The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

Recent advances in the discovery of copper(II) complexes as potential anticancer drugs

This review article offers a literature search of the most active, new copper (II) anticancer complexes based on nitrogen-containing ligands, reported in the literature over the past 5 years: from the beginning of 2019, until mid-2024. In the modern world, cancer remains one of the deadliest diseases of all. Although years of the ongoing research allowed us to better understand its nature, and thus aim more precisely at specific molecular targets and pathways, many of its aspects remain unclear. Today, chemotherapy still remains at the forefront of cancer treatment. With the ever-growing struggles to overcome chemoresistance and occurrence of serious side effects, the discovery of new, more selective and active drugs is a task of an utmost importance. At the same time, copper (II)-based compounds offer a wide array of biological activities and valuable biochemical properties. This review article provides the update on the recent advances in the discovery of new potential anticancer drugs among copper (II)-based compounds in the recent five years.

Significant Alterations of Colorectal Cancer Care in the COVID-19 Pandemic With High Adherence to Quality Criteria in German Cancer Centers (CC) ‒ Data From the AIO CancerCOVID Consortium (AIO-YMO/KRK 520/ass)

BACKGROUND

Colorectal cancer (CRC) remains a leading cause of death despite notable advancements through guideline-based management. We present data on changes of CRC care during the COVID-19 pandemic in Germany.

METHODS

Retrospective data from 22 AIO CCs and an academic Institute of Pathology compared the first (fw, 03-05.2020) and second wave (sw, 11-12.2020) of the pandemic with corresponding 2019 periods. Parameters were: number of cases diagnosed, age, sex, tumor stage, surgical procedures, quality criteria of CRC care (presentation in multidisciplinary tumor boards (MTB), psychological or social consultation), number of precancerous and malignant colorectal lesions (CRL). Data points were compared as mean values with confidence intervals estimated according to Clopper and Pearson (1934). Hypothesis tests were conducted using Poisson regression models that included interaction terms (year*sex or year*age over70). Statistical significance was considered at P < .05.

RESULTS

A total of 4316 cases diagnosed (AIO CC) revealed a substantial reduction (fw -20.58%; sw -23.48%). Hypothesis test showed a significant decline in incidence due to the fw and sw of the pandemic. Quality criteria of cancer care remained stable except for trial participation. Analysis from 60,695 CRL detected a decrease in precancerous (fw: -16 %/sw: -4 %) and malignant (fw: -18 %) lesions while malignant CRL increased in the sw (+8 %). Hypothesis test revealed a significant decline only for the fw 2020 and detected age > 70 as independent risk factor in both waves.

CONCLUSION

We detected substantial alterations in cancer care during the pandemic, including detected precancerous CRL. CCs showed high resilience in quality criteria for CRC care.

Location of Death in Developed Countries: Are Hospitals a Primary Place of Death and Dying Now?

Hospitals used to be a common site of death and dying. This scoping project sought published and unpublished information on current hospital death rates in developed countries. In total, death place information was gained from 21 countries, with the hospital death rate varying considerably from 23.9% in the Netherlands to 68.3% in Japan. This major difference is discussed, as well as the problem that death place information does not appear to be routinely collected or reported on in many developed countries. Without this information, efforts to ensure high quality end-of-life (EOL) care and good deaths are hampered.

Changes in female cancer diagnostic billing rates over the COVID-19 period in the Ontario Health Insurance Plan

Background

The initial response to coronavirus disease 2019 (COVID-19) in Ontario included suspension of cancer screening programs and deferral of diagnostic procedures and many treatments. Although the short-term impact of these measures on female cancers is well documented, few studies have assessed the mid- to long-term impacts.

Objectives

To compare annual billing prevalence and incidence rates of female cancers during the COVID-19 period (2020-2022) to pre-COVID-19 levels (2015-2019).

Design

Retrospective analysis of aggregated claims data for female cancer diagnostic codes from the Ontario Health Insurance Plan (OHIP).

Methods

Linear regression analysis was used to fit pre-COVID-19 (2015-2019) data for each OHIP billing code and extrapolate counterfactual values for the years of 2020-2022. Excess billing rates were calculated as the difference between projected and actual rates for each year.

Results

In 2020, OHIP billing prevalence rates for cervical, breast, uterine, and ovarian cancers decreased relative to projected values for that year by -50.7/100k, -13.9/100k, -3.5/100k, and -3.8/100k, respectively. The reverse was observed in 2021 with rate increases of 47.8/100k, 59.1/100k, 2.5/100k, and 3.7/100k, respectively. In 2022, the excesses were further amplified, especially for cervical and breast cancers (111.2/100k and 78.67/100k, respectively). The net excess patient billing rate for 2020-2022 was largely positive for all female cancer types (108.3/100k, 123.7/100k, 5.2/100k, and 1.8/100k, respectively). Analysis of billing incidence rates showed similar trends.

Conclusion

The expected female cancer billing rate decreases in 2020 were followed by large increases in 2021 and 2022, resulting in a cumulative excess during the COVID-19 period. Further research is required to assess the nature of these changes.

Direct and indirect burden of COVID-19 on mortality in Spain (2020 to 2022)

BACKGROUND

Life expectancy in high-income countries remained lower in 2022 compared to pre-pandemic levels in 2019. This study explores the deficit of life expectancy and excess of years of life lost (YLL) in Spain from 2020 to 2022, assessing both direct effects of infectious diseases and indirect effects of other causes of death.

METHODS

Data on life expectancy and YLL from 2010 to 2022 were obtained from the Spanish Institute for Statistics (INE). Using linear regression, we estimated expected life expectancy and YLL for 2020-2022 under the assumption that pre-pandemic trends (2010-2019) had continued.

RESULTS

During the first year of the pandemic, Spanish women lost 1.10 years and men lost 1.40 years in life expectancy. By 2022, life expectancy remained lower than in 2019 for both sexes. The excess YLL was similar across 2020 (2.40 million YLL and 5.3 YLL/100 people), 2021 (2.35 million YLL, 5.1 YLL/100 people), and 2022 (2.35 million YLL, 5.0 YLL/100 people). Approximately 70% of this excess was attributable to infectious diseases (87% in 2020, 78% in 2021, and 43% in 2022). Other major contributors to excess YLL included external causes, circulatory diseases, digestive diseases, and endocrine, nutritional, and metabolic diseases, while cancer mortality did not show an excess during the pandemic period.

CONCLUSIONS

Mortality in Spain in 2022 remained elevated compared to pre-pandemic expectations. The contribution of non-infectious diseases to excess mortality increased over time.

TRIAL REGISTRATION

Not applicable.

Effects of COVID-19 pandemic on breast cancer screening: A 6-year cohort study

ObjectiveBreast cancer screening facilitates the early detection of breast cancer and can reduce mortality among women. However, during the COVID-19 pandemic, regular screening was postponed or interrupted. This study investigated the effect of the pandemic on breast cancer screening and diagnosis rates.MethodsThis single-center, retrospective cohort study enrolled women aged 40-69 years. Mammography was performed at our hospital or in outreach screening vehicles. Follow-up rate, time to follow-up, time to diagnosis, cancer detection rate (CDR), positive predictive value (PPV), and cancer staging were compared between pre-pandemic (2017-2019) and pandemic (2020-2022) periods.ResultsA similar number of participants were screened during the pandemic (N = 77,901) and pre-pandemic periods (N = 75,403). However, mobile screening significantly increased from 89.4% to 94.9% during the pandemic. Education level, rate of self-examination of breasts, and the proportion of participants with a family history of breast cancer were higher during the pandemic than in the pre-pandemic period. Time to follow-up and time to diagnosis were significantly shorter during the pandemic than in the pre-pandemic period. No significant differences were observed in PPV, CDR, cancer staging, and rate of invasive carcinoma between the two periods.ConclusionDuring the pandemic, participants were more likely to promptly return for follow-up. The use of outreach screening vehicles and increased awareness for individuals with low education levels are crucial for maintaining screening volumes in the pandemic recovery period. Outreach screening strategies may serve as an alternative in a future pandemic crisis.

Did the COVID-19 consortium recommendations impact the treatment of breast cancer during the COVID-19 pandemic?

PURPOSE

We examined the impact of the COVID-19 consortium recommendations on the surgical management of breast cancer during the first year of the pandemic.

