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Mathur P, Ramamoorthy T, Lakshminarayana SK, Nath A, Mathew S, Rajput GK. Utilization of clinical practice guidelines for cancer care in routine practice and during the coronavirus disease 2019 pandemic in India. Asia Pac J Clin Oncol 2024; 20:507-514. [PMID: 38667342 DOI: 10.1111/ajco.14071] [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: 10/11/2023] [Accepted: 04/05/2024] [Indexed: 07/24/2024]
Abstract
AIM The coronavirus disease 2019 (COVID-19) pandemic affected cancer service delivery and the feasibility of following the standard treatment guidelines. The present paper describes the use of clinical care guidelines for cancer management in routine practice and the approach adopted towards cancer care during the COVID-19 pandemic in India. METHODS A web-based survey was done in 107 hospitals (including public and private health facilities) that hosted Hospital-Based Cancer Registries under the National Cancer Registry Programme. The participants comprised Principal Investigators of these registries, who were also medical, surgical, and radiation oncology clinicians. The survey was done between May 1, 2021, and July 31, 2021. Participants were provided with a web link for the survey questionnaire, confidential login, and password. RESULTS The study found high utilization of Clinical Practice Guidelines (CPGs) during practice, with eight out of ten physicians constantly to referring them. The study reported lack of knowledge, skills, and training to administer the treatment based on the guidelines followed by organizational infrastructure and affordability of treatment by the patients as the factors hampering utilization. International clinical guidelines were preferred when compared to national guidelines. The COVID-19 pandemic decreased the use of CPGs, wherein six out of ten clinicians reported their use. CONCLUSION Stakeholders who formulate clinical guidelines must consider the practical aspects and feasibility of implementing such guidelines during a pandemic and similar situations. This should be coupled with adequate changes in care practice to ensure optimal care delivery and a continuum of cancer care in routine and pandemic-imposed situations.
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Affiliation(s)
- Prashant Mathur
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Thilagavathi Ramamoorthy
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | | | - Anita Nath
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Stany Mathew
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Gurpreet Kaur Rajput
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
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2
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Low C, Tejero I, Toledano N, Mariano C, Alibhai S, Lemonde M, Haase K, Puts M. Impact of COVID-19 on older adults with cancer and their caregivers' cancer treatment experiences study: The ICE-OLD study. PLoS One 2023; 18:e0291756. [PMID: 37729131 PMCID: PMC10511107 DOI: 10.1371/journal.pone.0291756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
The COVID-19 pandemic and health services impacts related to physical distancing posed many challenges for older adults with cancer. The goal of this study was to examine the impact of the pandemic on cancer treatment plans and cancer treatment experiences of older adults (ie, aged 65 years and older) and their caregiver' experiences of caring for older adults during the pandemic to highlight gaps in care experienced. In this multi-centre qualitative study guided by an interpretive descriptive research approach we interviewed older adults diagnosed with cancer and caregivers caring for them. Participants were recruited via cancer treatment centres in the provinces of British Columbia and Ontario (Vancouver and Toronto), Canada, and through an online ad sent out through patient advocacy organization newsletters. Interviews were recorded and transcribed verbatim and data were analyzed using an interpretive thematic analysis approach. A total of 27 individuals (17 older adults, 52.9% female; 10 caregivers, 90% female) participated in interviews lasting on average 45 minutes. Older adults with cancer described many impacts and pressures created by the pandemic on their cancer experiences, though they generally felt that the pandemic did not impact treatment decisions made and access to care. We grouped our findings into two main themes with their accompanying sub-themes, related to: (1) alterations in the individual and dyadic cancer experience; and (2) navigating health and cancer systems during the pandemic. The additional stressors the pandemic placed on older adults during their treatment and decision-making process and their caregivers expose the need to create or avail additional supports for future disruptions in care.
