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Lugnier C, Sommerlatte S, Attenberger U, Beer AJ, Bentz M, Benz SR, Birkner T, Büntzel J, Ebert MPA, Fasching P, Fischbach W, Fokas E, Fricke B, Hense H, Grohmann E, Hofheinz RD, Hüppe D, Huster S, Jahn P, Klinkhammer-Schalke M, Knauf W, Kraeft AL, Maier BO, Marckmann G, Niegisch G, Otto L, Pelzer U, Piso P, Rosenau H, Schmitt J, Schoffer O, Sehouli J, Tannapfel A, Wedding U, Wesselmann S, Winkler EC, Zimmermann T, Wörmann B, Reinacher-Schick A, Schildmann J. Prioritization and Resource Allocation in the Context of the COVID-19 Pandemic: Recommendations for Colorectal and Pancreatic Cancer in Germany. Oncol Res Treat 2024; 47:296-305. [PMID: 38484712 DOI: 10.1159/000538171] [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] [Received: 10/06/2023] [Accepted: 02/28/2024] [Indexed: 06/06/2024]
Abstract
In the context of the COVID-19 pandemic, there has been a scarcity of resources with various effects on the care of cancer patients. This paper provides an English summary of a German guideline on prioritization and resource allocation for colorectal and pancreatic cancer in the context of the pandemic. Based on a selective literature review as well as empirical and ethical analyses, the research team of the CancerCOVID Consortium drafted recommendations for prioritizing diagnostic and treatment measures for both entities. The final version of the guideline received consent from the executive boards of nine societies of the Association of Scientific Medical Societies in Germany (AWMF), 20 further professional organizations and 22 other experts from various disciplines as well as patient representatives. The guiding principle for the prioritization of decisions is the minimization of harm. Prioritization decisions to fulfill this overall goal should be guided by (1) the urgency relevant to avoid or reduce harm, (2) the likelihood of success of the diagnostic or therapeutic measure advised, and (3) the availability of alternative treatment options. In the event of a relevant risk of harm as a result of prioritization, these decisions should be made by means of a team approach. Gender, age, disability, ethnicity, origin, and other social characteristics, such as social or insurance status, as well as the vehemence of a patient's treatment request and SARS-CoV-2 vaccination status should not be used as prioritization criteria. The guideline provides concrete recommendations for (1) diagnostic procedures, (2) surgical procedures for cancer, and (3) systemic treatment and radiotherapy in patients with colorectal or pancreatic cancer within the context of the German healthcare system.
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Affiliation(s)
- Celine Lugnier
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Sabine Sommerlatte
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany,
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Ulm University Medical Center, Ulm, Germany
| | - Martin Bentz
- Department of Internal Medicine III (Hematology, Oncology, Infectious Diseases and Palliative Care), Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Stefan R Benz
- Department of General, Visceral, Thoracic and Pediatric Surgery, Hospital Boeblingen, Boeblingen, Germany
| | - Thomas Birkner
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jens Büntzel
- Department of Palliative Medicine, Südharz Klinikum Nordhausen, Nordhausen, Germany
| | - Matthias P A Ebert
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Peter Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | | | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Birgit Fricke
- Arbeitskreis der Pankreatektomierten (AdP) e.V., Bonn, Germany
| | - Helene Hense
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Dietrich Hüppe
- Speaker of the Colorectal Carcinoma Specialist Group, Professional Association of Resident Gastroenterologists (BNG), Herne, Germany
| | - Stefan Huster
- Institute for Social and Health Law, Ruhr University Bochum, Bochum, Germany
| | - Patrick Jahn
- Health Services Research Working Group, Department of Internal Medicine, University Hospital Halle (Saale), Halle (Saale), Germany
| | | | - Wolfgang Knauf
- Center for Hematology and Oncology Bethanien, Frankfurt, Germany
| | - Anna-Lena Kraeft
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Bernd Oliver Maier
- Department for Palliative Medicine and Interdisciplinary Oncology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Georg Marckmann
- Institute of Ethics, History, and Theory of Medicine, LMU Munich, Munich, Germany
| | - Günter Niegisch
- Department of Urology, University Hospital and Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
- Center for Integrated Oncology (CIO) Düsseldorf, CIO Aachen Bonn Köln Düsseldorf, Dusseldorf, Germany
| | - Lutz Otto
- Arbeitskreis der Pankreatektomierten (AdP) e.V., Bonn, Germany
| | - Uwe Pelzer
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pompiliu Piso
- Department for General and Visceral Surgery, Krankenhaus Barmerzige Brueder Regensburg, Regensburg, Germany
| | - Henning Rosenau
- Interdisciplinary Scientific Center Medicine - Ethics - Law of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Simone Wesselmann
- Head of the Certification Division of the German Cancer Society, Berlin, Germany
| | - Eva C Winkler