METHODS

Patients with newly diagnosed ER + DCIS, ER- DCIS, AJCC Stage cT1-2N0-1 ER + , HER2-, HER2 + , and triple negative breast cancer were identified from the National Cancer Database from 2018 to 2021. An interrupted time series design evaluated differences in surgical delay and use of neoadjuvant chemotherapy/immunotherapy (NAC) and endocrine therapy (NET) before and after the pandemic.

RESULTS

A total of 895116 female patients were included in the study with a mean age of 61.7 years. Time to surgery decreased by an average 5.5 days from January 2020 to May 2020 for all breast cancer types, corresponding with a 62.2% decrease in breast cancer diagnoses per month from January 2020 to April 2020. The use of NET increased from 5.6 to 23.6% from January to March 2020 for patients with ER + DCIS and 8.0 to 31.1% for ER + cT1-2N0 cancer (both p < 0.01). The use of NAC for HER2 + tumors and triple negative breast cancers has been increasing since 2018 and a larger than expected increase was seen from 57.2 to 63.6% for HER2 + tumors and 55.6 to 68.7% for triple negative breast cancers (both p < 0.01). Treatment practices returned to pre-pandemic levels in June 2020.

CONCLUSION

Prior to the publication of the Consortium recommendations, time to surgery decreased while the use of NET and NAC increased, with the resumption of pre-pandemic practices by June 2020.

Prolonged time to breast cancer surgery and the risk of metastasis: an explorative simulation analysis using epidemiological data from Germany and the USA

PURPOSE

Growing breast cancer is associated with an inherent risk of metastasis. If surgical treatment of breast cancer is delayed, the prognosis worsens with increasing tumor size. This justifies the search for a safe time interval between diagnosis and surgery.

METHODS

The 2022 population-based data on incidence and the time interval to initial surgery for the United States (U.S.) and Germany are used. Tumor growth and initiation of metastases can be calculated using public data on hormone receptor status, volume doubling time, and tumor size-dependent relative survival. Our assumptions are based on an initial 19.8 mm mean tumor size. 15-year BC-specific mortality in both countries is assumed to be 19.6% without surgical delay. Volume doubling time stratified by hormone receptor status, assumed to be continuous may differ by a factor of 2.4.

RESULTS

The U.S. and Germany report 287,850/71,375 new breast cancers for the year 2022 and 2019. If tumor removal is delayed by 8 weeks, mortality rate increases by 2.25/4.79% (HR + /HR-) as estimated by our model. The currently reported mean delay in the U.S. and Germany of 33.7/26.0 days or 4.8/3.7 weeks, respectively, would lead to an estimated 4,676/918 additional BC deaths or a 1.6/1.2% rise in the 15-year BC-specific mortality rate.

CONCLUSIONS

This study offers reasonable evidence that confirmed cases of breast cancer should be prioritized and treated according to hormone receptor status and tumor size as soon as possible. Effective screening measures should be followed by timely treatment.

Exploring the changing landscape of medical imaging: insights from highly cited studies before and during the COVID-19 pandemic

OBJECTIVES

To investigate whether and how the COVID-19 pandemic has changed medical imaging trends by synthesizing the highly cited studies before and during the pandemic.

METHODS

In this cross-sectional study, we identified highly cited studies on medical imaging from the essential science indicators (ESI) database, categorizing them into two periods: before the pandemic (January 2016-December 2019) and during the pandemic (January 2020-December 2023). We conducted a global research landscape comparative analysis and utilized CiteSpace and VOSviewer software to create knowledge maps for analyzing the co-occurrences of keywords and references in this field.

RESULTS

A total of 2914 highly cited studies were included in this study, which revealed a notable 30.1% increase in medical imaging publications during the pandemic. Enhanced international cooperation has been observed, with European countries and the US leading the research efforts. Keyword analysis revealed that artificial intelligence (AI) has remained a dominant hotspot in medical imaging research before and during the pandemic. References analysis showed a shift in focus towards COVID-19-related studies, overshadowing some important areas including cancer imaging, cardiac imaging, and neuroimaging.

CONCLUSIONS

Over the past four years, the COVID-19 pandemic has led to changes in the research output, international collaborations, and hotspots within highly cited medical imaging studies. Navigating the post-COVID era, it is imperative to continue fostering international collaboration, prioritize resource allocation to refocus on overlooked research areas, and develop long-term strategic plans to prepare for and mitigate the impact of future public health crises.

KEY POINTS

Question Understanding how the COVID-19 pandemic has changed medical imaging trends and priorities, which is crucial for preparing against future public health crises, remains unclear. Findings The COVID-19 pandemic has led to increases in highly cited medical imaging studies, enhancements in international collaborations, and shifts in research hotspots. Clinical relevance This study provides a comprehensive overview of highly cited studies on medical imaging before and during the pandemic, highlighting the pivotal role of AI in the post-COVID era and emphasizing the need to refocus on potentially neglected research areas.

The long-lasting impacts of the COVID-19 pandemic on population-based cancer survival: what are the implications for data analysis?

Monitoring trends of cancer incidence, mortality and survival is vital for the planning and delivery of health services, and the evaluation of diagnostics and treatment at the population level. Furthermore, comparisons are often made between population subgroups to explore inequalities in outcomes. During the COVID-19 pandemic routine delivery of health services were severely disrupted. Resources were redeployed to COVID-19 services and patient risk of COVID-19 infection required serious consideration. Cancer screening services were paused, the availability of healthcare providers was reduced and, in some cases, patients faced difficulty in accessing optimal treatment in a timely manner. Given these major disruptions, much care should be taken when interpreting changes in cancer survival estimates during this period. The impact on cancer incidence and mortality statistics that have already been reported in some jurisdictions should drive further thought on the corresponding impact on cancer survival, and whether any differences observed are real, artificial or a combination of the two. We discuss the likely impact on key cancer metrics, the likely implications for the analysis of cancer registration data impacted by the pandemic and the implications for comparative analyses between population groups and other risk factor groups when using data spanning the pandemic period.

Maintaining health service during COVID-19: A study on regional health services

The pandemic has inevitably led to disruptions in the provision of health services for all those patients not affected by COVID-19. At the same time, we have observed differences among health services in their ability to maintain their activities in the face of shocks: while some health services were largely able to ensure core functions, other suffered delays in prevention, acute care, and rehabilitation. In this paper, we explore the effect of regional health policies in terms of governance, workforce, and health service delivery on the ability to maintain oncological services during the COVID-19 pandemic to assess the resilience of the system. The study is based on secondary data collected on the 21 Italian regional health services during the first wave of the pandemic. We discuss the theoretical and practical implications of providing health services with specific characteristics pertaining to governance, workforce, and health service delivery to support the resilience of regional health policies during a crisis or shock.

A Qualitative Descriptive Study to Assess Experiences and Care Needs of Patients With Cancer During the COVID-19 Pandemic

PURPOSE

To explore the experiences and unmet clinical needs of patients with cancer during the COVID-19 pandemic.

PARTICIPANTS & SETTING

The authors recruited patients with cancer who received cancer-directed therapy in March 2020 at a National Cancer Institute-designated comprehensive cancer center. Interviews with patients were conducted between June 2021 and January 2023.

METHODOLOGIC APPROACH

In this deductive-inductive descriptive qualitative investigation, participants completed a one-time 45-minute semistructured telephone interview via Zoom.

FINDINGS

The qualitative analysis revealed (a) a myriad of psychological stressors, (b) bolstered human connectedness, (c) disruptions to daily life, (d) clinical support and education from healthcare teams, and (e) looking ahead to postpandemic life. Participants experienced changes in health behaviors and material hardships but highlighted support from family, friends, and healthcare teams.

IMPLICATIONS FOR NURSING

The cohort of patients experienced significant distress and disruptions to their lives during the COVID-19 pandemic. Interventions implemented during an unanticipated event such as a pandemic need to be developed and tested to support patients with cancer.

COVID-19 Pandemic's Effects on Breast Cancer Screening, Staging at Diagnosis at Presentation, Oncologic Management, and Immediate Reconstruction: A Canadian Perspective

BACKGROUND

Did the COVID-19 pandemic lead to delays in breast cancer management, impacting treatment recommendations? The goal of this study was to assess the pandemic's effect on breast cancer treatment and management practices.