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Affiliation(s)
- Cydney Low
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Isabel Tejero
- Geriatrics Department, Hospital del Mar, Barcelona, Spain
| | - Nelly Toledano
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Mariano
- BC Cancer Agency, Vancouver and Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Shabbir Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Pisegna JL, BrintzenhofeSzoc K, Shahrokni A, Canin B, Plotkin E, Boehmer LM, Chien L, Malone MV, MacKenzie AR, Krok-Schoen JL. Differences in urban and suburban/rural settings regarding care provision and barriers of cancer care for older adults during COVID-19. Support Care Cancer 2022; 31:78. [PMID: 36562819 PMCID: PMC9780617 DOI: 10.1007/s00520-022-07544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Care for older adults with cancer became more challenging during the COVID-19 pandemic, particularly in urban hotspots. This study examined the potential differences in healthcare providers' provision of as well as barriers to cancer care for older adults with cancer between urban and suburban/rural settings. METHODS Members of the Advocacy Committee of the Cancer and Aging Research Group, with the Association of Community Cancer Centers, surveyed multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Respondents were recruited through organizational listservs, email blasts, and social media messages. Descriptive statistics and chi-square tests were used. RESULTS Complete data was available from 271 respondents (urban (n = 144), suburban/rural (n = 127)). Most respondents were social workers (42, 44%) or medical doctors/advanced practice providers (34, 13%) in urban and suburban/rural settings, respectively. Twenty-four percent and 32.4% of urban-based providers reported "strongly considering" treatment delays among adults aged 76-85 and > 85, respectively, compared to 13% and 15.4% of suburban/rural providers (Ps = 0.048, 0.013). More urban-based providers reported they were inclined to prioritize treatment for younger adults over older adults than suburban/rural providers (10.4% vs. 3.1%, p = 0.04) during the pandemic. The top concerns reported were similar between the groups and related to patient safety, treatment delays, personal safety, and healthcare provider mental health. CONCLUSION These findings demonstrate location-based differences in providers' attitudes regarding care provision for older adults with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Janell L. Pisegna
- Physical Therapy Program, Geriatric Research Education and Clinical Center VA Eastern Colorado Healthcare System, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | | | - Armin Shahrokni
- Department of Medicine, Gastrointestinal Oncology and Geriatrics Services, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Elana Plotkin
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leigh M. Boehmer
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leana Chien
- City of Hope Comprehensive Cancer Center, Duarte, CA USA
| | - Mariuxi Viteri Malone
- Division of Hematology, Florida Cancer Specialists and Research Institute, Venice, FL USA
| | - Amy R. MacKenzie
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA USA
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10Th Ave., Columbus, OH 43210 USA
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Impact of COVID-19 on care of older adults with cancer: a narrative synthesis of reviews, guidelines and recommendations. Curr Opin Support Palliat Care 2022; 16:3-13. [DOI: 10.1097/spc.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Daniali SS, Rahimi M, Salarvand S. Age discrimination in delivery of health services to old people during COVID-19 pandemic: a scoping review study. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alabraba E, Gomez D. Systematic Review of Treatments for Colorectal Metastases in Elderly Patients to Guide Surveillance Cessation Following Hepatic Resection for Colorectal Liver Metastases. Am J Clin Oncol 2021; 44:210-223. [PMID: 33710135 DOI: 10.1097/coc.0000000000000803] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although included in surveillance programmes for colorectal cancer (CRC) metastases, elderly patients are susceptible to declines in health and quality of life that may render them unsuitable for further surveillance. Deciding when to cease surveillance is challenging. METHODS There are no publications focused on surveillance of elderly patients for CRC metastases. A systematic review of studies reporting treatment outcomes for CRC metastases in elderly patients was performed to assess the risk-benefit balance of the key objectives of surveillance; detecting and treating CRC metastases. RESULTS Sixty-eight eligible studies reported outcomes for surgery and chemotherapy in the elderly. Liver resections and use of chemotherapy, including biologics, are more conservative and have poorer outcomes in the elderly compared with younger patients. Selected studies demonstrated poorer quality-of-life (QoL) following surgery and chemotherapy. Studies of ablation in elderly patients are limited. DISCUSSION The survival benefit of treating CRC metastases with surgery or chemotherapy decreases with advancing age and QoL may decline in the elderly. The relatively lower efficacy and detrimental QoL impact of multimodal therapy options for detected CRC metastases in the elderly questions the benefit of surveillance in some elderly patients. Care of elderly patients should thus be customized based on their preference, formal geriatric assessment, natural life-expectancy, and the perceived risk-benefit balance of treating recurrent CRC metastases. Clinicians may consider surveillance cessation in patients aged 75 years and above if geriatric assessment is unsatisfactory, patients decline surveillance, or patient fitness deteriorates catastrophically.
