COVID-19 pandemic and patients with cancer: The protocol of a Clinical Oncology center in Tehran, Iran

A Critical Review on the Long-Term COVID-19 Impacts on Patients With Diabetes

BACKGROUND

The world is currently grappling with the potentially life-threatening coronavirus disease 2019 (COVID-19), marking it as the most severe health crisis in the modern era. COVID-19 has led to a pandemic, with the World Health Organization (WHO) predicting that individuals with diabetes are at a higher risk of contracting the virus compared to the general population. This review aims to provide a practical summary of the long-term impacts of COVID-19 on patients with diabetes. Specifically, it focuses on the effects of SARS-CoV-2 on different types of diabetic patients, the associated mortality rate, the underlying mechanisms, related complications, and the role of vitamin D and zinc in therapeutic and preventive approaches.

METHODS

Relevant literature was identified through searches on PubMed, Web of Science, and Science Direct in English, up to April 2023.

RESULTS

COVID-19 can lead to distressing symptoms and pose a significant challenge for individuals living with diabetes. Older individuals and those with pre-existing conditions such as diabetes, coronary illness, and asthma are more susceptible to COVID-19 infection. Managing COVID-19 in individuals with diabetes presents challenges, as it not only complicates the fight against the infection but also potentially prolongs the recovery time. Moreover, the virus may thrive in individuals with high blood glucose levels. Various therapeutic approaches, including antidiabetic drugs, are available to help prevent COVID-19 in diabetic patients.

CONCLUSIONS

Diabetes increases the morbidity and mortality risk for patients with COVID-19. Efforts are globally underway to explore therapeutic interventions aimed at reducing the impact of diabetes on COVID-19.

Role of children in the Bulgarian COVID-19 epidemic: A mathematical model study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic affects all aspects of our lives, including children. With the advancement of the pandemic, children under five years old are at increased risk of hospitalization relative to other age groups. This makes it paramount that we develop tools to address the two critical aspects of preserving children's health - new treatment protocols and new predictive models. For those purposes, we need to understand better the effects of COVID-19 on children, and we need to be able to predict the number of affected children as a proportion of the number of infected children. This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID, as a part of the general picture of post-COVID among this age group.

AIM

To demonstrate the role of children in the COVID-19 spread in Bulgaria and to test the hypothesis that there are no secondary transmissions in schools and from children to adults.

METHODS

Our modeling and data show with high probability that in Bulgaria, with our current measures, vaccination strategy and contact structure, the pandemic is driven by the children and their contacts in school.

RESULTS

This makes it paramount that we develop tools to address the two critical aspects of preserving children's health - new treatment protocols and new predictive models. For those purposes, we need to understand better the effects of COVID-19 on children, and we need to be able to predict the number of affected children as a proportion of the number of infected children. This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID, as a part of the general picture of post-Covid among this age group.

CONCLUSION

Our modeling rejects that hypothesis, and the epidemiological data supports that. We used epidemiological data to support the validity of our modeling. The first summer wave in 2020 from the listed here school proms endorse the idea of transmissions from students to teachers.

Numerical investigation of airborne infection risk in an elevator cabin under different ventilation designs

Airborne transmission of SARS-CoV-2 via virus-laden aerosols in enclosed spaces poses a significant concern. Elevators, commonly utilized enclosed spaces in modern tall buildings, present a challenge as the impact of varying heating, ventilation, and air conditioning (HVAC) systems on virus transmission within these cabins remains unclear. In this study, we employ computational modeling to examine aerosol transmission within an elevator cabin outfitted with diverse HVAC systems. Using a transport equation, we model aerosol concentration and assess infection risk distribution across passengers' breathing zones. We calculate the particle removal efficiency for each HVAC design and introduce a suppression effect criterion to evaluate the effectiveness of the HVAC systems. Our findings reveal that mixing ventilation, featuring both inlet and outlet at the ceiling, proves most efficient in reducing particle spread, achieving a maximum removal efficiency of 79.40% during the exposure time. Conversely, the stratum ventilation model attains a mere removal efficiency of 3.97%. These results underscore the importance of careful HVAC system selection in mitigating the risk of SARS-CoV-2 transmission within elevator cabins.

