. The likelihood of receiving surgery following neoadjuvant-intent chemotherapy was similar in the COVID-19 era compared with the pre-COVID-19 era (log-rank P = .06). However, patients with breast cancer receiving neoadjuvant-intent hormonal therapy were significantly more likely to receive surgery in the COVID-19 era (log-rank P < .001). After adjustment, there were no significant changes in the rate of emergency department visits over time between patients receiving neoadjuvant ST, adjuvant ST, or ST only during the ST treatment period or postoperative period. Hospital admissions decreased in the COVID-19 era for patients who received neoadjuvant ST compared with adjuvant ST or ST alone (P for interaction = .01 for both) in either setting. CONCLUSIONS AND RELEVANCE In this cohort study, patients were more likely to start neoadjuvant ST in the COVID-19 era, which varied across the province and by indication. There was limited evidence to suggest any substantial impact on short-term outcomes.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Xiaochen Tai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jaclyn M Beca
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jessica Arias
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Michael J. Raphael
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Crespo
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Matthew C Cheung
- Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Maureen Trudeau
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Wei Fang Dai
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Jonathan Irish
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rohini Naipaul
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Stuart Peacock
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Lyndee Yeung
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Leta Forbes
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Division of Medical Oncology, RS McLaughlin Durham Regional Cancer Centre Lakeridge Health, Oshawa, Ontario, Canada
| | - Kelvin K. W. Chan
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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17
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Ma J, Zhu C, Li W, Qiu Z, Yang J, Ge L, Da M. The Effect of Delayed Oncology Surgery on Survival Outcomes for Patients With Gastric Cancer During the COVID-19 Pandemic: Evidence-Based Strategies. Front Oncol 2022; 12:780949. [PMID: 35664784 PMCID: PMC9162578 DOI: 10.3389/fonc.2022.780949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/12/2022] [Indexed: 01/10/2023] Open
Abstract
Objective To evaluate the impact of delay in gastrectomy on gastric cancer patients’ survival outcomes during the COVID-19 pandemic. Methods Databases including PubMed, MEDLINE (using the Ovid platform), Embase, the Cochrane Library, COVID-19 Open Research Dataset Challenge, COVID-19 Research Database (WHO), ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform were searched for studies of any design and in any setting that included patients with gastric cancer from their inception to July 31, 2021. Hazard ratio (HR) and 95% confidence intervals (CI) of research endpoints in each study were calculated. Statistical analyses were performed with Stata 12.0. Results A total of 8 studies involving 4,052 gastric cancer patients were eligible and included in the present meta-analysis. The result of the meta-analysis was shown that delaying surgery for less than 8 weeks may not decrease OS (HR = 0.91, 95% CI: 0.80~1.04, p = 0.167) and DFS (HR = 0.96, 95% CI: 0.62~1.50, p = 0.872) in gastric cancer. Our meta-analysis also illustrated that delay in surgery for more than 4 weeks (HR = 0.85, 95% CI: 0.56~1.27, p = 0.421), 6 weeks (HR = 0.88, 95% CI: 0.61~1.27, p = 0.490), and 8 weeks (HR = 0.93, 95% CI: 0.80~1.07, p = 0.314) was also not associated with a decreased OS. Conclusion A delay in surgery of less than 8 weeks is not associated with worse overall survival for patients with gastric cancer.
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Affiliation(s)
- Jichun Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Chenglou Zhu
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Weidong Li
- Clinical Medicine College, Ningxia Medical University, Yinchuan, China
| | - Zhisheng Qiu
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.,Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Jian Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.,Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mingxu Da
- Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
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18
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Chen MZ, Tay YK, Teoh WMK, Kong JCH, Carne P, D'Souza B, Chandra R, Bui A. Melbourne colorectal collaboration: a multicentre review of the impact of COVID-19 on colorectal cancer in Melbourne, Australia. ANZ J Surg 2022; 92:1110-1116. [PMID: 35393720 PMCID: PMC9111459 DOI: 10.1111/ans.17603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/07/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND As coronavirus (COVID-19) cases continue to rise, healthcare workers have been working overtime to ensure that all patients receive care in a timely manner. Our study aims to identify the impact and outcomes of COVID-19 on colorectal cancers presentations across the five major colorectal units in Melbourne, Australia. METHODS This is a retrospective study from a prospectively collected database from the binational colorectal cancer audit (BCCA) registry, as well as inpatient records. All patients with colorectal cancer between Pre-COVID-19 period (1 July 2018-2030 June 2019) and COVID-19 period (1 July 2020-2030 June 2021) were compared. Benign pathology and other cancer types were excluded. RESULTS A total of 1609 patients were included in the study (700 Pre-COVID-19 period, 906 COVID-19 period). During COVID-19 period, there was a higher proportion of emergency surgery (28.1% vs. 19.8%; P < 0.001), a higher nodal (P = 0.024) and metastatic stage (P = 0.018) at presentation, but no increase in the rate of return to operating theatres (P = 0.240), inpatient death (P = 0.019) or 30-day readmission (P = 0.000). There was also no difference in the post-operative surgical complications (P = 0.118). Utility of neoadjuvant therapy did not increase during the pandemic (P = 0.613). CONCLUSION The heightened measures in the healthcare system ensured CRC patients still received their surgery in a timely fashion. With the current rise in the new strain of COVID-19 (Omicron), we have to continue to come up with new strategies to provide timely access to CRC care.