METHODS

This study aimed to assess the pandemic's effect on breast cancer treatment from March 2018 to February 2020 (pre-pandemic) and March 2020 to February 2022 (during the pandemic) in Canada. A retrospective cohort study at The Ottawa Hospital, Ontario, Canada, compared breast cancer patients diagnosed in the two years before and after the pandemic's onset. The study examined patient demographics, cancer stages, treatment timelines, and procedures, including neoadjuvant chemotherapy, endocrine therapy, and surgical treatment. Descriptive statistics and frequencies identified changes. The study is limited to a single institution, which may restrict generalizability. Inclusion criteria focused on female patients over 18 years with newly diagnosed breast cancer, excluding recurrent cases. Stage IV patients were included, but further details on their management are needed.

RESULTS

Breast cancer diagnoses decreased from 2577 before the pandemic to 2290 after its onset. Surgeries decreased from 1226 to 1013 (p < 0.020), while neoadjuvant endocrine therapy increased from 148 to 169, and adjuvant radiotherapy rose from 586 to 722 (p < 0.001). The study revealed a decrease in breast cancer diagnoses and surgeries during the pandemic, with a rise in non-surgical treatments.

CONCLUSIONS

These changes indicate significant shifts in breast cancer management due to the pandemic. The decrease in surgical treatments and increase in non-surgical options such as endocrine therapy and radiotherapy suggest adaptations in clinical practices to cope with the challenges posed by the pandemic. Understanding these shifts is crucial for developing strategies to mitigate the impact of future disruptions on breast cancer care and ensuring optimal patient outcomes.

Modelling the impact of the COVID-19 pandemic on cancer stage migration and excess mortality in Ireland

Background

Cancer treatment services were interrupted during the pandemic, which potentially increased the time to treatment initiation (TTI). This study aimed to model the impact of a hypothetical three- and six-month delay in TTI on stage of breast cancer and non-small cell lung cancer (NSCLC) in Ireland.

Methods

The distribution of cancer stage at diagnosis, net survival at one to five years post diagnosis, and projected cancer incidence for 2020 were obtained for breast cancer and NSCLC, from the National Cancer Registry Ireland. The primary outcome, the probability of an upward stage-shift from stage I to II and stage II to III, is presented with 95 % CIs.

Results

For breast cancer, the stage-shift probability after a hypothetical three-month and six-month delay was 0.13 (0.11, 0.15) and 0.25 (0.21, 0.27) in stage I and 0.09 (0.08, 0.11) and 0.17 (0.14, 0.21) in stage II. For NSCLC, the stage-shift probability after three-month and six-month delays was 0.51 (0.49, 0.53) and 0.76 (0.74, 0.78) in stage I and 0.27 (0.24, 0.30) and 0.47 (0.43, 0.51) in stage II.

Conclusions

The study provides potential evidence for an upward stage migration in those with breast cancer and NSCLC due to the pandemic. It is important to determine the longer-term impacts so that strategies are developed to mitigate adverse effects and improve health system preparedness for future unprecedented events.

The COVID-19 pandemic reduced delays in the care pathway for patients with glioma at a French institute

CONTEXT

Delays in cancer management have been reported during the COVID-19 pandemic. Neuro-oncology patients represent a real challenge as their disease can progress rapidly without appropriate care. However, data available for these patients over this period is scarce.

OBJECTIVE

Therefore, the aim of this study was to examine the impact of the COVID-19 pandemic on therapeutic care within a specific population at a French institute. A retrospective descriptive study was conducted using electronic medical records. All patients who underwent surgery for glioma in a neurosurgery unit between January 1st, 2019 and December 31st, 2020 were included.

RESULTS

A total of 114 patients were operated for a glioma; 70 patients in 2019 (before the pandemic) and 44 in 2020 (during the pandemic). Among these patients, 89% were diagnosed with a high-grade glioma, including 81% with glioblastoma. The mean time between first symptoms and imaging process increased from 35days in 2019 to 40days in 2020. However, in the subsequent steps of the care pathway, timelines improved at each stage with a reduction up to four days. The time reduction was statistically significant for two specific stages of care: (i) the interval between the surgery and the histomolecular diagnosis, with a reduction of two days, and (ii) the period between the histomoleculardiagnosis and the consultation for results announcement, with a reduction of three days. In summary, on average, the first treatment was initiated 49 days post-surgery in 2019 and 36days post-surgery in 2020.

CONCLUSION

This study showed that the COVID-19 outbreak positively impacted the therapeutic care pathway of patients with glioma at a French institute. Although the improvement can be measured in days, this acceleration of care was nonetheless crucial for the population studied.

Spatio-temporal epidemic forecasting using mobility data with LSTM networks and attention mechanism

The outbreak of infectious diseases can have profound impacts on socio-economic balances globally. Accurate short-term forecasting of infectious diseases is crucial for policymakers and healthcare systems. This study proposes a novel deep learning approach for short-term forecasting of infectious disease trends, using COVID-19 confirmed cases and hospitalizations in Japan as a case study. This method provides weekly updates and forecasts outcomes over 1-4 weeks. The proposed model combines long short-term memory (LSTM) networks and multi-head attention mechanism strengths and is trained on public data sourced from open-access platforms. We conduct a comprehensive and rigorous evaluation of the performance of our model. We assess its weekly predictive capabilities over a long period of time by employing multiple error metrics. Furthermore, we carefully explore how the performance of the model varies over time and across geographical locations. The results demonstrate that the proposed model outperforms baseline approaches, particularly in short-term forecasts, achieving lower error rates across multiple metrics. Additionally, the inclusion of mobility data improves the predictive accuracy of the model, especially for longer-term forecasts, by capturing spatio-temporal dynamics more effectively. The proposed model has the potential to assist in decision-making processes, help develop strategies for controlling the spread of infectious diseases, and mitigate the pandemic's impact.

Comparative inpatient care of cancer vs. non-cancer patients in Switzerland during the national COVID-19 lockdown: a nationwide interrupted time series analysis

BACKGROUND

The COVID-19 pandemic exerted unprecedented pressure on healthcare systems worldwide, leading governments and hospitals to postpone elective procedures to prioritize care for COVID-19 patients. Cancer patients, who often require frequent interactions with hospital services, may have been disproportionately affected by these disuptions in healthcare delivery. This study aimed to analyze and compare hospital care provided to cancer and non-cancer inpatients during the lockdown and post-lockdown periods in Switzerland.

METHODS

This study analyzed comprehensive adult acute care inpatient records from national administrative hospital data spanning 2017 to 2021. Using monthly patient-level data, comparative interrupted time series and difference-in-differences analysis were conducted to assess changes in hospital care between patients with and without an ICD-10 cancer diagnosis. Changes in admission volumes, hospital outcomes (length of stay, mortality), and cancer-specific treatments (chemotherapy, radiation therapy, and palliative care) during the lockdown and post-lockdown phases of the pandemic were analyzed.

RESULTS

Hospital admissions decreased substantially during the lockdown period. From March to May 2020, non-cancer patients experienced a reduction of 17'368 admissions (-18%) (95% CI [-24'333, -10'402]), compared with a reduction of 966 admissions (-9%) (95% CI [-1'636, -296]) for cancer patients. However, despite reduction in admissions, cancer inpatients received critical treatments at rates that were no lower for chemotherapy, and 6% (95% CI [1, 12]) and 15.2% (95% CI [10; 20]) higher for radiation therapy and palliative care, respectively, during the lockdown period compared to pre-pandemic levels. The mortality rate for both groups increased during the lockdown, but the rise was 22% (95% CI [8, 32]) smaller for cancer patients compared to non-cancer patients. The length of stay increased for both groups during the lockdown. However, the difference in length of stay between cancer and non-cancer patients vanished during the lockdown, with a higher length of stay of only 0.06 days (95% CI [-0.05, 0.18]) for cancer patients, compared to 0.40 days (95% CI [0.37, 0.43]) before the lockdown.

CONCLUSION

Swiss hospitals were able to maintain access to cancer services during the pandemic, mitigating the impact of the COVID-19 crisis for cancer population. These findings contribute to highlight the resilience of healthcare systems and understand decision-making processes during public health emergencies. However, long-term consequences of reduced care for cancer patients warrants further investigation.