COVID-19 Adverse Outcomes in Immunocompromised Patients

Background: Coronavirus disease 2019 (COVID-19) is a devastating viral pandemic infecting millions of people with a wide range of symptoms from fever to death. It has been suggested that immunocompromised patients are at a higher risk of severe disease, poor clinical outcomes, and mortality. However, these patients’ risk factors and COVID-19-related outcomes are not well characterized. Objectives: We evaluated the COVID-19-related outcomes among immunocompromised patients ranging from solid tumors, hematological malignancies, and HIV to autoimmune disease and transplant recipients who received immunosuppressive agents. We also aimed at finding risk factors related to mortality among immunocompromised patients with COVID-19. Methods: This cross-sectional study was conducted in Khansari Hospital, Iran between March and November 2021. We included immunocompromised patients with nasal swab positive SARS-CoV-2 polymerase chain reaction (PCR) results in the study. Patient outcomes, including hospitalization ward and the mortality rate, were assessed till three months after COVID-19 infection were evaluated in all patients. Moreover, the relation between risk factors and the rate of the mortality rate was analyzed in immunocompromised patients with COVID-19. Results: A total number of 74 immunocompromised patients with solid tumors, hematologic malignancies, autoimmune diseases, acquired immunodeficiencies, and solid-organ transplant recipients were included in the study. Results indicated that the male gender and ICU hospitalization significantly increase the mortality risk. Surprisingly, chemotherapy is associated with a lower risk of mortality. Conclusions: Identifying the risk factors can improve the decision-making on cancer patients’ management during the COVID-19 infection. A further large cohort of patients would be required to identify risk factors relating to poor clinical outcomes and mortality rates in immunocompromised patients with COVID-19.

Monoclonal antibody infusion reaction with bamlanivimab and etesevimab in a 5-year-old male with coronavirus disease 2019: a case report

BACKGROUND

Bamlanivimab and etesevimab had been granted emergency use authorization in children under 12 years who are at risk of progression from mild/moderate coronavirus disease 2019 to severe disease and hospitalization.

CASE REPORT

We report on a 5-year-old white male with preexisting conditions, predisposing him to severe disease, who developed hypoxia and flushing 3 minutes into his infusion, thus meeting the criteria for anaphylaxis.

CONCLUSIONS

We believe this patient developed either an immunoglobulin E-mediated anaphylactic or a non-immunoglobulin E-mediated anaphylactoid reaction to bamlanivimab and etesevimab, which is an important possibility to consider on administration.

Reducing Virus Transmission from Heating, Ventilation, and Air Conditioning Systems of Urban Subways

Aerosols carrying the virus inside enclosed spaces is an important mode of transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as supported by growing evidence. Urban subways are one of the most frequented enclosed spaces. The subway is a utilitarian and low-cost transit system in modern society. However, studies are yet to demonstrate patterns of viral transmission in subway heating, ventilation, and air conditioning (HVAC) systems. To fill this gap, we performed a computational investigation of the airflow (and associated aerosol transmission) in an urban subway cabin equipped with an HVAC system. We employed a transport equation for aerosol concentration, which was added to the basic buoyant solver to resolve the aerosol transmission inside the subway cabin. This was achieved by considering the thermal, turbulent, and induced ventilation flow effects. Using the probability of encountering aerosols on sampling surfaces crossing the passenger breathing zones, we detected the highest infection risk zones inside the urban subway under different settings. We proposed a novel HVAC system that can impede aerosol spread, both vertically and horizontally, inside the cabin. In the conventional model, the maximum probability of encountering aerosols from the breathing of infected individuals near the fresh-air ducts was equal to 51.2%. This decreased to 3.5% in the proposed HVAC model. Overall, using the proposed HVAC system for urban subways led to a decrease in the mean value of the probability of encountering the aerosol by approximately 84% compared with that of the conventional system.

Effect of Physical Activity and Exercise on the Level of COVID-19 Antibodies and Lifestyle-Related Factors among Vaccinated Health Science Center (HSC) Students: A Pilot Randomized Trial