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Affiliation(s)
| | - Yeng Kwang Tay
- Department of Colorectal SurgeryMonash HealthVictoriaAustralia
| | - Wiliam MK Teoh
- Department of Colorectal SurgeryMonash HealthVictoriaAustralia
| | - Joseph CH Kong
- Division of Cancer SurgeryPeter MacCallum Cancer CentreMelbourne, VictoriaAustralia
- Department of Colorectal SurgeryAlfred HospitalMelbourne, VictoriaAustralia
- Central Clinical SchoolAlfred Hospital, Monash UniversityMelbourne, VictoriaAustralia
| | - Peter Carne
- Department of Colorectal SurgeryAlfred HospitalMelbourne, VictoriaAustralia
- Central Clinical SchoolAlfred Hospital, Monash UniversityMelbourne, VictoriaAustralia
| | - Basil D'Souza
- Department of Colorectal SurgeryNorthern HospitalVictoriaAustralia
- Department of Colorectal SurgerySt Vincent's HospitalMelbourne, VictoriaAustralia
| | - Raaj Chandra
- Department of Colorectal SurgeryEastern Health, Boxhill HospitalMelbourne, VictoriaAustralia
| | - Andrew Bui
- Department of Colorectal SurgeryNorthern HospitalVictoriaAustralia
- Department of Colorectal SurgeryAustin HospitalMelbourne, VictoriaAustralia
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19
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The Impact of the Ban on Elective Surgery in New York City during the Coronavirus Outbreak on Gynecologic Oncology Patient Care. Gynecol Oncol Rep 2022; 41:100997. [PMID: 35573131 PMCID: PMC9085382 DOI: 10.1016/j.gore.2022.100997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 12/03/2022] Open
Abstract
During the ban on elective surgery due to the COVID-19 pandemic in NYC, 40% of patients experienced surgical delays. 77% of patients experiencing delays were due to hospital-initiated delays due to the elective surgical ban. 93% of patients ultimately underwent their planned surgery. Of patients recommended to undergo adjuvant therapy, 67% completed their adjuvant therapy. Overall, 81% of patients completed their planned treatment during and after the COVID-19 ban on elective surgery.
Introduction Elective surgical procedures were suspended during the coronavirus disease pandemic (COVID-19) in New York City (NYC) between March 16 and June 15, 2020. This study characterizes the impact of the ban on surgical delays for patients scheduled for surgery during this first wave of the COVID-19 outbreak. Methods Patients who were scheduled for surgical treatment of malignant or pre-invasive disease by gynecologic oncologists at three NYC hospitals during NYC’s ban on elective surgery were included. Outcomes of interest were the percentage of patients experiencing surgical delay and the nature of delays. Kruskal-Wallis, chi-square, and logistic regression tests were performed with significance set at p < 0.05. Results Of the 145 patients with malignant or pre-invasive diseases scheduled for surgery during the ban on elective surgery, 40% of patients experienced one or more surgical delays, 10% experienced two or more and 1% experienced three surgical delays. Of patients experiencing an initial delay, 77% were hospital-initiated and 11% were due to known or suspected personal COVID-19. Overall, 81% of patients completed their planned treatment, and 93% of patients underwent their initially planned surgery. Among patients for whom adjuvant therapy was recommended, 67% completed their planned treatment, and the most common reasons for not completing treatment were medically indicated followed by concerns regarding COVID-19. Conclusion During the ban on elective surgery in NYC during the first outbreak of the COVID-19 pandemic, many patients experienced minor surgical delays, but most patients obtained appropriate, timely care with either surgery or alternative treatment.
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20
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Walker MJ, Wang J, Mazuryk J, Skinner SM, Meggetto O, Ashu E, Habbous S, Nazeri Rad N, Espino-Hernández G, Wood R, Chaudhry M, Vahid S, Gao J, Gallo-Hershberg D, Gutierrez E, Zanchetta C, Langer D, Zwicker V, Rey M, Tammemägi MC, Tinmouth J, Kupets R, Chiarelli AM, Singh S, Warde P, Forbes L, Dobranowski J, Irish J, Rabeneck L. Delivery of Cancer Care in Ontario, Canada, During the First Year of the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e228855. [PMID: 35467731 PMCID: PMC9039771 DOI: 10.1001/jamanetworkopen.2022.8855] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has impacted cancer systems worldwide. Quantifying the changes is critical to informing the delivery of care while the pandemic continues, as well as for system recovery and future pandemic planning. OBJECTIVE To quantify change in the delivery of cancer services across the continuum of care during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study assessed cancer screening, imaging, diagnostic, treatment, and psychosocial oncological care services delivered in pediatric and adult populations in Ontario, Canada (population 14.7 million), from April 1, 2019, to March 1, 2021. Data were analyzed from May 1 to July 31, 2021. EXPOSURES COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Cancer service volumes from the first year of the COVID-19 pandemic, defined as April 1, 2020, to March 31, 2021, were compared with volumes during a prepandemic period of April 1, 2019, to March 31, 2020. RESULTS During the first year of the pandemic, there were a total of 4 476 693 cancer care services, compared with 5 644 105 services in the year prior, a difference of 20.7% fewer services of cancer care, representing a potential backlog of 1 167 412 cancer services. While there were less pronounced changes in systemic treatments, emergency and urgent imaging examinations (eg, 1.9% more parenteral systemic treatments) and surgical procedures (eg, 65% more urgent surgical procedures), major reductions were observed for most services beginning in March 2020. Compared with the year prior, during the first pandemic year, cancer screenings were reduced by 42.4% (-1 016 181 screening tests), cancer treatment surgical procedures by 14.1% (-8020 procedures), and radiation treatment visits by 21.0% (-141 629 visits). Biopsies to confirm cancer decreased by up to 41.2% and surgical cancer resections by up to 27.8% during the first pandemic wave. New consultation volumes also decreased, such as for systemic treatment (-8.2%) and radiation treatment (-9.3%). The use of virtual cancer care increased for systemic treatment and radiation treatment and psychosocial oncological care visits, increasing from 0% to 20% of total new or follow-up visits prior to the pandemic up to 78% of total visits in the first pandemic year. CONCLUSIONS AND RELEVANCE In this population-based cohort study in Ontario, Canada, large reductions in cancer service volumes were observed. While most services recovered to prepandemic levels at the end of the first pandemic year, a substantial care deficit likely accrued. The anticipated downstream morbidity and mortality associated with this deficit underscore the urgent need to address the backlog and recover cancer care and warrant further study.