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Affiliation(s)
- Edward Alabraba
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| | - Dhanny Gomez
- Department of Hepatobiliary Surgery and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust
- NIHR Nottingham Digestive Disease Biomedical Research Unit, University of Nottingham, Nottingham, UK
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Xu Y, Huang ZH, Zheng CZL, Li C, Zhang YQ, Guo TA, Liu FQ, Xu Y. The impact of COVID-19 pandemic on colorectal cancer patients: a single-center retrospective study. BMC Gastroenterol 2021; 21:185. [PMID: 33879095 PMCID: PMC8057666 DOI: 10.1186/s12876-021-01768-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Since December 2019, China has experienced a public health emergency from the coronavirus disease, which has become a pandemic and is impacting the care of cancer patients worldwide. This study evaluated the impact of the pandemic on colorectal cancer (CRC) patients at our center and aimed to share the lessons we learned with clinics currently experiencing this impact. Methods We retrospectively collected data on CRC patients admitted between January 1, 2020 and May 3, 2020; the control group comprised patients admitted between January 1, 2019 and May 3, 2019. Results During the pandemic, outpatient volumes decreased significantly, especially those of nonlocal and elderly patients, whereas the number of patients who received chemotherapy and surgery remained the same. During the pandemic, 710 CRC patients underwent curative resection. The proportion of patients who received laparoscopic surgeries was 49.4%, significantly higher than the 39.5% during the same period in 2019. The proportion of major complication during the pandemic was not significantly different from that of the control group. The mean hospital stay was significantly longer than that of the control group. Conclusions CRC patients confirmed to be infection-free can receive routine treatment. Using online medical counseling and appropriate identification, treatment and follow-up can be effectively maintained. Adjuvant and palliative chemotherapy should not be discontinued. Endoscopic polypectomy, elective, palliative, and multidisciplinary surgeries can be postponed, while curative surgery should proceed as usual. For elderly CRC patients, endoscopic surgery and neoadjuvant radiotherapy are recommended.
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Affiliation(s)
- Yun Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an Road, 270, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zong-Hao Huang
- Hospital Information Centre, Fudan University Shanghai Cancer Center, Dong'an Road, 270, Shanghai, 200032, China
| | - Charlie Zhi-Lin Zheng
- Mechanical and Aerospace Engineering, University of California, 7400 Boelter Hall, Los Angeles, CA, 90095, USA
| | - Cong Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an Road, 270, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yu-Qin Zhang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an Road, 270, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Tian-An Guo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an Road, 270, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Fang-Qi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an Road, 270, Shanghai, 200032, China.
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Dong'an Road, 270, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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8
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Covid-19 infection in cancer patients: the management in a diagnostic unit. Radiol Oncol 2021; 55:121-129. [PMID: 33675200 PMCID: PMC8042821 DOI: 10.2478/raon-2021-0010] [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: 09/17/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 infection is particularly aggressive in frail patients, as cancer patients. Therefore, the more suitable management of the oncological patient requires a multidisciplinary assessment, to identify which patients should be treated, as inpatients or outpatients, and which treatments can be procrastinated. Conclusions The role of radiologist is crucial, and, all cancer patients who need an imaging evaluation will need to be studied, using the most appropriate imaging tools related to the clinical question and paying a special attention to preserve public health. Guidelines are necessary in the correct organization of a radiology unit to manage patients with suspected or confirmed COVID-19 infection, and whenever possible, a satellite radiography center with dedicated equipment should be used to decrease the transmission risk.