A vaccine is a type of medicine that increases immunity and the number of antibodies (IgM and IgG) when injected into the body, preparing it in case of an actual viral infection. It has been shown in several studies that there is a significant relationship between physical activity and vaccination. Furthermore, it has been documented that physical activity can play a major role in reducing stress. Evidence also shows the existence of a relationship between immunity, vaccine response, and sleep duration. To investigate the effects of physical activity on the level of COVID-19 antibodies and lifestyle-related factors, Health Science Center (HSC) students who had taken the third dose of the vaccine and had no prior infection of the COVID-19 virus were investigated. To serve the purpose of this study, an anti-SARS-CoV-2 test was applied by taking a blood sample from the students. The Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) questionnaires and the Borg’s 15-point scale were given to the participants to fill out. The study utilized a two-arm randomized control research design in which 40 participants were randomly assigned into one of two groups, either the control group (n = 20) or the treatment group (n = 20). All tests and assessments were performed before and after intervention for both groups. The control group walked less than 5000 steps every day for one month with a 20 min rest during the exercise session, while the treatment group walked more than 12,000 steps every day for the same time and exercise task session. The students’ steps were monitored using an Apple watch. There was a significant decrease in the IgG antibody level in the treatment group compared to the control group (p < 0.001). The IgM antibody level of all groups did not show any significant difference before starting the intervention. However, there was a significant (p < 0.05) decrease in the IgM level of the treatment group after treatment compared to before treatment. Moreover, there was a significant decrease in the treatment group’s stress level and sleep disruption, indicating better sleep quality, compared to the control group (p < 0.035). The levels of IgG and IgM did not improve for the treatment group. However, the treatment group improved their stress level and sleep disruption. Therefore, further rigorous research is needed to investigate vaccine efficacy among more physically active people.

Evaluation of Nutritional Status and Anxiety Levels in Patients Applying to the Radiation Oncology Outpatient Clinic during the COVID-19 Pandemic: Turkish Society for Radiation Oncology Group Study (TROD 12:02)

Cancer patients often face malnutrition, which negatively affects their response to cancer treatment. This study aims to analyze the effects of the COVID-19 pandemic on nutritional status and anxiety in cancer patients with different types and stages of cancer. This is a cross-sectional cohort study that includes 1,252 patients with varying cancer types from 17 radiation oncology centers. The nutritional risk scores (NRS-2002) and coronavirus anxiety scale (CAS) scores of all patients were measured. NRS-2002 ≥ 3 and CAS ≥ 5 were accepted as values at risk. Of all patients, 15.3% had NRS-2002 ≥ 3. Breast cancer was the most prevalent cancer type (24.5%) with the lowest risk of nutrition (4.9%, p < 0.001). Nutritional risk was significantly higher in patients with gastrointestinal cancer, head and neck cancer, and lung cancer (p < 0.005) and in patients with stage IV disease (p < 0.001). High anxiety levels (CAS ≥ 5) were significantly related to voluntary avoidance and clinical postponement of hospital visits due to the pandemic (p < 0.001), while clinical postponement was particularly frequent among patients with NRS-2002 < 3 (p = 0.0021). Fear and anxiety in cancer patients with COVID-19 cause hesitations in visiting hospitals, leading to disrupted primary and nutritional treatments. Thus, nutritional monitoring and treatment monitoring of cancer patients are crucial during and after radiotherapy.

Clinical Characteristics and Outcomes of COVID-19 in 1294 New Cancer Patients: Single-Center, Prospective Cohort Study from Iran

OBJECTIVE

To determine the clinical characteristics and outcomes of COVID-19 in a large cohort of new cancer patients referred to an oncology clinic in the north of Iran.

METHODS

During the 20-month COVID-19 pandemic, new cancer patients were followed-up. Demographic, pathologic, and clinical variables were collected for each patient. COVID-19 was confirmed based on a positive polymerase chain reaction test. Analyses were performed using the STATA version 14.0 at a significance level of 0.05.

RESULTS

In this study, 1294 new cancer patients were followed for 24 months (mean age: 58.7 years [range 10-95]). During the study period, COVID-19 was diagnosed in 9.4% of the patients with hospitalization rate of 3.4%, an ICU admission rate of 0.7%, and COVID-19 mortality rate of 4.9%. Hematological malignancies (ORU= 2.6, CI95% 1.28-5.34), receiving palliative treatments (ORA=3.03, CI95% 1.6-5.45) and receiving radiotherapy (ORA=2.07, 1.17-3.65) were the most common predictive factors of COVID infection in cancer patients. Also, the COVID mortality was higher in brain cancer patients (p = 0.07), metastatic disease (p = 0.01) and patients receiving palliative treatments (p = 0.02).