Managing HIV-Associated Hodgkin Lymphoma During the COVID-19 Pandemic: Case Report and Literature Review

The COVID-19 pandemic delayed the consultation of many patients with specialists. We present the case of a 57-year-old patient with HIV infection, COVID-19 pneumonia, and Hodgkin lymphoma. Discordant immunohistochemistry results from biopsy samples delayed the hematological diagnosis and initiation of oncological therapy. The late diagnosis of HIV infection at the stage of severe immunosuppression, along with advanced Hodgkin lymphoma and COVID-19 co-infection, represents a complex pathogenic triad that is challenging to manage. Healthcare-associated COVID-19 infections pose a significant risk during the pandemic for chronic patients requiring frequent hospital visits.

Cancer burden in Europe: a systematic analysis of the GLOBOCAN database (2022)

BACKGROUND

Cancer remains a significant public health challenge in Europe, with substantial regional disparities in incidence, mortality, and access to healthcare. This study analyses cancer patterns across Eastern, Northern, Southern, and Western Europe in 2022, highlighting key public health implications and gaps in prevention and treatment.

METHODS

Using data from GLOBOCAN 2022, this study assessed total new cancer cases, age-standardized incidence and mortality rates (ASRs) per 100,000, and cumulative cancer risk at age 75. The top three cancers by sex and region were also analysed to identify trends and disparities.

RESULTS

In 2022, Europe recorded 4,471,422 new cancer cases (ASR 280 per 100,000), with a cumulative risk of 27.9% by age 75. Males accounted for 2,359,303 cases (ASR 319.6, cumulative risk 31.9%), while females had 2,112,119 cases (ASR 253.4, cumulative risk 24.7%). Northern and Western Europe had the highest incidence rates, with Denmark leading at 374.7 per 100,000 (cumulative risk 34.9%), likely due to advanced screening and healthcare. Conversely, Eastern Europe had the highest mortality, with 1,091,871 deaths (ASR 135.3), reflecting late diagnoses and limited access of treatment. Hungary exhibited the highest mortality rate (ASR 143.7, cumulative risk 15.8%), followed by Poland (ASR 133.1). Prostate and breast cancers were the most common in males and females, respectively. Lung cancer, despite a lower incidence (ASR 24.7), had the highest mortality (ASR 17.7), while pancreatic cancer showed high fatality (ASR 6.3, mortality ASR 5.6). Thyroid cancer had a relatively high incidence (ASR 7.5) but low mortality (ASR 0.21).

CONCLUSIONS

Significant regional disparities in cancer burden underscore the need for targeted public health strategies. Expanding cancer screening programs, strengthening smoking cessation and HPV vaccination efforts, and improving healthcare accessibility particularly in Eastern Europe are critical to reducing mortality and enhancing early detection. Differences in mortality-to-incidence ratios also highlight the role of healthcare infrastructure and timely interventions. Future research should explore the socioeconomic and environmental determinants driving these disparities to inform evidence-based cancer control policies across Europe.

COVID-19 lockdown-related treatment modifications did not impact the outcome of digestive cancers: the Clin-COVIDICA prospective study

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic modified the organization of cancer care pathways worldwide. Few prospective long-term data assessing these therapeutic modifications are available.

METHODS

Clin-COVIDICA was a prospective cohort aiming at determining the clinical impact of COVID-19-related therapeutic modifications in patients with digestive cancer in our center. All consecutive patients undergoing an oncologic treatment for a digestive cancer from March 1 to April 30, 2020, were enrolled in the cohort and followed-up for 24 months. The primary endpoint was progression-free survival (PFS). Secondary endpoints included COVID-19 rate, adverse events (AE) and overall survival (OS). Survival curves were estimated using the Kaplan-Meier method and compared by the log-rank test.

RESULTS

Of the 401 patients included, 39.6% were female, mean age was 68 years old and most frequent tumor were colorectal (50.0%) and pancreatic (17.9%) cancers. All in all, 55 patients (13.7%) have undergone therapeutic modifications. The most frequent were a switch to an oral drug (capecitabine, 30.9%), treatment holidays (29.1%) and treatment cancellation (18.2%). Considering patients with palliative treatment (n = 339), there was a non-significant trend for longer OS (52.0 months versus 36.4 months, p = 0.07) and a significant longer PFS (15.4 months versus 6.2 months, p = 0.009) in patients with therapeutic modifications. There were more all grades AEs in patients without therapeutic modifications (84.4% vs. 65.5%, p = < 0.001), but more severe AEs (grade 3-5) among patients with therapeutic modifications (18.2% versus 8.7%, p = 0.048), especially for patients with a switch to an oral drug, which resulted in 8 severe adverse events and one death. Six patients (1.5%) had a COVID-19, with one COVID-19-related death and one definitive cancellation of a curative surgery due to the consequences of COVID-19.

DISCUSSION

We observed no negative survival impact of therapeutic modifications due to the COVID-19 pandemic in digestive cancer management. This may be due to the selection of patients with less aggressive disease. More severe AEs were observed upon therapeutic modifications, especially switching to oral capecitabine.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT04389684; date of registration (15/05/2020).

"It's a low-key thing of eugenics": Disability reproductive injustice in barriers to cervical cancer screening during the COVID-19 pandemic

Cervical cancer screening (CCS) is a critical component of preventative sexual and reproductive healthcare, yet there are disparities in access to CCS for people with disabilities. This qualitative community-engaged study uses the disability reproductive justice framework to examine how the COVID-19 pandemic impacted people with disabilities' experiences with CCS in Canada. From May 2022 to March 2023, semi-structured interviews were conducted with 40 women and gender-diverse people with physical, sensory, cognitive, and/or mental health disabilities. Results from a thematic analysis indicate that barriers to CCS before and during the COVID-19 pandemic were characterized by inaccessibility, ableism and intersecting forms of oppression, provider distrust, the deprioritization of people with disabilities' sexual and reproductive healthcare, and the disregard for disabled people's autonomy. Grounded in these findings, this article situates preventative sexual and reproductive healthcare like CCS as a disability reproductive justice concern. Amplified by the COVID-19 pandemic, barriers to CCS enacted disability reproductive injustice through everyday ableism and micro-eugenics that devalued people with disabilities. Barriers to CCS must be addressed in collaboration with disability communities. Guided by participant insights, recommendations include making preventative sexual and reproductive health services like CCS more accessible and available to people with disabilities, especially in the aftermath of public health emergencies that disproportionately impact disability communities.

"Everything has been Dramatically Changed Since The Outbreak Began": A Descriptive Qualitative Study of Cancer Care Experiences of Patients and Oncology Nurses during the COVID-19 Pandemic

Background

Cancer during the novel coronavirus disease 2019 (COVID-19) pandemic has changed, leading to challenges in the management of the two serious health conditions of cancer and COVID-19. This study was conducted to explore the experiences of cancer care among hospitalized patients with cancer and oncology nurses in the COVID-19 pandemic environment.

Materials and Methods

This descriptive qualitative study included interviews with patients with cancer and oncology nurses. Observations and field notes were recorded. In this study, we purposively recruited 11 patients and 10 oncology nurses from a tertiary referral hospital affiliated with the Tabriz University of Medical Sciences, northwest Iran. Face-to-face interviews were conducted between June and July 2021. The interviews were recorded, transcribed verbatim, open-coded, and analyzed thematically. All these steps were managed using MAXQDA 10.

Results

Three themes were generated regarding patients' and nurses' experiences of cancer care during the COVID-19 pandemic: 1) feeling scared and neglected, 2) appearance of fundamental changes in all aspects of life, and 3) facing challenges beyond routine cancer care.

Conclusions

This study demonstrates the experiences of a "vulnerable" population during the COVID-19 pandemic. Understanding the experiences of patients with cancer and frontline healthcare providers during this unprecedented time of COVID-19 can help provide guidance and support for health policymakers in evidence-informed decision-making for cancer care beyond the COVID-19 pandemic era.