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9
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BrintzenhofeSzoc K, Krok-Schoen JI, Pisegna JL, MacKenzie AR, Canin B, Plotkin E, Boehmer LM, Shahrokni A. Survey of cancer care providers' attitude toward care for older adults with cancer during the COVID-19 pandemic. J Geriatr Oncol 2021; 12:196-205. [PMID: 33144071 PMCID: PMC7534786 DOI: 10.1016/j.jgo.2020.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Care for older adults with cancer became more challenging during the COVID-19 pandemic. We sought to examine cancer care providers' attitudes toward the barriers and facilitators related to the care for these patients during the pandemic. MATERIALS AND METHODS Members of the Advocacy Committee of the Cancer and Aging Research Group, along with the Association of Community Cancer Centers, developed the survey distributed to multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Participants were recruited by email sent through four professional organizations' listservs, email blasts, and messages through social media. RESULTS Complete data was available from 274 respondents. Only 15.4% had access to written guidelines that specifically address the management of older adults with cancer during the COVID-19 pandemic. Age was ranked fifth as the reason for postponing treatment following comorbid conditions, cancer stage, frailty, and performance status. Barriers to the transition to telehealth were found at the patient-, healthcare worker-, and institutional-levels. Providers reported increased barriers in accessing basic needs among older adults with cancer. Most respondents agreed (86.3%) that decision making about Do Not Resuscitate orders should be the result of discussion with the patient and the healthcare proxy in all situations. The top five concerns reported were related to patient safety, treatment delays, healthcare worker mental health and burnout, and personal safety for family and self. CONCLUSION These findings demand resources and support allocation for older adults with cancer and healthcare providers during the COVID-19 pandemic.
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Affiliation(s)
- Karlynn BrintzenhofeSzoc
- College of Allied Health Sciences, School of Social Work, University of Cincinnati, United States.
| | - Jessica I Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University, United States
| | - Janell L Pisegna
- School of Health and Rehabilitation Sciences, The Ohio State University, United States
| | | | | | - Elana Plotkin
- Association of Cancer Community Centers, United States
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Aapro M, Lyman GH, Bokemeyer C, Rapoport BL, Mathieson N, Koptelova N, Cornes P, Anderson R, Gascón P, Kuderer NM. Supportive care in patients with cancer during the COVID-19 pandemic. ESMO Open 2020; 6:100038. [PMID: 33421735 PMCID: PMC7808078 DOI: 10.1016/j.esmoop.2020.100038] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/25/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022] Open
Abstract
Cancer care has been profoundly impacted by the global pandemic of severe acute respiratory syndrome coronavirus 2 disease (coronavirus disease 2019, COVID-19), resulting in unprecedented challenges. Supportive care is an essential component of cancer treatment, seeking to prevent and manage chemotherapy complications such as febrile neutropenia, anaemia, thrombocytopenia/bleeding, thromboembolic events and nausea/vomiting, all of which are common causes of hospitalisation. These adverse events are an essential consideration under routine patient management, but particularly so during a pandemic, a setting in which clinicians aim to minimise patients' risk of infection and need for hospital visits. Professional medical oncology societies have been providing updated guidelines to support health care professionals with the management, treatment and supportive care needs of their patients with cancer under the threat of COVID-19. This paper aims to review the recommendations made by the most prominent medical oncology societies for devising and modifying supportive care strategies during the pandemic. Cancer care has been profoundly impacted by the global pandemic of COVID-19, resulting in unprecedented challenges. Oncology societies have updated guidelines for the supportive care needs of patients with cancer under the threat of COVID-19. This paper reviews recommendations from prominent oncology societies for providing supportive care during the pandemic.