- Section Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), NCT Heidelberg, a Partnership between DKFZ and Heidelberg University Hospital, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tanja Zimmermann
- Department of Psychosomatics and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Bernhard Wörmann
- Division of Hematology, Oncology and Tumour Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Hagenbeck C, Soff J, Mause L, Hoffmann J, Ohnhäuser T, Stöcker A, Zöllkau J, Scholten N. Gynaecologists' perceptions of outpatient gynaecologic and obstetric care in Germany during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:1079. [PMID: 37817213 PMCID: PMC10566176 DOI: 10.1186/s12913-023-10045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023] Open
Abstract
The measures taken to contain the COVID-19 pandemic had a major impact on society, affecting medical care as well as the utilization of medical services. We aimed to identify pandemic-related changes in gynaecologic/obstetric care through the personal experience of practitioners in the outpatient sector in Germany. Three consecutive anonymous online surveys of practising gynaecologists were conducted during the pandemic (07-09/2020, 11-12/2020 and 09-11/2021). Appointment management, medical supply and patients' demand as well as concomitant circumstances were queried. Data from 860 (393, 262 and 205 from the first, second and third surveys, respectively) respondents were analysed. At the peak of the first COVID-19 wave, more than 50% of the gynaecologists surveyed had cancelled cancer screening appointments. There was a significant association between fear of self-infection and cancellation of cancer screening appointments (p = 0.006). An increase in domestic violence was reported by 13%, an increase in obesity by 67% and more advanced tumours due to delayed screening by 24% of respondents. Primary gynaecological oncological prevention was reduced in supply and demand during the COVID-19 pandemic, and this shortfall should be addressed in future similar situations. Prenatal care has been offered continuously since the start of the pandemic in Germany.
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Affiliation(s)
- Carsten Hagenbeck
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Johannes Soff
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Laura Mause
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Jan Hoffmann
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Tim Ohnhäuser
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Arno Stöcker
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Janine Zöllkau
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Nadine Scholten
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
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Trommer M, Adams A, Bürkle C, Brunner S, Grandoch A, Geffroy A, Franklin C, Gassa A, Meißner AK, Mellinghoff S, Sharma SJ, Schrittenlocher S, Witte L, Marnitz S. Impact of the COVID-19 pandemic on training conditions and education in oncologic disciplines: a survey-based analysis. Strahlenther Onkol 2023; 199:806-819. [PMID: 37540263 PMCID: PMC10449661 DOI: 10.1007/s00066-023-02121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE The COVID-19 pandemic has led to changes in global health care. Medical societies had to update guidelines and enhance new services such as video consultations. Cancer treatment had to be modified. The aim of this study is to ensure optimal care for cancer patients with the help of high-quality training even in times of crisis. We therefore conducted a nationwide survey of physicians in training in oncological disciplines during the pandemic to assess the impact on their education. METHODS The survey was sent to tumour centres, hospitals, specialist societies, and working and junior research groups and distributed via newsletters and homepages. Interim results and a call for participation were published as a poster (DEGRO) [26] and in the German Cancer Society (DKG) journal FORUM [42]. The survey contained 53 questions on conditions of education and training and on clinical and scientific work. Statistics were carried out with LimeSurvey and SPSS (IBM Corp., Armonk, NY, USA). RESULTS Between February and November 2022, 450 participants answered the survey, with radio-oncologists being the largest group (28%). Most colleagues (63%) had access to digital training methods. Virtual sessions were rated as a good alternative, especially as multidisciplinary meetings (54%) as well as in-house and external training programs (48%, 47%). The time spent by training supervisors on education was rated as less than before the pandemic by 57%. Half of all participants perceived communication (54%), motivation (44%) and atmosphere (50%) in the team as bad. The participants felt strongly burdened by extra work (55%) and by a changed team atmosphere (49%). One third felt a change in the quality of training during the pandemic and rated it as negative (35%). According to 37% of the participants, this had little influence on their own quality of work. Additional subgroup analyses revealed significant differences in gender, specialty and education level. CONCLUSION In order to improve oncology training in times of crisis, access to digital training options and meetings should be ensured. Participants wish for regular team meetings in person to enable good team spirit, compensation for overtime work and sufficient time for training supervisors for discussion and feedback.