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Affiliation(s)
- Meghan J. Walker
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | | | | | - Eta Ashu
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | | | | | | | - Ryan Wood
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | | | - Saba Vahid
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Julia Gao
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Daniela Gallo-Hershberg
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | | | | | | | - Michelle Rey
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Martin C. Tammemägi
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Health Sciences, Brock University, St Catharines, Canada
| | - Jill Tinmouth
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Rachel Kupets
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Anna M. Chiarelli
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Simron Singh
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, , Canada
| | - Padraig Warde
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Leta Forbes
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Canada
| | - Julian Dobranowski
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Radiology, McMaster University, Hamilton, Canada
- Niagara Health, St Catharines, Ontario, Canada
| | - Jonathan Irish
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Linda Rabeneck
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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21
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Fujita S, Sakuramoto S, Miyawaki Y, Morimoto Y, Ebara G, Nishibeppu K, Oya S, Fujihata S, Lee S, Sugita H, Sato H, Yamashita K. Impact of the first era of the coronavirus disease 2019 pandemic on gastric cancer patients: a single-institutional analysis in Japan. Int J Clin Oncol 2022; 27:930-939. [PMID: 35344118 PMCID: PMC8958809 DOI: 10.1007/s10147-022-02142-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
Background Little is known about the disadvantages of the coronavirus disease 2019 (COVID-19) pandemic in patients with gastric cancer. This study aimed to examine the negative impact of the COVID-19 pandemic on patients with gastric cancer in the first era in Japan. Methods This retrospective study included 725 patients diagnosed with gastric cancer who visited our hospital between April 2019 and March 2021. The number of patients and their characteristics before and during the COVID-19 pandemic were compared. Results The number of patients diagnosed with gastric cancer during the COVID-19 pandemic decreased by 26.2% (from 417 to 308; p = 0.013) compared to that before the COVID-19 pandemic. There was a significant decrease in cStage I cancer and an increase in cStage III cancer (p = 0.004). Patients were often symptomatic (p = 0.029), especially those with stenosis-related symptoms (p < 0.001) and longer symptom duration (p < 0.001). The number of endoscopic resections was decreased by 34.8% (p = 0.005). The number of total gastrectomy was higher than that of partial gastrectomy (p = 0.021). The median time to treatment was significantly shorter (p < 0.001). Conclusions In Japan, delays diagnosing patients with gastric cancer, probably due to refraining from consultation, may have resulted in an increase in the diagnosis of advanced-stage cancer. Moreover, an increasing proportion of patients required more invasive gastrectomy. Therefore, it may be necessary to educate patients not to refrain from consultation, even during the COVID-19 pandemic, as it can have a negative impact on treatment, policy decision, and prognosis of gastric cancer.
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Affiliation(s)
- Shohei Fujita
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Shinichi Sakuramoto
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yosuke Morimoto
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Gen Ebara
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keiji Nishibeppu
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shiro Fujihata
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Seigi Lee
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Saitama, 252-0374, Japan
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22
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Quality of Life in Patients with Pancreatic Cancer before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063731. [PMID: 35329416 PMCID: PMC8948872 DOI: 10.3390/ijerph19063731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 01/05/2023]
Abstract
Background: Coronavirus disease 19 (COVID-19) substantially affects cancer patients due to adverse outcomes and disruptions in cancer care. Recent studies have indicated the additional stress and anxiety burden arising from the pandemic and impairing quality of life in this vulnerable group of patients. However, patients with cancer represent a heterogenous group. Therefore, we conducted a study on patients with pancreatic cancer, requiring demanding surgical interventions and chemotherapy regimens due to its aggressive tumor biology, to explore the pandemic’s impact on quality of life within this homogenous cohort. Methods: In a descriptive observational study, the quality of life of patients who had undergone pancreatic surgery for tumor resection at our institution between 2014 and the beginning of the pandemic in March 2020 was assessed. For HRQoL measurement, we used the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), comparing their situation before the pandemic and since its beginning. An additional self-developed questionnaire was applied to assess the life circumstances during the pandemic. Results: Our cohort included 26 patients. Scores from the survey in HRQoL revealed no significant changes over time between before and during the pandemic. A medium deterioration in HRQoL was apparent in social functioning, as well as a small deterioration in role functioning and emotional functioning. Worries concerning a potential impact of COVID-19 on personal health were expressed. Psychological limitations in QoL were mainly attributed to the pandemic, whereas physical limitations in QoL were rather associated with the underlying disease of pancreatic cancer. Conclusion: The COVID-19 pandemic is causing considerable social and emotional distress among pancreatic cancer patients. These patients will benefit from psychological support during the pandemic and beyond. Long-time survivors of pancreatic cancer, such as those included in our cohort, appear to have improved resilience facing the psychosocial challenges of the pandemic. For pancreatic cancer, surgical care is considered the cornerstone of treatment. Prolonged delays in healthcare cause serious damage to mental and physical health. To date, the longer-term clinical consequences are not known and can only be estimated. The potential tragic outcome for the vulnerable group of pancreatic cancer patients highlights the urgency of timely healthcare decisions to be addressed in the future.
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23
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Gastric cancer during COVID-19 pandemic: What changed? JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1072900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Groenewold M, Olthof C, Bosch D. Anaesthesia after neoadjuvant chemotherapy, immunotherapy or radiotherapy. BJA Educ 2022; 22:12-19. [PMID: 34992796 PMCID: PMC8703124 DOI: 10.1016/j.bjae.2021.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- M.D. Groenewold
- University Medical Centre Groningen, Groningen, the Netherlands
| | | | - D.J. Bosch
- University Medical Centre Groningen, Groningen, the Netherlands,Corresponding author:
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25
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Liu R, Yu X, Zeng X, Wang Z, Zhou D, Liu Z, Liu F, Zhuang C, Zhuang Y, Zhang J, Niu P, Yan B, Zhi R, Li J, Huang J, Qin H. Preliminary evaluation of a new initiative to centralize colorectal cancer care during the COVID-19 epidemic in Shanghai, China: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:94. [PMID: 35282090 PMCID: PMC8848422 DOI: 10.21037/atm-21-7030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
Background A novel colorectal cancer center (CCC) was developed in the Shanghai Tenth People’s hospital of Tongji University during the COVID-19 epidemic. In this study, we aimed to evaluate the CCC model in terms of three aspects. Methods This retrospective study used data from the Shanghai Tenth People’s hospital patient databases. The research hypothesis was that the CCC reduces preoperative waiting time (PWT), length of hospital stay (LOS), and costs of hospitalization, without reducing the quality of surgery. Thus, we compared the time, cost, and quality between March 1 to December 31, 2019, and March 1 to December 31, 2020. Descriptive and inferential analyses of patient demographic characteristics, time, postoperative outcomes, and inpatient costs were conducted. Results A total of 965 hospitalizations for colorectal cancer (CRC) were identified—415 in 2019 and 550 in 2020. In the CCC, PWT declined by 26.2 hours (P<0.01). Patients in the CCC express group only needed to wait for 24.5 hours before undergoing surgery, with a shorter LOS than the normal group (P<0.01). None of the patients had any symptoms of COVID-19 or were high-risk COVID-19 contacts, and the incidence of immediate postoperative complications was low. The mean total inpatient cost (TIC) for all patients with CRC was 78,309.824 Chinese Yuan in 2020, which was slightly lower than that in 2019. Conclusions This study found that the centralized management model for CRC care could help patients save the PWT, LOS and costs of hospitalization during the COVID-19 epidemic.