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Affiliation(s)
- M Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - G H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Research Center and the University of Washington Schools of Medicine, Public Health and Pharmacy, Seattle, USA.
| | - C Bokemeyer
- Department of Oncology, Hematology & BMT with Section of Pneumology, Universitaetsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - B L Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; The Medical Oncology Centre of Rosebank, Johannesburg, South Africa; Neutropenia, Infection and Myelosuppression Study Group (Chair), The Multinational Association for Supportive Care in Cancer, Aurora, Canada
| | | | | | - P Cornes
- Comparative Outcomes Group, Bristol, UK
| | - R Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - P Gascón
- Department of Hematology-Oncology, Laboratory of Molecular & Translational Oncology-CELLEX University of Barcelona, Barcelona, Spain
| | - N M Kuderer
- Advanced Cancer Research Group, Seattle, USA
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11
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Cherif MA, Loganadane G, Debbi K, Coraggio G, Ghith S, Hadhri A, Hassani W, Grellier N, To NH, Belkacemi Y. Radiation Therapy Delivery Challenges in Older Patients During Coronavirus Disease 2019 Pandemic. Adv Radiat Oncol 2020; 6:100626. [PMID: 33313442 PMCID: PMC7718104 DOI: 10.1016/j.adro.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The management of older patients in radiation therapy (RT) departments has been challenging in the context of the Coronavirus Disease 2019 (COVID-19) outbreak. We report our experience of RT adapted schedules or strategy changes in older patients during the COVID-19 pandemic. Methods and Materials Patients aged ≥75 years were recruited during weekly chart rounds. All were potentially eligible for a specific intervention to reduce the frequency of patients' visits to the hospital. The effect of deferring radiation and hypofractionation of RT schedules was assessed in terms of the number of courses initially planned and replanned during the lockdown. Results Twenty patients were identified during the official lockdown in France (March 17 to May 11). Median age was 78 years (75-95 years). Most patients were male (n = 12, 60%) being treated in the postoperative setting (n = 17, 85%). RT was delayed in 11 cases (55%) with hormonal therapy prescribed in 10 cases (50%). Altered RT fractionation was proposed for 5 cases (25%); combinations of altered fractionation and deferral of radiation were applied in 3 cases (15%). The number of radiation courses initially planned and replanned according to the pandemic context: 563 and 197, respectively (-62%; P < .001). None presented recurrence when RT was initiated, and no patient developed symptomatic COVID-19 infection. Conclusions In the context of the COVID-19 outbreak, individual risk-based radiation therapy seems to be safe. Systematic screening of patients for COVID-19 before starting radiation therapy is mandatory. In our department the oncogeriatrics expertise availability for daily practice was of great use during the pandemic. Other prospective studies are needed to validate such strategies in case of resurgence of similar outbreaks.
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Affiliation(s)
- Mohamed Aziz Cherif
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
| | - Gokoulakrichenane Loganadane
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Kamel Debbi
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Gabriele Coraggio
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
| | - Sahar Ghith
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Asma Hadhri
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Wissal Hassani
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Noémie Grellier
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
| | - Nhu Hanh To
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- INSERM Unit 955; Team 21, IMRB, University of Paris-Est (UPEC), Creteil, France
| | - Yazid Belkacemi
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
- INSERM Unit 955; Team 21, IMRB, University of Paris-Est (UPEC), Creteil, France
- Corresponding author: Yacid Belkacemi MD, PhD
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Amicucci M, Mastronuzzi A, Ciaralli I, Piccioni F, Schiopu AC, Tiozzo E, Gawronski O, Biagioli V, Dall’Oglio I. The Management of Children with Cancer during the COVID-19 Pandemic: A Rapid Review. J Clin Med 2020; 9:E3756. [PMID: 33233447 PMCID: PMC7700610 DOI: 10.3390/jcm9113756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
Despite the fact that cancer patients seem to be at a higher risk of being infected with SARS-CoV-2, limited data are available in the pediatric oncology setting. A systematic rapid review was conducted to analyze scientific literature regarding the management, interventions, and strategies adopted to prevent the spread of COVID-19 in the pediatric cancer population. Our search on PubMed, Scopus, Cochrane, and EMBASE databases yielded 505 articles. After removing duplicates, 21 articles were included. Articles focused on infection prevention (n = 19; 90.5%), management (n = 18; 85.7%), overall management of specific treatments for cancer (n = 13; 61.9%), and education (n = 7; 33.3%). The interventions adopted to prevent the spread of COVID-19 were similar across organizations and in line with general recommendations. Most of them reported interventions that could be used as valid strategies for similar emergencies. The strategies included limiting the risk of contagion by restricting access to the wards and implementing hygiene measures, the identification of separate pathways for the management of patients suspected or confirmed to be infected with COVID-19, the postponement of people accessing the hospital for non-urgent or unnecessary tests or medical examinations, and the preventive screening of patients before chemotherapy treatment or transplantation of hematopoietic stem cells. It is necessary to identify key indicators in order to better evaluate the effectiveness of the interventions implemented over time. A summary of the recommendations is provided.