CONCLUSION

In patients suffering from cancer, COVID-19 infection can be predicted by cancer type, palliative care, and radiotherapy in cancer patients. Furthermore, brain cancers, metastasis, and palliative care were all associated with COVID-19-related mortality.

The asymmetric nexus between air pollution and COVID-19: Evidence from a non-linear panel autoregressive distributed lag model

The emergence of a new coronavirus (COVID-19) has become a major global concern that has damaged human health and disturbing environmental quality. Some researchers have identified a positive relationship between air pollution (fine particulate matter PM2.5) and COVID-19. Nonetheless, no inclusive investigation has comprehensively examined this relationship for a tropical climate such as India. This study aims to address this knowledge gap by investigating the nexus between air pollution and COVID-19 in the ten most affected Indian states using daily observations from 9th March to September 20, 2020. The study has used the newly developed Hidden Panel Cointegration test and Nonlinear Panel Autoregressive Distributed Lag (NPARDL) model for asymmetric analysis. Empirical results illustrate an asymmetric relationship between PM2.5 and COVID-19 cases. More precisely, a 1% change in the positive shocks of PM2.5 increases the COVID-19 cases by 0.439%. Besides, the estimates of individual states expose the heterogeneous effects of PM2.5 on COVID-19. The asymmetric causality test of Hatemi-J's (2011) also suggests that the positive shocks on PM2.5 Granger-cause positive shocks on COVID19 cases. Research findings indicate that air pollution is the root cause of this outbreak; thus, the government should recognize this channel and implement robust policy guidelines to control the spread of environmental pollution.

Tailored treatment strategies for cancer patients during COVID-19 pandemic

The global pandemic of respiratory disease caused by the novel human coronavirus (SARS-CoV-2) has caused indefinite global distress, uncertainty, and disturbance. This pandemic has had direct and indirect impacts for the healthcare systems across the world, but certain subgroups of patients have been particularly affected. Among these groups are patients with cancer, who as a result of their immunosuppressed status either from the disease itself or as a consequence of treatment, are at increased risk of severe COVID-19 infection and complications. The pandemic has also led to limited resources as medical services have been primarily directed to emergency care. In this context, physicians and healthcare providers have had to balance the importance of continuing treatment of cancer patients with the risk of virus infection. In this review, we outline the treatment strategies for cancer patients during this pandemic, focusing on tailored treatment in this challenging situation of varying risks and benefits.

An epidemiological, strategic and response analysis of the COVID-19 pandemic in South Asia: a population-based observational study

INTRODUCTION

South Asia has had a dynamic response to the ongoing COVID-19 pandemic. The overall burden and response have remained comparable across highly-burdened countries within the South Asian Region.

METHODOLOGY

Using a population-based observational design, all eight South Asian countries were analyzed using a step-wise approach. Data were obtained from government websites and publicly-available repositories for population dynamics and key variables.

RESULTS

South Asian countries have a younger average age of their population. Inequitable distribution of resources centered in urban metropolitan cities within South Asia is present. Certain densely populated regions in these countries have better testing and healthcare facilities that correlate with lower COVID-19 incidence per million populations. Trends of urban-rural disparities are unclear given the lack of clear reporting of the gaps within these regions. COVID-19 vaccination lag has become apparent in South Asian countries, with the expected time to complete the campaign being unfeasible as the COVID-19 pandemic progresses.

CONCLUSION

With a redesigning of governance policies on preventing the rise of COVID-19 promptly, the relief on the healthcare system and healthcare workers will allow for adequate time to roll out vaccination campaigns with equitable distribution. Capacity expansion of public health within the Region is required to ensure a robust healthcare response to the ongoing pandemic and future infectious disease outbreaks.

COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center

BACKGROUND

The COVID-19 pandemic started a little later in Ethiopia than the rest of the world and most of the initial cases were reported to have a milder disease course and a favorable outcome. This changed as the disease spread into the population and the more vulnerable began to develop severe disease. Understanding the risk factors for severe disease in Ethiopia was needed to provide optimal health care services in a resource limited setting.

OBJECTIVE

The study assessed COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia for characteristics associated with COVID-19 disease severity.

METHODS

A cross-sectional study was conducted from June to August 2020 among 686 randomly selected patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild vs Moderate vs Severe). A multinomial logistic regression model was used to identify factors associated with COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for significance testing.