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Affiliation(s)
- Rui Liu
- Tongji University Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Xuejing Yu
- Tongji University Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Xueyun Zeng
- Tongji University Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Department of Medical Affairs, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Wang
- Colorectal Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Danqing Zhou
- Tongji University Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Zhongchen Liu
- Colorectal Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Feng Liu
- Colorectal Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Chengle Zhuang
- Colorectal Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Ying Zhuang
- Colorectal Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Ji Zhang
- Medical Service Section, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Peiqin Niu
- Medical Service Section, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Department of Gastroenterology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Ben Yan
- Department of Infrastructure, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Rui Zhi
- Department of Infrastructure, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Jiyu Li
- Tongji University Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Geriatric Oncology Center, Huadong Hospital, Fudan University, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huanlong Qin
- Tongji University Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Colorectal Cancer Center, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China.,Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
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26
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Kariyawasam JC, Jayarajah U, Riza R, Abeysuriya V, Seneviratne SL. Gastrointestinal manifestations in COVID-19. Trans R Soc Trop Med Hyg 2021; 115:1362-1388. [PMID: 33728439 PMCID: PMC7989191 DOI: 10.1093/trstmh/trab042] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory viral infection, has affected more than 78 million individuals worldwide as of the end of December 2020. Previous studies reported that severe acute respiratory syndrome coronavirus 1 and Middle East respiratory syndrome-related coronavirus infections may affect the gastrointestinal (GI) system. In this review we outline the important GI manifestations of COVID-19 and discuss the possible underlying pathophysiological mechanisms and their diagnosis and management. GI manifestations are reported in 11.4-61.1% of individuals with COVID-19, with variable onset and severity. The majority of COVID-19-associated GI symptoms are mild and self-limiting and include anorexia, diarrhoea, nausea, vomiting and abdominal pain/discomfort. A minority of patients present with an acute abdomen with aetiologies such as acute pancreatitis, acute appendicitis, intestinal obstruction, bowel ischaemia, haemoperitoneum or abdominal compartment syndrome. Severe acute respiratory syndrome coronavirus 2 RNA has been found in biopsies from all parts of the alimentary canal. Involvement of the GI tract may be due to direct viral injury and/or an inflammatory immune response and may lead to malabsorption, an imbalance in intestinal secretions and gut mucosal integrity and activation of the enteric nervous system. Supportive and symptomatic care is the mainstay of therapy. However, a minority may require surgical or endoscopic treatment for acute abdomen and GI bleeding.
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Affiliation(s)
- Jayani C Kariyawasam
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Rishdha Riza
- Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Visula Abeysuriya
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals, Colombo, Sri Lanka
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27
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Boutros M, Moujaess E, Kourie HR. Cancer management during the COVID-19 pandemic: Choosing between the devil and the deep blue sea. Crit Rev Oncol Hematol 2021; 167:103273. [PMID: 33737160 PMCID: PMC7959683 DOI: 10.1016/j.critrevonc.2021.103273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/02/2021] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
COVID-19 was declared a "Public Health Emergency of International Concern" in March 2020. Since then, drastic measures were implemented to reduce the virus spread. These measures prevented cancer patients from receiving prompt medical care. A delay in testing and treating cancer patients is thought to protect them from serious COVID-19 complications but exposes them at the same time to the risk of disease progression and cancer related mortality. Healthcare providers are therefore facing the dilemma of choosing between two unpleasant scenarios. To shed light upon the matter, we present in this review article, based on an extensive search of the literature, an overview of the delay in the management of cancer patients, possible contributors to this delay and its benefits and risks on cancer patients' health.
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Affiliation(s)
- Marc Boutros
- Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Elissar Moujaess
- Department of Hematology and Oncology, Hotel Dieu de France University Hospital, Beirut, Lebanon,Corresponding author
| | - Hampig Raphael Kourie
- Department of Hematology and Oncology, Hotel Dieu de France University Hospital, Beirut, Lebanon
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28
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Johnson GGRJ, Hershorn O, Singh H, Park J, Helewa RM. Sampling error in the diagnosis of colorectal cancer is associated with delay to surgery: a retrospective cohort study. Surg Endosc 2021; 36:4893-4902. [PMID: 34724583 PMCID: PMC8559691 DOI: 10.1007/s00464-021-08841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
Background Accurate histopathologic diagnosis of colorectal cancer is important for treatment decision-making and timely care. The aim of this study was to measure rates and predictors of sampling errors for biopsy specimens attained at flexible lower gastrointestinal endoscopy, and to determine whether these events lead to a delay in surgical care. Methods This is a retrospective observational study of patients who underwent elective resection for colorectal adenocarcinoma between January 2007 and June 2020. Primary outcomes were proportion of incorrectly diagnosed colorectal adenocarcinomas at index endoscopy by histopathology, and time between endoscopy and surgery. Secondary outcomes were predictors of sampling error, and diagnostic yield of repeat endoscopy. Results Sampling errors occurred in 217/962 (22.6%) flexible endoscopies for colorectal adenocarcinomas. Negative biopsies were associated with a longer median time to surgery (87.6 days, IQR 48.8–180.0) compared to true positive biopsies (64.0 days, IQR 38.0–119.0), p < 0.001. Controlling for lesion location, neoadjuvant therapy, endoscopist specialty, year, and repeat endoscopies, time to surgery remained 1.40-fold longer (p < 0.001) following sampling error. Repeat endoscopy occurred following 62/217 (28.6%) cases of sampling errors, yielding a correct diagnosis of cancer in 38/62 (61.3%) cases. On multivariable analysis, sampling errors were less likely to occur for lesions endoscopists described as suspicious for malignancy (OR 0.12, 95% CI 0.07–0.21) or simple polyps (OR 0.24, 95% CI 0.08–0.70) compared to endoscopically unresectable polyps. Conclusions Colorectal cancers are frequently improperly sampled, which may lead to treatment delays for these patients. When cancer is suspected, surgeons should take care to ensure timely management.