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Affiliation(s)
- Maike Trommer
- Klinik und Poliklinik für Radioonkologie, Cyberknife- und Strahlentherapie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Cologne, Germany.
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany.
- Center for Molecular Medicine Cologne, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany.
| | - Anne Adams
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät, Universität zu Köln, Cologne, Germany
| | - Carolin Bürkle
- Medizinische Klinik und Poliklinik III, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Stefanie Brunner
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Center for Molecular Medicine Cologne, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Andrea Grandoch
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik für Poliklinik für Mund-Kiefer- und Plastische Gesichtschirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Alexandra Geffroy
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg im Breisgau, Medizinische Fakultät, Universität Freiburg, Freiburg im Breisgau, Germany
| | - Cindy Franklin
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik und Poliklinik für Dermatologie und Venerologie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Asmae Gassa
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Herzzentrum an der Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Anna-Katharina Meißner
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Sibylle Mellinghoff
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Shachi Jenny Sharma
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Center for Molecular Medicine Cologne, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf und Halschirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Silvia Schrittenlocher
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Luisa Witte
- Urologische Klinik, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Simone Marnitz
- Klinik und Poliklinik für Radioonkologie, Cyberknife- und Strahlentherapie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
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Reinacher-Schick A, Ebert MP, Piso P, Hüppe D, Schmitt* J, Schildmann* J. Effects of the Pandemic on the Care of Patients With Colorectal Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:545-552. [PMID: 37427989 PMCID: PMC10546886 DOI: 10.3238/arztebl.m2023.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, there was a decrease in the rates of diagnosis and treatment of cancer. However, only a few detailed analyses have been made to date regarding the effect of the pandemic on the care of cancer patients in Germany. Such studies are needed as the basis for well-founded recommendations on health-care delivery priorities during pandemics and other, comparable situations of crisis. METHODS This review is based on publications that were retrieved by a selective search of the literature for controlled studies from Germany on the effects of the pandemic on colonoscopies, first diagnoses of colorectal cancer (CRC), surgical procedures for CRC, and CRC-related mortality. RESULTS Compared to 2019, the rate of screening colonoscopies performed by physicians in private practice was 1.6% higher in 2020 and 4.3% higher in 2021. On the other hand, the rate of diagnostic colonoscopies in the inpatient setting was 15,7% lower in 2020, while that of therapeutic colonoscopies was 11.7% lower. According to the data evaluated here, first diagnoses of CRC were 2.1% less common in January to September in 2020 than they had been in 2019; according to routine data collected by the statutory health insurance provider GRK, surgery for CRC was 10% less common in 2020 than in 2019. With regard to mortality, sufficient data from Germany were lacking to draw definite conclusions. International modeling data suggest an increase in mortality due to decreased colorectal screening rates during the pandemic that may at least be partially compensated for by intensified screening strategies following the pandemic. CONCLUSION Three years after the onset of the COVID-19 pandemic, there is still only a limited evidence base for an evaluation of the effects of the pandemic on medical care and on the outcomes of patients with CRC in Germany. The implementation of central data and research infrastructures will be necessary for further study of the long-term effects of this pandemic, as well as to enable optimal preparedness for future crisis situations.
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Affiliation(s)
- Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr University Bochum, Germany
| | - Matthias Philip Ebert
- Department of Internal Medicine II and DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brueder Regensburg, teaching hospital of the University of Regensburg, Germany
| | | | - Jochen Schmitt*
- * These authors share last authorship. Additional contributors are listed in the eBox
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technical University Dresden, Germany
| | - Jan Schildmann*
- * These authors share last authorship. Additional contributors are listed in the eBox
- Institute for the History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle, Germany
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