RESULTS

Having moderate as compared with mild disease was significantly associated with having hypertension (AOR = 2.30, 95%CI = 1.27,4.18), diabetes mellitus (AOR = 2.61, 95%CI = 1.31,5.19for diabetes mellitus), fever (AOR = 6.12, 95%CI = 2.94,12.72) and headache (AOR = 2.69, 95%CI = 1.39,5.22). Similarly, having severe disease as compared with mild disease was associated with age group (AOR = 4.43, 95%CI = 2.49,7.85 for 40-59 years and AOR = 18.07, 95%CI = 9.29,35.14for ≥ 60 years), sex (AOR = 1.84, 95%CI = 1.12,3.03), hypertension (AOR = 1.97, 95%CI = 1.08,3.59), diabetes mellitus (AOR = 3.93, 95%CI = 1.96,7.85), fever (AOR = 13.22, 95%CI = 6.11, 28.60) and headache (AOR = 4.82, 95%CI = 2.32, 9.98). In addition, risk factors of severe disease as compared with moderate disease were found to be significantly associated with age group (AOR = 4.87, 95%CI = 2.85, 8.32 for 40-59 years and AOR = 18.91, 95%CI = 9.84,36.331 for ≥ 60 years), fever (AOR = 2.16, 95%CI = 1.29,3.63) and headache (AOR = 1.79, 95%CI = 1.03, 3.11).

CONCLUSIONS

Significant factors associated with severe COVID-19 in Ethiopia are being older than 60 years old, male, a diagnosis of hypertension, diabetes mellitus, and the presence of fever and headache. This is consistent with severity indicators identified by WHO and suggests the initial finding of milder disease in Ethiopia may have been because the first people to get COVID-19 in the country were the relatively younger with fewer health problems.

A Proactive Approach to Identify the Exposure Risk to COVID-19: Validation of the Pandemic Risk Exposure Measurement (PREM) Model Using Real-World Data

Purpose

To statistically validate the PREM (Pandemic Risk Exposure Measurement) model devised in a previous paper by the authors and determine the model’s relationship with the level of current COVID-19 cases (NLCC) and the level of current deaths related to COVID-19 (NLCD) based on the real country data.

Methods

We used perceived variables proposed in a previous study by the same lead authors and applied the latest available real data values for 154 countries. Two endogenous real data variables (NLCC) and (NLCD) were added. Data were transformed to measurable values using a Likert scale of 1 to 5. The resulting data for each variable were entered into SPSS (Statistical Package for the Social Sciences) version 26 and Amos (Analysis of a Moment Structures) version 21 and subjected to statistical analysis, specifically exploratory factor analysis, Cronbach’s alpha and confirmatory factor analysis.

Results

The results obtained confirmed a 4-factor structure and that the PREM model using real data is statistically reliable and valid. However, the variable Q14 – hospital beds available per capita (1000 inhabitants) had to be excluded from the analysis because it loaded under more than one factor and the difference between the factor common variance was less than 0.10. Moreover, its Factor 1 and Factor 3 with NLCC and Factor 1 with NLCD showed a statistically significant relationship.

Conclusion

Therefore, the developed PREM model moves from a perception-based model to reality. By proposing a model that allows governments and policymakers to take a proactive approach, the negative impact of a pandemic on the functioning of a country can be reduced. The PREM model is useful for decision-makers to know what factors make the country more vulnerable to a pandemic and, if possible, to manage or set tolerances as part of a preventive measure.

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Haemodialysed patient with lung cancer in the COVID-19 era: a clinical challenge

A 66-year-old man was referred to the oncological pneumology consultation due to a mass in the right upper lobe observed in a routine X-ray of the chest. The CT scan confirmed a mass in the same location. The biopsy revealed a lung adenocarcinoma. It was decided to start chemotherapy adapted to kidney function. In April 2020, the patient contracted SARS-CoV-2 infection and developed bilateral pneumonia with partial respiratory failure. He was transferred to the intensive care unit, where he had a positive evolution. In the next 5 months, there was a clinical improvement; however, the CT scan of the chest showed disease progression. After a new multidisciplinary approach, it was decided to start a second line with atezolizumab. After four cycles of atezolizumab, there was a clear clinical improvement, and a reduction by more than 50% in the tumour size, without significant adverse effects.

Efficacy and toxicity hypofractionated radiotherapy for centrally located non-small cell lung cancer

Aim:

Centrally located early-stage non-small cell lung cancer in patients who are unfit for surgery are treated with fractionated radiotherapy. We present the outcomes of a moderately hypofractionated accelerated dose regimen of 50 Gy in 15 fractions from a single centre in the UK.