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Affiliation(s)
- Garrett G R J Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023 - 409 Taché Avenue, Winnipeg, MB, R2H 2A6, Canada.,Clinician Investigator Program, University of Manitoba, Winnipeg, MB, Canada
| | - Olivia Hershorn
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023 - 409 Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Harminder Singh
- Department of Internal Medicine, University of Manitoba and University of Manitoba IBD Clinical and Research Center and Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jason Park
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023 - 409 Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, St. Boniface General Hospital, Z3023 - 409 Taché Avenue, Winnipeg, MB, R2H 2A6, Canada.
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Kuzuu K, Misawa N, Ashikari K, Kessoku T, Kato S, Hosono K, Yoneda M, Nonaka T, Matsushima S, Komatsu T, Nakajima A, Higurashi T. Gastrointestinal Cancer Stage at Diagnosis Before and During the COVID-19 Pandemic in Japan. JAMA Netw Open 2021; 4:e2126334. [PMID: 34546368 PMCID: PMC8456386 DOI: 10.1001/jamanetworkopen.2021.26334] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has delayed medical consultations, possibly leading to the diagnosis of gastrointestinal cancer at advanced stages. OBJECTIVE To evaluate stage at diagnosis among patients with gastrointestinal cancer in Japan before and during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients in a hospital-based cancer registry who were diagnosed with gastrointestinal cancer (ie, esophageal, gastric, colorectal, pancreatic, liver, and biliary tract cancers) between January 2016 and December 2020 at 2 tertiary Japanese hospitals. EXPOSURES The pre-COVID-19 period was defined as January 2017 to February 2020, and the COVID-19 period was defined as March 2020 to December 2020. MAIN OUTCOME AND MEASURE Monthly numbers of patients with newly diagnosed cancer were aggregated, classified by stage, and compared. RESULTS The study evaluated 5167 patients, including 4218 patients (2825 [67.0%] men; mean [SD] age, 71.3 [10.9] years) in the pre-COVID-19 period and 949 patients (607 [64.0%] men; mean [SD] age, 71.8 [10.7] years) in the COVID-19 period. Comparing the pre-COVID-19 period with the COVID-19 period, significant decreases were observed in the mean (SD) number of patients with newly diagnosed gastric cancer (30.63 [6.62] patients/month vs 22.40 [5.85] patients/month; -26.87% change; P < .001) and colorectal cancer (41.61 [6.81] patients/month vs 36.00 [6.72] patients/month; -13.47% change; P = .03). Significant decreases were also observed in the mean (SD) number of cases of stage I gastric cancer (21.55 [5.66] cases/month vs 13.90 [5.99] cases/month; -35.51% change; P < .001), stage 0 colorectal cancer (10.58 [3.36] cases/month vs 7.10 [4.10] cases/month; -32.89% change; P = .008), and stage I colorectal cancer (10.16 [3.14] cases/month vs 6.70 [2.91] cases/month; -34.04% change; P = .003). No significant increases were observed for esophageal, gastric, pancreatic, liver, or biliary tract cancers. A significant decrease was observed in the mean (SD) number of cases per month of stage II colorectal cancer (7.42 [3.06] cases/month vs 4.80 [1.75] cases/month; -35.32% change; P = .01); a significant increase was observed for the mean (SD) number of cases per month of stage III colorectal cancer (7.18 [2.85] cases/month vs 12.10 [2.42] cases/month; 68.42% change; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study of patients in a hospital-based cancer registry form Japan, significantly fewer patients were diagnosed with stage I gastric and colorectal cancers during the COVID-19 pandemic. Thus, the number of screening-detected cancers might have decreased, and colorectal cancer may have been diagnosed at more advanced stages.
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Affiliation(s)
- Kento Kuzuu
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Noboru Misawa
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Kunihiro Hosono
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Takashi Nonaka
- National Hospital Organization Yokohama Medical Center, Totuka-ku, Yokohama, Japan
| | - Shozo Matsushima
- National Hospital Organization Yokohama Medical Center, Totuka-ku, Yokohama, Japan
| | - Tatsuji Komatsu
- National Hospital Organization Yokohama Medical Center, Totuka-ku, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
| | - Takuma Higurashi
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanazawa-ku, Yokohama, Japan
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Shafiee S, Cegolon L, Khafaei M, Gholami N, Zhao S, Khalesi N, Moosavian H, Fathi S, Izadi M, Ghadian A, Javanbakht M, Javanbakht A, Akhavan-Sigari R. Gastrointestinal cancers, ACE-2/TMPRSS2 expression and susceptibility to COVID-19. Cancer Cell Int 2021; 21:431. [PMID: 34399734 PMCID: PMC8365127 DOI: 10.1186/s12935-021-02129-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/30/2021] [Indexed: 12/22/2022] Open
Abstract
Recent studies on the pathophysiology of COVID-19 are indicating that the Angiotensin convertase enzyme 2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) can act as a major component in the fusion of SARS-Cov-2 with target cells. It has also been observed that the expression of ACE-2 and TMPRSS2 can be altered in malignancies. Shedding light on this matter could be crucial since the COVID-19 pandemic interfered with many gastrointestinal cancer screening programs. Herein we discuss the possibility of severe forms of COVID-19 in patients with gastrointestinal cancers due to the gastrointestinal entry route of SARS-CoV-2 into the human body. The disruption of cancer screening programs caused by the current COVID-19 pandemic could therefore have massive negative health impact on patients affected by gastrointestinal malignancies.