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Affiliation(s)
- Matteo Amicucci
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | - Angela Mastronuzzi
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | - Italo Ciaralli
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | - Federico Piccioni
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | | | - Emanuela Tiozzo
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
| | - Orsola Gawronski
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
| | - Valentina Biagioli
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
| | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
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Kawahara LT, Costa IBSDS, Barros CCS, Almeida GCD, Bittar CS, Rizk SI, Testa L, Moniz CMV, Pereira J, Oliveira GMMD, Diz MDPE, Guimarães PO, Pinto IM, Kalil R, Hajjar LA, Hoff PM. Câncer e Doenças Cardiovasculares na Pandemia de COVID-19. Arq Bras Cardiol 2020; 115:547-557. [PMID: 33027380 PMCID: PMC9363105 DOI: 10.36660/abc.20200405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
O desafio imposto ao sistema de saúde pela pandemia da COVID-19 faz com que haja uma necessidade de readequações de rotinas e serviços de saúde, com os objetivos de controlar a disseminação do vírus e preservar a saúde. Torna-se ainda mais importante o manejo seguro e correto dos pacientes dos grupos de risco, como os pacientes idosos, os portadores de doenças cardiovasculares e os pacientes com câncer. Dessa forma, a cardio-oncologia ganha novo dimensionamento, no intuito de se adequar às necessidades dos pacientes diante de uma pandemia, reestruturando o sistema de atendimento de forma a oferecer qualidade e segurança na assistência à saúde.
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Gale RP. COVID-19 in Patients with Hematologic Disorders Undergoing Therapy: Perspective of a Large Referral Hematology Center in Rome. Acta Haematol 2020; 143:574-582. [PMID: 32155631 PMCID: PMC7573911 DOI: 10.1159/000510769] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022]
Abstract
Introduction Patients with cancer may be more susceptible to and have higher morbidity and mortality rates from COVID-19 than the general population, while epidemiologic data specifically addressed to hematologic patients are limited. To investigate whether patients with hematologic diseases undergoing therapy are at increased risk for acquiring SARS CoV-2 infection compared to the general population, a retrospective study was carried out at a referral hematologic center in Rome, Italy, during the period of the greatest epidemic spread (March 8 to May 14, 2020). Methods All adult and pediatric patients with a diagnosis of a neoplastic or a nonneoplastic hematologic disease who underwent treatment (chemotherapy or immunosuppressive or supportive therapy) during the study period or in the previous 6 months were considered. The prevalence of COVID-19 in the overall outpatient and inpatient population undergoing hematologic treatment compared to that of the general population was analyzed. The measures taken to manage patients during the epidemic period are described. Results Overall, 2,513 patients with hematological diseases were considered. Out of 243 (9.7%) patients who were screened for SARS CoV-2, three of 119 (2.5%) outpatients with fever or respiratory symptoms and none of 124 asymptomatic patients were diagnosed with COVID-19. Three further patients were diagnosed with COVID-19 and managed in other hospitals in Rome. As of May 14, 2020, the prevalence of COVID-19 in our hematologic population accounted for 0.24% (95% CI 0.23–0.25; 6 of 2,513 patients: 1 case in every 419 patients) as compared to 0.12% (7,280 of 5,879,082 residents; 1 case in every 807 residents) in the general population (p = 0.14). Three of 6 patients diagnosed with COVID-19 required critical care and 2 died while still positive for SARS CoV-2. Out of 225 healthcare providers on duty at our Institution during the study period, 2 (0.9%) symptomatic cases were diagnosed with COVID-19. Conclusion In our experience, the prevalence of COVID-19 in hematologic patients, mainly affected by malignancies, was not significantly higher compared to that of the general population. Definition of adapted strategies for healthcare services, while continuing to administer the standard hematologic treatments, represents the crucial challenge for the management of hematologic diseases in the COVID-19 era.