Polypharmacy Prevalence Among Older Adults Based on the Survey of Health, Ageing and Retirement in Europe: An Update

Polypharmacy, a common condition among the older population, is associated with adverse outcomes, including higher mortality, falls and hospitalization rates, adverse drug reactions, drug-drug interactions, medication nonadherence, and consequently increased healthcare costs. Background/Objectives: This study aims to explore the prevalence of polypharmacy and its associated factors among older adults across 27 European countries and Israel. Methods: In this cross-sectional analysis, we used data from participants aged 65 years or older from Wave 9 of the Survey of Health, Aging, and Retirement in Europe (SHARE) database. The variables studied were classified into the following categories: sociodemographic, behavioral factors, physical functioning, physical health, mental health, and living conditions. Results: Our results showed an overall prevalence of polypharmacy of 36.2%, ranging from 25.0 to 51.8%. Slovenia, Greece, and Switzerland were the countries with the lowest prevalence, whereas Portugal, Israel, and Poland were the countries where the prevalence of polypharmacy was the highest. Polypharmacy was shown to be associated with variables from all categories. Conclusions: Polypharmacy is a highly prevalent condition in the older population. Identification of variables associated with polypharmacy, such as those identified in this study, is important to identify and monitor older groups, which are most vulnerable to polypharmacy. Interventions designed to reduce polypharmacy should consider these associations.

Telemedicine in cancer care: lessons from COVID-19 and solutions for Europe

The COVID-19 pandemic challenged healthcare delivery, especially cancer care. Telemedicine emerged as an important tool to reduce disease transmission risks, maintain continuity of care, and improve accessibility. This study explores temporary measures during the pandemic as well as challenges and facilitators for integrating telemedicine into the European healthcare landscape in five case countries, focusing on cancer care. Expert interviews were conducted in five EU countries with diverse health systems: Austria, Belgium, Denmark, Italy, and Poland. A thematic analysis was performed. Themes were further explored related to regulatory changes during COVID-19 as well as barriers and facilitators to telemedicine implementation. COVID-19 accelerated telemedicine uptake and processes (i.e. regulations, reimbursement) in all case countries. Acceptance of telemedicine increased among healthcare professionals and patients. Post-pandemic telemedicine use and acceptance declined to pre-pandemic levels in some countries and was attributed to several factors including preferences for in-person visits. Overall, persistent barriers were identified by all country experts including lack of standardized policies, data privacy concerns, technological infrastructure issues, and digital literacy gaps. Telemedicine was validated by all country experts as an important tool to enhance cancer care access and efficiency and to help maintaining continuity of cancer care during crises. Our findings highlight some overlapping barriers and suggest solutions to overcome these barriers across the selected countries. Recommendations for policymakers are listed, emphasizing the importance of telemedicine services in improving healthcare access, efficiency, and resilience. Future research should incorporate diverse population studies, patient perspectives, cost-effectiveness, and policy impacts.

Palliative care management of head and neck cancer patients amongst oral and maxillofacial surgeons: A novel national survey assessing knowledge, decision making, perceived confidence, and training in the UK

Palliative care strives to improve the quality of life of patients experiencing life-limiting conditions by providing personalised holistic care. Head and neck cancer patients may require palliation at different stages of their disease, thus timely recognition and management is vital when considering supportive care. This study assesses the awareness, perceived confidence, and knowledge of palliative care management of UK-based oral and maxillofacial surgery (OMFS) head and neck surgeons. The study comprised eight multiple-choice questions developed by five palliative care consultants via the Delphi method and distributed over three months. Alongside knowledge, perceived confidence, and exposure and training, shortfalls in palliative care management were assessed. A total of 50 eligible responses were collated from middle grade (n = 34, 68%) and consultant (n = 16, 32%) OMFS surgeons in the UK. The mean knowledge score was 3.2 out of 10, with only 28% stating they were confident with the palliative management of head and neck patients. Only 10% had had palliative care rotations during their postgraduate training and the majority (86%) felt that further palliative care training should be incorporated into the OMFS curriculum. Our findings suggest a need for focused palliative care training and education amongst UK-based OMFS surgeons. A greater understanding through curriculum integration and a collaborative multidisciplinary approach will ultimately enhance the quality of care delivered to these patients.

Analysis of lung cancer incidence, mortality trends, and smoking rates in Japan:1975-2022 with insights on the impact of COVID-19

In Japan, high-quality cancer statistics are collected through cancer registries. However, these data are rarely summarized or reported in research articles. We compiled statistical data on lung cancer in Japan including the COVID-19 pandemic. In 2019, the number of cases of lung cancer in Japan was 126,548. The age-adjusted incidence rate of lung cancer increased from 23.2/100,000 to 42.4/100,000 in males and from 7.2/100,000 to 18.3/100,000 in females between 1975 and 2019. The age-adjusted mortality rate of lung cancer in Japan increased since 2000, after which it decreased. This trend was similar in both males and females. We also investigated statistics on lung cancer worldwide (Australia, Sweden, England, and the United States [USA]). The age-adjusted incidence rate of lung cancer in the data standardized to the world population for males has increased only in Japan; for females, it has decreased only in the USA. Global age-adjusted lung cancer mortality rates have been declining in all countries. In addition, the COVID-19 pandemic has not affected the age-adjusted mortality rate of lung cancer. On the other hand, the number of individuals undergoing lung cancer screening in Japan decreased from 7.92 million in 2019 to 6.59 million in 2020. The COVID-19 pandemic may have affected individuals undergoing lung cancer screening, and its impact on lung cancer needs to be continuously monitored in the future.

Exploring perceived barriers to palliative and end of life care provision in South-West England: bringing together the perspectives of professionals, patients, and families

Introduction

Palliative and End of Life care (PEoLC) in the United Kingdom (UK) is increasingly being reported as inadequate. This is occurring amidst a wider backdrop of health and social care systems facing unprecedented pressure, particularly as they recover from the long-term impact of the COVID-19 pandemic. This study aimed to explore the barriers to PEoLC faced by those providing and receiving care in South-West England (UK). This region of the UK brings its own set of unique challenges due to its rural and coastal location, an aging population, and a historical lack of research.

Methods

An exploratory study was conducted which involved patients, families, and professionals who were providing and receiving PEoLC. A total of 13 qualitative focus groups were held with a total of 63 participants; 45 were health and care professionals and 18 were people toward the end of their life, family/carers and people who were bereaved.

Results

A range of barriers were identified for those providing and receiving PEoLC services. These were a lack of specialist palliative and EoL care resources (particularly in out-of-hours care); poor communication, collaboration and co-ordination across providers; inequalities in the access and provision of care; the impact of the COVID-19 pandemic; and a reluctance to have conversations about death and dying.

Conclusion

This study brings together the voices of patients, family, and professionals from different settings in a geographical area of the UK. Understanding their experiences and perceived barriers to care is key to being able to develop and transform care. Ultimately, there is a need for a collaborative and co-ordinated approach across both practice and research, working toward what is important to those providing, and most importantly, those receiving care at the end of their lives.

The Impact of COVID-19 Pandemic on the Diagnosis, Treatment, and Outcomes of Colorectal Cancer in Singapore

Background and Objectives: During the COVID-19 pandemic, many countries implemented lockdowns and social distancing measures, which may delay the early diagnosis of colorectal cancer (CRC). This study aims to review the impact of the pandemic on the diagnosis and treatment outcomes of CRC. Materials and Methods: Patients who underwent colonoscopy or surgery for CRC were included. The study was divided into the pre-COVID-19 (January 2019-January 2020), early COVID-19 (February-May 2020), recovery (June-December 2020), and heightened alert (January-December 2021) periods. Cox regression was used to model the waiting time to colonoscopy. Multivariable logistic regression identified associations between time periods and incidence of CRC diagnosed. The characteristics and outcomes of the surgical procedures that were performed were compared across the time periods. Results: A total of 18,662 colonoscopies and 1462 surgical procedures were performed in the study period. Compared to the pre-COVID-19 period, there was a longer time to colonoscopy during the recovery (HR: 0.91; 95% CI: 0.87, 0.94) and heightened alert periods (HR: 0.88; 95% CI 0.85, 0.91). The early COVID-19 (OR: 1.36; 95% CI: 1.04, 1.77) and recovery (OR: 1.20; 95% CI: 1.01, 1.43) periods were associated with higher odds of diagnosing CRC. Compared to the pre-COVID-19 period, there was a higher proportion of ASA 4 patients (4.3% vs. 1.3%; p < 0.001) and stage 4 CRC patients (22.2% vs. 16.9%; p = 0.001) that required surgery during the heightened alert period. Similarly, there was a higher proportion of emergency surgeries (22% vs. 13.3%; p = 0.002); diverting stomas (13.5% vs. 10.5%; p = 0.005), and Hartmann's procedures (4.4% vs. 0.4%; p = 0.001) performed during the heightened alert period. Conclusions: The pandemic was associated with a higher proportion of metastatic CRC patients requiring surgery. Healthcare policies should facilitate early cancer screening, diagnosis, and treatment to reduce cancer-related morbidity for future pandemics.