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Affiliation(s)
- Sepehr Shafiee
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Luca Cegolon
- Public Health Department, Local Health Unit N.2 "Marca Trevigiana", 31100, Treviso, Italy
| | - Mostafa Khafaei
- Human Genetics Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Nasrin Gholami
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Nasrin Khalesi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moosavian
- Department of Clinical Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Saeid Fathi
- Department of Parasite Vaccine Research and Production, Razi Vaccine and Serum Research Institute, Agriculture Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Ghadian
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Perkons NR, Kim C, Boedec C, Keele LJ, Schneider C, Teitelbaum UR, Ben‐Josef E, Gabriel PE, Plastaras JP, Shulman LN, Wojcieszynski AP. Quantifying the impact of the COVID-19 pandemic on gastrointestinal cancer care delivery. Cancer Rep (Hoboken) 2021; 5:e1427. [PMID: 34137216 PMCID: PMC8420475 DOI: 10.1002/cnr2.1427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND AIM This study quantifies how changes in healthcare utilization and delivery during the first months of the COVID-19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies within an academic health system. METHODS AND RESULTS Patients diagnosed with a GI malignancy (ICD10: C15-C26) who received medical care within the health system during the observation period (first 44 weeks of 2019 and 2020) were identified for a retrospective cohort study. Deidentified patient encounter parameters were collected for this observation period and separated into pre-pandemic (weeks 1-10) and early pandemic (weeks 11-20) study periods. Difference-in-difference analyses adjusted for week-specific and year-specific effects quantified the impact of the COVID-19 pandemic on care delivery between pre-pandemic and early pandemic study periods in 2020. Across all GI malignancies, the COVID-19 pandemic has been associated with a significant decline in the number of patients with new patient visits (NPVs) (p = 1.2 × 10-4 ), Radiology encounters (p = 1.9 × 10-7 ), Surgery encounters (p = 1.6 × 10-3 ), Radiation Oncology encounters (p = 4.1 × 10-3 ), and infusion visits (6.1 × 10-5 ). Subgroup analyses revealed cancer-specific variations in changes to delivery. Patients with colorectal cancer (CRC) had the most significant decrease in NPVs (p = 7.1 × 10-5 ), which was significantly associated with a concomitant decrease in colonoscopies performed during the early pandemic period (r2 = 0.722, p = 2.1 × 10-10 ). CONCLUSIONS The COVID-19 pandemic has been associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC, diagnosed and managed by periodic screening, has been affected most acutely.
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Affiliation(s)
| | - Casey Kim
- Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Chris Boedec
- Data Analytics CenterPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Luke J. Keele
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Charles Schneider
- Department of MedicinePerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | | | - Edgar Ben‐Josef
- Department of Radiation OncologyPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Peter E. Gabriel
- Department of Radiation OncologyPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - John P. Plastaras
- Department of Radiation OncologyPerelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Lawrence N. Shulman
- Department of MedicinePerelman School of MedicinePhiladelphiaPennsylvaniaUSA
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32
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Raducka A, Czylkowska A, Gobis K, Czarnecka K, Szymański P, Świątkowski M. Characterization of Metal-Bound Benzimidazole Derivatives, Effects on Tumor Cells of Lung Cancer. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2958. [PMID: 34070886 PMCID: PMC8198142 DOI: 10.3390/ma14112958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023]
Abstract
Four new ligands and four new copper (II) coordination compounds were prepared and characterized by chemical, elemental analysis, cytotoxicity, and FTIR spectroscopy (Fourier transform infrared spectroscopy). The nature of metal-ligand coordination was investigated. The thermal properties of complexes in the solid state were studied using TG-MS techniques (thermogravimetric analysis coupled with mass spectrometry) under dynamic flowing air atmosphere to analyze the principal volatile thermal decomposition and fragmentation products that evolved during thermolysis. The intermediate and final solid thermolysis products were also determined. The MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide) assay was used to evaluate active metabolic cells as an IC50 (half maximal inhibitory concentration). The relationship between antitumor activity and the position of nitrogen atoms in the organic ligand has been shown.
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Affiliation(s)
- Anita Raducka
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Lodz University of Technology, Zeromskiego 116, 90-924 Lodz, Poland;
| | - Agnieszka Czylkowska
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Lodz University of Technology, Zeromskiego 116, 90-924 Lodz, Poland;
| | - Katarzyna Gobis
- Department of Organic Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gen. Hallera 107, 80-416 Gdansk, Poland;
| | - Kamila Czarnecka
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland; (K.C.); (P.S.)
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163 Warsaw, Poland
| | - Paweł Szymański
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland; (K.C.); (P.S.)
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163 Warsaw, Poland
| | - Marcin Świątkowski
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Lodz University of Technology, Zeromskiego 116, 90-924 Lodz, Poland;
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33
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Choi JY, Park IJ, Lee HG, Cho E, Kim YI, Kim CW, Yoon YS, Lim SB, Yu CS, Kim JC. Impact of the COVID-19 Pandemic on Surgical Treatment Patterns for Colorectal Cancer in a Tertiary Medical Facility in Korea. Cancers (Basel) 2021; 13:cancers13092221. [PMID: 34066390 PMCID: PMC8125443 DOI: 10.3390/cancers13092221] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The COVID-19 pandemic is threatening to public health, including malignant disease. Fear of viral infection has influenced the diagnosis and treatment of colorectal cancer and may result in impairment of surgical and oncologic outcomes. Therefore, we need to analyze the influence of COVID-19 on surgical outcomes of colorectal cancer and provide guidance on proper diagnosis and treatment, including public messaging regarding appropriate healthcare. Abstract Because of their reluctance to visit the hospital due to concerns about contracting coronavirus disease 2019 (COVID-19), patients with colorectal cancer have been affected by delays in care during the pandemic. This study assessed the effects of the pandemic on the clinical characteristics and surgical treatment patterns of colorectal cancer patients at a tertiary medical facility in Korea. Patients who underwent colorectal cancer surgery at our institution between March and September 2020 were analyzed. Clinicopathological and treatment characteristics were compared with those of patients who underwent surgery in 2018 and 2019. The patients who did not undergo tumor resection (4.1% vs. 1.8%, p < 0.001) and who received neoadjuvant treatment (16.7% vs. 14.7%, p = 0.039) were significantly higher during the COVID period. The minimally invasive approach was performed less during the COVID period (81.2% vs. 88%, p < 0.001). More patients in the COVID period required combined resection of organs adjacent to the tumor (4.8% vs. 2.8%, p = 0.017). Surgical aggressiveness, as shown by the proportion of patients undergoing minimally invasive surgery and adjacent organ resection, was significantly influenced by the pandemic. In addition, resectability decreased during the COVID period. These characteristics will likely influence long-term oncological outcomes, indicating the need for long-term monitoring of this cohort.
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Affiliation(s)
- Ju Yeon Choi
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
- Correspondence: ; Tel.: +82-2-3010-3937
| | - Hyun Gu Lee
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Eunhae Cho
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Young Il Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Chan Wook Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Yong Sik Yoon
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (H.G.L.); (E.C.); (Y.I.K.); (C.W.K.); (Y.S.Y.); (S.-B.L.); (C.S.Y.); (J.C.K.)