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Affiliation(s)
- Robert Peter Gale
- Centre forHaematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom,
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Cassell III AK, Cassell LT, Bague AH. Management of cancer patients during the COVID-19 pandemic: A comprehensive review. Artif Intell Cancer 2020; 1:8-18. [DOI: 10.35713/aic.v1.i1.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
The novel 2019 corona virus disease also called severe acute respiratory syndrome coronavirus 2 has caused a global pandemic and more than 2.5 million people have been affected globally with over 100000 deaths. The disease has caused an escalation in hospitalization with growing need for hospital beds and intensive care unit for severe cases. Recent evidence has shown that a significant proportion of cancer patients affected by the corona virus present with severe respiratory pneumonia-like illness with need for subsequent intensive care unit ventilation and higher mortality risk. This susceptibility may be due to the immunosuppressive state of patients with malignancy confounded by chemotherapy, immunotherapy and targeted therapy. Many solid tumors (lung cancer, pancreatic cancer) as well as hematological malignancies (leukemias) may require prompt diagnosis and treatment based on the disease aggression and progression. Many centers lack clear guideline on the management of cancer during the pandemic. The objective of this review is to synthesize the available literature and provide recommendations on the management of various soft tissue and hematological malignancies. The review will also assess the management guidelines for hospitalized cancer patients; cancer patients in the outpatient setting as well as available modalities for follow-up.
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Affiliation(s)
- Ayun K Cassell III
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar 3270, Senegal
| | - Lydia T Cassell
- Department of Public Health, Cuttington University, Graduate School and Professional Studies, Monrovia 10010, Liberia
| | - Abdoul Halim Bague
- Unit of Surgical Oncology, Department of General Surgery, Yalgado Ouedraogo Teaching Hospital, Ouagadougou 160, Burkina Faso
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Mourey L, Falandry C, de Decker L, Boulahssass R, Carola E, Bengrine Lefevre L, Cudennec T, Brain E, Paillaud E, Soubeyran P. Taking care of older patients with cancer in the context of COVID-19 pandemic. Lancet Oncol 2020; 21:e236. [PMID: 32302533 PMCID: PMC7156244 DOI: 10.1016/s1470-2045(20)30229-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Loïc Mourey
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Claire Falandry
- Geriatrics Unit, Lyon Sud University Hospital, Hospices Civils de Lyon and Lyon University, Pierre-Bénite, France
| | - Laure de Decker
- Médecine Aiguë Gériatrique, Université de Nantes, Vice-Présidente de la Société Francophone d'Oncogériatrie, CHU Nantes, Saint Herblain, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Elisabeth Carola
- Pôle d'Oncologie Médicale, Groupe Hospitalier Public du Sud de l'Oise, Creil, France
| | | | - Tristan Cudennec
- Service de Médecine Gériatrique du Pr Teillet AP-HP, Université Paris Saclay Hôpitaux Antoine-Béclère, Boulogne-Billancourt, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Eléna Paillaud
- Geriatric Oncology Unit, APHP, Hôpital Européen Georges Pompidou, Paris, France; Clinical Epidemiology and Ageing Unit, Université Paris-Est, Créteil, France
| | - Pierre Soubeyran
- Department of Medical Oncology, Institut Bergonié, Université de Bordeaux, Inserm U1218, 33076 Bordeaux Cedex, France.
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Gale RP. Treating Plasma Cell Myeloma in Developing Countries: Does Everyone Need the Newest Drugs? Acta Haematol 2020; 143:513-515. [PMID: 32155631 DOI: 10.1159/000505991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Peter Gale
- Centre forHaematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom,
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