Reflecting on the impact of the COVID pandemic on patient management and its subsequent influence on long-term outcomes: a case-control study in the field of esophago-gastric cancer

BACKGROUND

The delivery of cancer services changed significantly during the COVID-19 pandemic. This study aimed to describe changes in presentations, assess the change in recommendations by the MDT during the pandemic, and describe the subsequent long-term impact of these changes on survival rates in patients with EG cancer.

METHODS

A retrospective cohort study was designed comparing three patient groups of those referred to EG MDT in the same 6-month period pre-pandemic (PP;2019) during the initial phase of the pandemic (P1;2020) and the year after the initial phase (P2;2021). The primary aim of this study was to describe and compare deviations from the standard of care across these three timeframes. Secondary outcomes included differences in the number of new cases with early and advanced oesophageal and gastric lesions, a comparison of survival rates among the groups, and an analysis of postoperative histopathology to identify any shifts in the tumour stage across the studied periods.

RESULTS

A consistent demographic profile across these periods was maintained, but with a significant decrease in patient referrals during P1 (35.25% reduction from PP to P1 and 9.5% reduction from PP to P2), quicker 'time to treatment' during P1 (130.8 days in P1 vs 162 in PP and 178.9 in P2), and notable changes in treatment modalities. Additionally, we found an increased deviation from initial curative to palliative intent in the P2 group (6.4% changed in P2 vs 2.2% in PP and 3.5% in P2) primarily driven by disease progression. A further significant observation was the emergence of more aggressive tumour characteristics, particularly in the P2 group, albeit without a statistically significant difference in two-year overall survival rates among the groups (p-value 0.31).

CONCLUSION

The COVID-19 pandemic significantly impacted oesophagogastric cancer care, with a reduction in patient referral rates during the initial pandemic phase and a subsequent increase in more advanced stage disease. Our findings from a major UK EG centre highlight accelerated treatment decision-making during the initial pandemic phase was possible and that standard of care was maintained. These insights provide valuable lessons for healthcare systems in managing cancer care during global health emergencies.

Risk factors for all-cause mortality during the COVID-19 pandemic compared with the pre-pandemic period in an adult population of Arkhangelsk, Russia

We investigated and compared mortality rates and risk factors for pre-pandemic and pandemic all-cause mortality in a population-based cohort of men and women in Arkhangelsk, Russia. A prospective cohort study enrolled 2,324 participants aged 35 to 69 years between 2015 and 2017. All participants were followed up for all-cause deaths using the mortality registry. Mortality rates per 1000 person-years were calculated for men and women in the pre-pandemic and pandemic periods. Cox regression models were used to investigate demographic, lifestyle, and health characteristics associated with increased risk of death in both periods. During the pandemic, age-standardized all-cause mortality increased in women, but minor change was observed in men. Older age, smoking, and diabetes were associated with a higher risk of all-cause death in both periods and for both sexes. In women, higher risk during the pandemic was associated with obesity, angina, elevated cystatin C levels, and a history of COVID-19. In men, asthma and elevated hs-Troponin T levels increased the risk of death during the pandemic, while elevated hs-CRP and NT-proBNP levels were associated with higher risk in both periods. Targeted preventive interventions for men and women with specific risk factors can be implemented during potential future infectious disease outbreaks.

Diagnostic Challenges of Medullary Carcinoma of the Small Intestine During the COVID-19 Pandemic

Background: Medullary carcinoma of the small intestine is an exceptionally rare subtype of gastrointestinal cancer, characterized by its solid growth pattern and lack of glandular structures, which complicate timely diagnosis. During the COVID-19 pandemic, diagnostic delays for rare cancers became increasingly common due to the prioritization of COVID-related cases and patient reluctance to seek medical attention. Methods and Result: We present the case of a 70-year-old male initially misdiagnosed with COVID-19, whose persistent symptoms led to the eventual discovery of medullary carcinoma. Imaging studies revealed focal lesions in the liver, spleen, and thickened small intestinal walls, prompting surgical resection of a 16 cm intestinal segment. Histopathological examination confirmed medullary carcinoma with lymph node and liver metastases, supported by immunohistochemistry, which showed positive markers (calretinin, pancytokeratin, cytokeratin 7) and excluded other malignancies. Conclusions: The diagnostic delay, exacerbated by the pandemic, highlights the challenges of distinguishing rare cancers from more common conditions during global health crises. This case underscores the importance of advanced diagnostic techniques, such as immunohistochemistry, for accurate identification. Maintaining robust cancer diagnostic pathways during emergencies is crucial to avoid delays in treatment. Future research should focus on improving screening methods for rare cancers and developing resilient healthcare systems to mitigate similar challenges in future crises.

Impact of the COVID-19 Pandemic on Histopathological Cancer Diagnostics in Lower Silesia: A Comparative Analysis of Prostate, Breast, and Colorectal Cancer from 2018 to 2022

BACKGROUND/OBJECTIVE

The COVID-19 pandemic significantly disrupted healthcare systems worldwide including cancer diagnostics. This study aimed to assess the impact of the pandemic on histopathological cancer diagnostics in Lower Silesia, Poland, specifically focusing on prostate, breast, and colorectal cancer cases from 2018 to 2022. The objective was to evaluate diagnostic volumes and trends before, during, and after the pandemic and to understand the effect of healthcare disruptions on cancer detection.

METHODS

Histopathological and cytological data were collected from multiple laboratories across Lower Silesia. Samples were categorized into three periods: pre-pandemic (January 2018-February 2020), pandemic (March 2020-May 2022), and post-pandemic (June-December 2022). Statistical analyses included comparisons of diagnostic volumes and positive diagnoses across these periods.

RESULTS

A significant reduction in the number of histopathological examinations occurred during the pandemic, particularly during its early phase. This decline was accompanied by a higher frequency of positive cancer diagnoses, suggesting the prioritization of high-risk cases. Post-pandemic, diagnostic activity showed partial recovery, though it remained below the pre-pandemic levels, with notable differences across cancer types.

CONCLUSIONS

The COVID-19 pandemic significantly disrupted cancer diagnostics in Lower Silesia, delaying detection and highlighting healthcare system vulnerabilities. These findings underscore the importance of resilient healthcare systems that can ensure the continuity of essential diagnostic services and address inequalities in access to care during crises.

The global impact of the COVID-19 pandemic on delays and disruptions in cancer care services: a systematic review and meta-analysis

The coronavirus disease 2019 pandemic substantially impacted the delivery of cancer services and programs. Here we reviewed and synthesized the global scale and impact of pandemic-related delays and disruptions on cancer services, including diagnosis, diagnostic procedures, screening, treatment and supportive and palliative care. Based on data from 245 articles in 46 countries, we observed declines in the number of cancer screening participation (39.0%), diagnoses (23.0%), diagnostic procedures (24.0%) and treatment (28.0%), ranging from a 15.0% decline for radiotherapy to a 35.0% decline for systemic treatment during the pandemic compared to during the prepandemic period. Medium-human development index (HDI) category countries experienced greater reductions than high- and very-high-HDI countries. Missing data from low-HDI countries emphasize the need for increased investments in cancer surveillance and research in these settings. PROSPERO registration: CRD42022301816.

Impact of the COVID-19 Pandemic on Breast Cancer Patient Care: Results From a Tertiary Care Center in Lebanon

PURPOSE

We aimed to evaluate the impact of COVID-19 on breast cancer care in terms of the stage at presentation, treatment delays, and follow-up in a tertiary care center in Lebanon.

MATERIALS AND METHODS

This retrospective study compared patients with breast cancer who presented to a tertiary care center in Lebanon before (September 2019-December 2019) and during (September 2020-December 2020) the COVID-19 pandemic. We extracted data from the electronic medical records of patients with breast cancer who had their initial presentation, were under treatment, or were on follow-up during our period of interest.