Materials and methods:

Electronic case notes and radiotherapy records of lung cancer patients treated between January 2014 and December 2016 were retrospectively reviewed. Adult Comorbidity Evaluation-27 score was used to evaluate comorbidities. Mean lung doses and percentage of lung receiving more than 20 Gy were calculated for all patients. Survival outcomes were estimated using Kaplan–Meier curves.

Results:

Fifty-three patients were included in the study; the median follow-up was 20.2 months. 87% of patients had stage I disease. There was no 30-day post-treatment mortality. Ninety-day mortality rate after radiotherapy was 3.8%. Grade 2 pneumonitis was seen in five patients while no grade 3 or 4 pneumonitis was observed. The median progression-free survival (PFS) and overall survival (OS) were 18.5 months and 28.2 months, respectively. The estimated 1 and 2 years PFS were 62.3% and 41.3%, respectively, and OS were 77.4% and 56.6%, respectively. Worsening performance status was associated with worse survival on cox regression analysis. Disease relapsed in 36% of patients. 7.5% of patients with relapsed disease had infield recurrence.

Findings:

50 Gy in 15 fractions radiotherapy for central early-stage lung cancer is a feasible choice that requires further randomised trials.

Cancer and Coronavirus Disease (COVID-19): Comorbidity, Mechanical Ventilation, and Death Risk

BACKGROUND

The presence of comorbidity poses a major clinical challenge in the care and treatment of COVID-19 patients. Moreover, having one or more comorbidities could be a life-threatening situation in COVID-19 patients. Cancer is substantially associated with significant morbidity and mortality in COVID-19 patients. However, there is not sufficient data to conclude that cancer patients have a higher risk of COVID-19 infection. In this study, we reviewed cancer comorbidity and risk of mechanical ventilation or death in patients with confirmed COVID-19.

METHODS

A comprehensive systematic search was performed on PubMed, Scopus, Web of Science, SciELO, and CNKI, to find articles published until August 01, 2020. All relevant case series, case reports, systematic and narrative reviews, meta-analyses, and prospective and retrospective studies that reported clinical characteristics and epidemiological information of cancer patients infected with COVID-19 were included in the study.

RESULTS

A total of 12 cohort studies exclusively on cancer patients with confirmed COVID-19 were selected.

CONCLUSIONS

According to the findings of this study, cancer was not among the most prevalent underlying diseases in patients with confirmed COVID-19. Moreover, cancer patients infected with COVID-19 had the lowest risk of mechanical ventilation or death than the non-cancer infected patients.

Review on the Oncology Practice in the Midst of COVID-19 Crisis: The Challenges and Solutions

As of late 2019, the outbreak of novel coronavirus disease (COVID-19) -that started in China- has rapidly afflicted all over the world. The COVID-19 pandemic has challenged health-care facilities to provide optimal care. In this context, cancer care requires special attention because of its peculiar status by including patients who are commonly immunocompromised and treatments that are often highly toxic. In this review article, we have classified the main impacts of the COVID-19 pandemic on oncology practices -followed by their solutions- into ten categories, including impacts on (1) health care providers, (2) medical equipment, (3) access to medications, (4) treatment approaches, (5) patients' referral, (6) patients' accommodation, (7) patients' psychological health, (8) cancer research, (9) tumor board meetings, and (10) economic income of cancer centers. The effective identification and management of all these challenges will improve the standards of cancer care over the viral pandemic and can be a practical paradigm for possible future crises.
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Decision on Chemotherapy Amidst COVID-19 Pandemic: a Review and a Practical Approach from Iran

To provide a step-by-step approach to chemotherapy (CTx) in the novel coronavirus disease 2019 (COVID-19) era. The COVID-19 pandemic is the current global issue resulting in vast health implications. Amid the COVID-19 era, special attention must be paid to at-risk groups, including patients with cancer. To our knowledge, there is a paucity of data on the decision for CTx during the pandemic. We herein provide practical recommendations on the CTx of cancer patients over the pandemic based on our experience in an educational hospital. The decision on CTx should be considered to be individualized based on clinical findings. We hope that our experience provides a practical guide for clinical oncologists to deliver more effective cancer care over the COVID-19 pandemic.