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Okuno T, Takada D, Shin JH, Morishita T, Itoshima H, Kunisawa S, Imanaka Y. Surgical volume reduction and the announcement of triage during the 1st wave of the COVID-19 pandemic in Japan: a cohort study using an interrupted time series analysis. Surg Today 2021; 51:1843-1850. [PMID: 33881619 PMCID: PMC8059122 DOI: 10.1007/s00595-021-02286-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
Purpose The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for surgical staffs to minimize exposure to COVID-19 or save medical resources without harmful patient outcomes, in accordance with the statement of each surgical society. No research has empirically validated declines in surgical volume in Japan, based on the usage of surgical triage. We aimed to identify whether the announcement of surgical priorities by each Japanese surgical society may have affected the surgical volume decline during the 1st wave of this pandemic. Methods We extracted 490,719 available cases of patients aged > 15 years who underwent elective major surgeries between July 1, 2018, and June 30, 2020. After the categorization of surgical specialities, we calculated descriptive statistics to compare the year-over-year trend and conducted an interrupted time series analysis to validate the decline of each surgical procedure. Results Monthly surgical cases of eight surgical specialities, especially ophthalmology and ear/nose/throat surgeries, decreased from April 2020 and reached a minimum in May 2020. An interrupted time series analysis showed no significant trends in oncological and critical surgeries. Conclusion Non-critical surgeries showed obvious and statistically significant declines in case volume during the 1st wave of the COVID-19 pandemic according to the statement of each surgical society in Japan. Supplementary Information The online version contains supplementary material available at 10.1007/s00595-021-02286-6.
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Affiliation(s)
- Takuya Okuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Daisuke Takada
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Tetsuji Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Hisashi Itoshima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.
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Morris EJA, Goldacre R, Spata E, Mafham M, Finan PJ, Shelton J, Richards M, Spencer K, Emberson J, Hollings S, Curnow P, Gair D, Sebag-Montefiore D, Cunningham C, Rutter MD, Nicholson BD, Rashbass J, Landray M, Collins R, Casadei B, Baigent C. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study. Lancet Gastroenterol Hepatol 2021; 6:199-208. [PMID: 33453763 PMCID: PMC7808901 DOI: 10.1016/s2468-1253(21)00005-4] [Citation(s) in RCA: 205] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England. METHODS Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated. FINDINGS As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020. INTERPRETATION The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England. FUNDING Cancer Research UK, the Medical Research Council, Public Health England, Health Data Research UK, NHS Digital, and the National Institute for Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Eva J A Morris
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK.
| | - Raphael Goldacre
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Enti Spata
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Marion Mafham
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Paul J Finan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | | | | | - Katie Spencer
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | | | | | | | - David Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Chris Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - Matthew D Rutter
- Population Health Sciences Institute, University of Newcastle, Newcastle, UK; Department of Gastroenterology, North Tees University Hospital NHS Trust, Stockton on Tees, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Martin Landray
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
| | - Barbara Casadei
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, UK
| | - Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Big Data Institute, University of Oxford, Oxford, UK
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Gojayev A, Yuksel C, Ersen O, Celasin H, Ekrem Unal A, Demirci S. The Impact of the COVID-19 Pandemic on Gastric Cancer Surgery: A Single-Center Study. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2021. [DOI: 10.46327/msrjg.1.000000000000186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) was declared to be a global pandemic by the World Health Organization on March 11, 2020. The impact on gastric cancer (GC) surgery is unknown. Various reports have shown data indicating that cancer patients with COVID-19 have high morbidity and mortality rates. The choice of surgical procedures and perioperative management of the patients with malignancy has become even more impor¬tant in the COVID-19 pandemic. In this study, we aimed to evaluate the effects of the COVID-19 pandemic on the preopartive, intraoperative, and postoperative findings of patients operated for gastric cancer in our clinic. Materials and Methods: We defined the ‘COVID-19’ period as occurring between 12-03-2020 and 31-08-2020. All the enrolled patients were divided into two groups, pre-COVID-19 group (Pre-CG; 64 cases) and COVID-19 group (CG; 39 cases). A total of 103 patients with gastric cancer were included in this study. Patient characteristics, preoperative, intraoperative, and postoperative clinicopathological findings were compared between groups. Results: The waiting times before admission increased in CG (Pre-CG [6.73±2.85] vs CG [20.61±5.16] ; p<0.001). After admission, the waiting time before surgery was longer in CG (Pre-CG [5.06±3.06] vs CG [6.89±3.32] ; p=0.006). No significant difference was detected between the groups in terms of operation time, surgical procedure, combine organ resection, intraoperative blood transfusion requirment (p values, respectively; p=0.108; p=0.951; p=0.204; p=0.597). Postoperative complications were oesophagojejunostomy leak (3/1) , atelectasis (2/2), duodenal leak (2/2), ileus (3/0), pleural effusion (2/2), and others (1/1), and there was no statistically significant difference between the two groups (p = 0.333). There was no significant difference between the two groups in terms of hospital stay (p = 0.086) and ICU stay (p = 0.989). Conclusion: In this study, it was seen that the COVID-19 pandemic did not affect morbidity and mortality in gastric cancer surgery, but it prolonged admission waiting and operation waiting times. Since there is very little data in the literature regarding the effect of COVID-19 on gastric cancer surgery, our study will guide future studies on this subject.
Keywords: COVID-19, Impact, Gastric Cancer, Pandemics, Surgery
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Onesti CE, Tagliamento M, Curigliano G, Harbeck N, Bartsch R, Wildiers H, Tjan-Heijnen V, Martin M, Rottey S, Generali D, Campone M, Cristofanilli M, Pusztai L, Peeters M, Berchem G, Cortes J, Ruhstaller T, Ciruelos E, Rugo HS, Jerusalem G. Expected Medium- and Long-Term Impact of the COVID-19 Outbreak in Oncology. JCO Glob Oncol 2021; 7:162-172. [PMID: 33529077 PMCID: PMC8081548 DOI: 10.1200/go.20.00589] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has affected healthcare systems globally, leading to reorganization of medical activities. We performed an international survey aimed to investigate the medium- and long-term impact on oncology units. MATERIALS AND METHODS An 82-item survey was distributed from June 17 to July 14, 2020 among medical oncologists worldwide. RESULTS One hundred nine medical oncologists from 18 countries in Europe (n = 93), United States (n = 5), and Latin America (n = 11) answered the survey. A systematic tracing of COVID-19–positive patients was continued in the postacute phase by 77.1% of the centers; 64.2% of the respondents participated in a local registry and 56% in international or national registries of infected patients. Treatment adaptations were introduced, and surgery was the most affected modality being delayed or canceled in more than 10% of patients in 34% of the centers, whereas early cessation of palliative treatment was reported in 32.1% of the centers; 64.2% of respondents reported paying attention to avoid undertreatments. The use of telemedicine has been largely increased. Similarly, virtual tools are increasingly used particularly for medical education and international or national or multidisciplinary meetings. 60.6% of the participants reduced clinical activity, and 28.4% compensated by increasing their research activity. Significant reduction of clinical trial activities is expected in 37% of centers this year. The well-being of healthcare staff would not recover by the end of the year according to 18% of the participants. CONCLUSION The COVID-19 outbreak has had a major impact on oncologic activity, which will persist in the future, irrespective of geographical areas.