RESULTS

Of the 333 patients, 186 visited the hospital in the pre-COVID-19 period and 147 during the pandemic, showing almost a 12% reduction in the number of patients during the COVID-19 pandemic. In the pre-COVID period, more patients were presented for screening (52%); however, more symptomatic patients were presented during the pandemic (51.4%). Almost 54% had an advanced stage at presentation during the pandemic compared with 48% before the pandemic but with no statistical significance (P = .50). Significantly fewer patients came for chemotherapy in the COVID-19 period (38.1%) compared with the pre-COVID-19 period (52.2%). Fewer patients underwent surgery during the pandemic, although the difference was not statistically significant. Multivariate analysis showed that the COVID-19 pandemic was not associated with having an advanced stage at presentation (P = .24).

CONCLUSION

The management of breast cancer was not substantially affected by the COVID-19 pandemic in a sample of Lebanese patients. However, 4 months might not be sufficient to draw a solid conclusion.

Clinical outcomes of abbreviated high dose-rate brachytherapy in locally advanced cervical cancer: lessons from the COVID pandemic for high dose-rate fractionation

PURPOSE

To evaluate outcomes of cervical cancer patients treated with abbreviated high dose rate brachytherapy (HDR-BT) that used 2-implants and delivered 4-5 fractions over 7-12 days rather than 21-28 days.

MATERIALS AND METHODS

Patients with stage IB2-IVA cervical cancer, treated with external beam radiation (EBRT) ± chemotherapy followed by abbreviated MR/CT-based HDR-BT were included. The planning aim was to achieve > 70Gy equivalent doses in 2Gy (EQD210Gy) at Point A dose in patients undergoing intracavitary BT (ICBT) and > 85Gy EQD210Gy to the HRCTV in intracavitary-interstitial BT (IC-ISBT). The dose constraints to 2 cc of bladder, rectum and sigmoid were restricted to < 90Gy3, < 75Gy3 and < 75Gy EQD23Gy respectively.

RESULTS

From 2020 to 2022, 245 patients were treated with EBRT followed by MR/CT-based HDR-BT. Median OTT was 57 days. The median HRCTV volume was 35.5cc with higher HRCTV in MR than CT-based (42.3cc vs. 32.8cc). The median dose to Point-A, HRCTV-D90, B2cc, R2cc and S2cc for ICBT was 78.1, 86.2, 87, 70.2 and 70.4Gy respectively. For IC-ISBT cohort, the median dose to HRCTV-D90, B2cc, R2cc, and S2cc was 86.1, 88.6, 70 & 66.7Gy respectively. The 3-years local control, pelvic control, locoregional, disease free and overall survival was 90%, 88%, 83.7%, 75.5% and 85% respectively. Late ≥ grade III gastrointestinal and genitourinary toxicities were 7.3% and 1.6% respectively with marginally higher toxicity in CT based cohort.

CONCLUSION

Accelerated HDR-BT schedule of 2-implants 4-5 fractions is radiobiological iso-effective and clinically safe with comparable oncological outcomes and adverse events.

Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020

OBJECTIVE

Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic.

METHODS

From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening.

RESULTS

Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9).

CONCLUSION

The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.

Excess mortality and years of life lost from 2020 to 2023 in France: a cohort study of the overall impact of the COVID-19 pandemic on mortality

Introduction

Excess mortality has been frequently used worldwide for summarising the COVID-19 pandemic-related burden. Estimates for France for the years 2020-2022 vary substantially from one report to another, and the year 2023 is poorly documented. The present study assessed the level of excess mortality that occurred in France between 2020 and 2023 together with the corresponding years of life lost (YLL), in order to provide a reliable, detailed and comprehensive description of the overall impact of the pandemic.

Method

This open cohort study of the whole French population analysed the 8 451 372 death occurrences reported for the years 2010-2023. A Poisson regression model was trained with years 2010-2019 for determining the age-specific and sex-specific evolution trends of mortality before the pandemic period. These trends were then used for estimating the excess mortality during the pandemic period (years 2020-2023). The life expectancies of the persons in excess mortality were used for estimating the corresponding YLL.

Results

From 2020 to 2023, the number of excess deaths (mean (95% CI) (percentage of change versus expected mortality)) was, respectively, 49 541 (48 467; 50 616) (+8.0%), 42 667 (41 410; 43 909) (+6.9%), 53 129 (51 696; 54 551) (+8.5%), and 17 355 (15 760; 18 917) (+2.8%). Corresponding YLL were 512 753 (496 029; 529 633), 583 580 (564 137; 602 747), 663 588 (641 863; 685 723), and 312 133 (288 051; 335 929). Individuals younger than 60 years old accounted for 17% of the YLL in 2020, 26% in 2021, 32% in 2022 and 50% in 2023. Men were more affected than women by both excess mortality and YLL.

Conclusion

This study highlights the long-lasting impact of the pandemic on mortality in France, with four consecutive years of excess mortality and a growing impact on people under 60, particularly men, suggesting lasting and profound disruption to the healthcare system.

The impact of the COVID-19 pandemic on clinical practices related to colorectal cancer and colonoscopy in South Korea: a nationwide population-based study

BACKGROUND/AIMS

Despite of the coronavirus disease 2019 (COVID-19) pandemic, there is little data regarding its impact on colorectal cancer (CRC)-related clinical practice. This study aimed to assess the changes in its impact during the COVID-19 pandemic.

METHODS

This was a retrospective national population-based study using the Health Insurance Review and Assessment database from January 2019 to December 2021. The number of patients in 2020 and 2021 was compared with those in 2019 for the diagnostic and therapeutic colonoscopy, CRC-related operation, and any treatment for CRC.

RESULTS

The annual number of patients undergoing diagnostic colonoscopies decreased by 6.9% in 2020 but increased 8.1% in 2021, compared to those in 2019; number of patients undergoing therapeutic colonoscopies increased by 6.0% and 37.7% in 2020 and 2021, respectively; number of patients operated for CRC decreased by 4.2% in 2020 and increased by 2.3% in 2021. The number of patients treated for CRC decreased by 2.8% in 2020 and increased by 4.4% in 2021. Diagnostic and therapeutic colonoscopies and any CRC-related treatment decreased by 43.8%, 37.5%, and 11.3% in March 2020, during the first surge of COVID-19, but increased by 26.0%, 58.1%, and 9.5% in June 2021, respectively. CRC-related operations decreased by 24.1% in April 2020 and increased by 12.6% in August 2021.

CONCLUSIONS

Negative impact of the COVID-19 pandemic on clinical practices related to CRC completely recovered within second year. It could be considered for the development of an optimal strategy on CRC management in response to the pandemic-driven crisis.

Changes in the Percentage of Patients Treated for Cancer Before and After the SARS-CoV-2 Epidemic: A Retrospective Observational Study

Objectives

After the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) outbreak, a state of emergency was imposed to stop the spread of infection, resulting in restrictions on routine medical examinations. As a result, there has been a decline in cancer screening and detection. However, it is uncertain how many more cancer cases among routine outpatients have been detected recently.

Methods

We retrospectively identified regular outpatients with no history of cancer treatment at the Juntendo University Hospital. The difference in the percentage of these patients who initiated cancer treatment within the following year, before and after the SARS-CoV-2 pandemic was analyzed.

Results

A total of 33,417, 32,579, and 30,303 regular outpatients with no history of cancer treatment were identified for fiscal years 2018, 2019, and 2020, respectively. The percentage of these patients with new cancer treatment within the following fiscal year was 454 (1.36%) for 2018, 440 (1.35%) for 2019, and 416 (1.37%) for 2021. There was no statistically significant difference in the percentage of patients initiating cancer treatments before and after the SARS-CoV-2 pandemic (2018 vs. 2020, 2019 vs. 2020, respectively P = 0.88, 0.81) among patients who regularly visited outpatients at our hospital.

Conclusions

The SARS-CoV-2 pandemic had no effect on the percentage of regular outpatients newly treated for cancer.

Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom-Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients.