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Affiliation(s)
- Concetta Elisa Onesti
- Medical Oncology Department, CHU Sart Tilman Liege and Laboratory of Human Genetics, GIGA Research Institute, University of Liège, Liège, Belgium
| | - Marco Tagliamento
- Oncology Department, University of Genova and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Curigliano
- Oncology and Hemato-Oncology, European Institute of Oncology, IRCCS and University of Milan, Milan, Italy
| | - Nadia Harbeck
- Breast Center, Department OB&GYN and CCCLMU, LMU University Hospital, Munich, Germany
| | - Rupert Bartsch
- Department of Medicine I, Division of Oncology, Comprehensive Cancer Center, Medical University of Vienna, Wien, Austria
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Vivianne Tjan-Heijnen
- Medical Oncology, Maastricht University Medical Center (MUMC), Maastricht, Netherlands
| | - Miguel Martin
- Departamento de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón Universidad Complutense, Madrid, Spain
| | - Sylvie Rottey
- Department of Medical Oncology, UZ Gent, Gent, Belgium
| | - Daniele Generali
- UO Patologia Mammaria e Ricerca Traslazionale-Breast Unit, Azienda Socio-Sanitaria, Territoriale di Cremona and University of Trieste, Cremona, Italy
| | - Mario Campone
- Medical Oncology, Institut de Cancérologie de l'Ouest-Pays de la Loire, Saint-Herblain, France
| | - Massimo Cristofanilli
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lajos Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Marc Peeters
- Oncology Department, University Hospital Antwerp (UZA), Edegem, Belgium
| | - Guy Berchem
- Hemato-Oncology Department, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Javier Cortes
- Oncology Department, IOB Institute of Oncology, Quiron Group, Madrid, Barcelona, Spain.,Vall d'Hebron Institute of Oncology (VHIO), Centro Cellex, Carrer de Natzaret, Barcelona, Spain
| | - Thomas Ruhstaller
- Medical Oncology, Breast Center Eastern Switzerland, St Gallen, Switzerland.,University of Basel, St Gallen, Switzerland
| | - Eva Ciruelos
- Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Hope S Rugo
- Breast Care Center, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Guy Jerusalem
- Medical Oncology, CHU Sart Tilman Liège and University of Liège, Liège, Belgium
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Kakeji Y. Under any circumstances, perform the best treatment for cancer. Ann Gastroenterol Surg 2021; 5:5-6. [PMID: 33532675 PMCID: PMC7832963 DOI: 10.1002/ags3.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yoshihiro Kakeji
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
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Apostolou K, Vogli S, Frountzas M, Syllaios A, Tolia M, Papanikolaou IS, Schizas D. Upper Gastrointestinal Cancer Management in the COVID-19 Era: Risk of Infection, Adapted Role of Endoscopy, and Potential Treatment Algorithm Alterations. J Gastrointest Cancer 2020; 52:407-413. [PMID: 33244705 PMCID: PMC7690947 DOI: 10.1007/s12029-020-00557-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The safety of upper gastrointestinal cancer patients in the SARS-CoV-2 outbreak is extremely important and most surgeons need to establish a contingency management. AIM In this study, we present the surgical outlines of patients suffering from upper gastrointestinal cancers. MATERIALS AND METHODS Data were obtained from PubMed, Cochrane Database of Controlled Trials, and SCOPUS of reports up to September 2020. RESULTS The COVID-19 outbreak makes surgical procedures extremely difficult to be performed. The most common criteria to prioritize patients for surgical treatment are stage, tumor biology, presence of tumor-related symptoms, the risk of tumor to become non-resectable, and time interval from neoadjuvant therapy. The multidisciplinary teams can help assigning a priority level to each clinical case. CONCLUSION We have to continue providing treatment to oncologic patients in the face of COVID-19 uncertainty, with higher caution and responsibility in order to develop a safer and more effective personalized treatment plan.
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Affiliation(s)
- Konstantinos Apostolou
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 Street, 11527, Athens, Greece.
| | - Stamatina Vogli
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 Street, 11527, Athens, Greece
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Syllaios
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 Street, 11527, Athens, Greece
| | - Maria Tolia
- Department of Radiotherapy, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 Street, 11527, Athens, Greece
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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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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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Cancerona: Challenges of Cancer Management in Times of COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 2:2005-2014. [PMID: 33015555 PMCID: PMC7524598 DOI: 10.1007/s42399-020-00549-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has infected millions of people worldwide and emerged to be the biggest global health threat claiming hundreds of thousands of lives at exponential rates. The severity of the disease increases with old age and presence of underlying health conditions, such as cancer. Managing cancer patients under these circumstances is rather challenging, given their compromised immunity and the overwhelmed health care services by COVID-19 community transmission. Thus, it is prudent to establish common guidelines for the monitoring and treatment of cancer patients. In this review, we comprehensively investigate the various aspects of cancer care during the COVID-19 pandemic, discuss challenges faced while treating cancer patients, and propose potential approaches to manage COVID-19 among this vulnerable population. We also discuss molecular aberrations and genetic changes associated with cancer and their role in affecting the virus' infectivity and severity. Lastly, we shed light on therapeutic approaches that can encompass both diseases without compromising one over the other.
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Bhat PKR, Sorake C, Kulamarva G. Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. J Gastrointest Surg 2020; 24:2698-2699. [PMID: 32935269 PMCID: PMC7491593 DOI: 10.1007/s11605-020-04796-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/06/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Praveen Kumar R Bhat
- Department of Surgical Gastroenterology, Nitte University, K S Hegde Medical Academy, Mangaluru, India
| | - Chandrashekar Sorake
- Department of Medical Gastroenterology, Nitte University, K S Hegde Medical Academy, Mangaluru, India
| | - Ganaraj Kulamarva
- Department of Medical Gastroenterology, Nitte University, K S Hegde Medical Academy, Mangaluru, India
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