Alterations in care for children with special healthcare needs during the early COVID-19 pandemic: ethical and policy considerations

Healthcare delivery and access, both in the United States and globally, were negatively affected during the entirety of the COVID-19 pandemic. This was particularly true during the first year when countries grappled with high rates of illness and implemented non-pharmaceutical interventions such as stay-at-home orders. Among children with special healthcare needs, research from the United Kingdom (U.K.) has shown that the pandemic response uniquely impacted various aspects of their care, including decreased access to care, delays in diagnosis, and poorer chronic disease control. In response to these findings, and to begin to comprehend whether the concerning findings from the nationalized system of healthcare in the U.K. extend to the highly dissimilar United States (U.S.) healthcare context, we reviewed the literature on alterations in access to and delivery of care during the early stages of the COVID-19 pandemic for children with special healthcare needs in the U.S. We then utilize these findings to consider the ethical and policy considerations of alterations in healthcare provision during pandemics and crisis events in the U.K. and U.S. and make recommendations regarding how the needs of CSHCN should be considered during future responses.

Time From Screening to Treatment at Accredited Breast Centers in the United States

PURPOSE

The National Accreditation Program for Breast Centers (NAPBC) launched the Patient-Reported Observations for Medical Procedure Timeliness quality collaborative to assess time intervals between screening and treatment for patients with breast cancer.

METHODS

Sites submitted monthly timeliness data in calendar days from 2019 to 2021 along with their perceptions of timeliness at their centers and facility characteristics. All patients were included in the interval from screening to diagnosis, whereas only patients with cancer were included in the biopsy to treatment intervals. Institutions were compared and assessed for differences and associations with center characteristics via the Kruskal-Wallis test.

RESULTS

Three hundred seventy-three (64.5%) NAPBC-accredited breast centers enrolled, and 311 (83.3%) provided complete timeliness metrics. Two hundred nine (56%) sites did not have trainees, 154 (41.3%) sites were within 10 miles of a major city, and the median number of annual breast cancer cases was 280 (IQR, 189-366). From 2019 to 2021, the time between diagnosis and treatment was as follows: 11-12 days between screening mammogram (MGM) and diagnostic MGM, 8-9 days between diagnostic MGM and biopsy, 32-34 days between biopsy and neoadjuvant therapy, and 39-42 days between biopsy and surgery. The enrolled centers believe that these intervals should be 7, 7, 21, and 28 days, respectively. Higher annual case volume and a larger number of surgeons exclusively devoted to breast disease were significantly associated with longer time intervals.

CONCLUSION

Time from biopsy to first treatment is longer than that centers expected compared with time from screening to diagnosis. There is significant variability across NAPBC in time from screening mammogram to treatment, and some institutions will face more challenges with timely quality measures than others. Further investigation into whether these differences confer outcome differences should be pursued.

Changes in Technical Equipment and Patient Perspectives Navigating Towards Enhanced Digitalization in Breast Cancer Across Pre-COVID-19 and Early COVID-19 Eras

INTRODUCTION

The potential benefits of eHealth support in enhancing patient care, satisfaction, and cancer outcomes are well-established; however, its integration into routine care has been gradual. The emergence of the COVID-19 pandemic in 2020 dramatically affected cancer patients, imposing multifaceted challenges that impede traditional doctor-patient interactions. Consequently, there has been a surge in the adoption of eHealth for supporting oncological therapies. This study investigates the fundamental prerequisites for transitioning to a more digitally oriented routine care, focusing on the availability of appropriate technical equipment and the cultivation of a positive mindset towards eHealth among breast cancer patients.

PATIENTS AND METHODS

In 2013, 2016, and 2020, breast cancer patients participated in surveys utilizing a comprehensive paper questionnaire encompassing 29 inquiries about their health status, technical equipment, and attitudes toward digital therapy support.

RESULTS

A total of 959 patients participated in the interviews. Comparative analyses between the 2013, 2016, and 2020 surveys revealed a widespread increase in internet access and device ownership across various age groups. By 2020, 3 quarters of patients were utilizing the internet for health-related topics. Notably, there has been a considerable improvement in patients' personal attitudes towards eHealth and their expectations for future digital therapy support.

DISCUSSION

Over the seven years spanned by the surveys, there has been a substantial positive shift in the attitudes of breast cancer patients towards eHealth, accompanied by a marked improvement in their technical equipment. This study reveals that the essential prerequisites for digital therapy support now appear to be prevalent among breast cancer patients.

One-Stop-Shop Cancer Screening Clinic: Acceptability Testing

Cancer screenings aid in the early detection of cancer and can help reduce cancer-related mortality. The current model of care for cancer screening is often siloed, based on the targeted cancer site. We tested the acceptability of a new model of care, called the One-Stop-Shop Cancer Screening Clinic, that centralizes cancer screenings and offers patients the option to complete all their recommended cancer screenings within one to two visits. We administered surveys to 59 community members and 26 healthcare providers to gather feedback about the One-Stop-Shop model of care. Both community members and providers identified potential benefits (e.g., decreased patient burden, increased completion of cancer screenings) and also potential challenges (e.g., challenges with workflow and timing of care) of the model of care. The results of the study support the acceptability of the model of care. Of the community members surveyed, 89.5% said, if offered, they would be interested in participating in the One-Stop-Shop Cancer Screening Clinic. Future studies are needed to formally evaluate the impact and cost effectiveness of the One-Stop-Shop Cancer Screening Clinic.

Can we empirically derive a geographic definition of 'coastal' for use in cancer data reporting? An ecological modelling study using England's national cancer registry

Background

Reducing avoidable systematic differences in population health requires first understanding which populations are currently disadvantaged. Although the health of coastal communities in England has been of concern for some years, an operationalised definition of 'coastal' is lacking. This study aims to use national cancer statistics to define and validate a small area-level definition of 'coastal' that could be used to better report cancer-related health inequalities in England.

Methods

Information on the geography and demography of English populations at the Lower Super Output Area (LSOA) level were used to define a suite of candidate coastal variables that considered foreshore proximity, resident population location, rurality and deprivation. Adjusted linear models of LSOA-level statistics of cancer incidence, prevalence and mortality in England (2016 to 2020) were used to identify candidate coastal variable(s) that explained the greatest proportion of variation in cancer outcomes after adjustment.

Results

The candidate 'G_25_5' (LSOA's designated as 'coastal' if 25% or more of postcodes were within 5 km of the coastline) was selected as the candidate that explained the most residual variation in cancer incidence and prevalence after adjustment. This variable would assign 7377 2011 LSOAs as coastal, whose populations summed to 12.3 million people (22% of England's population, in 2016). This candidate variable was not significantly associated with cancer mortality.

Conclusions

The coastal variable that we identify can explain some of the 'coastal excess' in poor cancer outcomes. We propose that this variable is now embedded into health inequalities reporting and adopted as the working definition of 'coastal' implicated in NHS England's 'Core20PLUS5' approach for use in cancer data reporting.

Surveillance, Epidemiology, and End Results Data Show Increasing Rates of Distant-Stage Breast Cancer at Presentation in U.S. Women

Background The incidence of distant-stage (metastatic) breast cancer at initial presentation has increased significantly in U.S. women under 40 years of age, but no clear trend in older women has been reported. Purpose To investigate trends in distant-stage breast cancer incidence using the latest available Surveillance, Epidemiology, and End Results (SEER) data, including the COVID-19 pandemic years 2020 and 2021. Materials and Methods In this retrospective study of 71 million to 80 million women annually, SEER 22 stage-specific breast cancer incidence rates from January 2004 to December 2021 were analyzed using Joinpoint software to evaluate trends in distant-stage disease in U.S. women overall, by age group, and by race and ethnicity. Results Distant-stage breast cancer incidence rates at presentation increased significantly for U.S. women overall, with an annual percentage change (APC) of 1.16% (95% CI: 0.92, 1.42; P < .001) over 2004-2021. Distant-stage disease increased consistently for women aged 20-39 years (APC, 2.91%; P < .001) and for women aged 75 years or older (APC, 1.44%; P < .001). For women aged 40-74 years, the distant-stage breast cancer incidence rate increased with an APC of 2.10% over 2004-2010 (P = .002) and an APC of 2.73% over 2018-2021 (P = 0.01). The interruption of care in 2020 due to COVID-19 affected distant-stage breast cancer detection, especially for older women from racial and ethnic minority groups. The incidence of distant-stage breast cancer increased over 2004-2021 for Asian women (APC, 2.90%; P < .001), Black women (0.86%; P = .008), and Hispanic women (1.56%; P < .001) and over 2004-2019 for Native American women (3.86%; P = .04). White women showed an increase over 2004-2012 (1.68%; P = .01) but no evidence of a trend over 2012-2021. Distant-stage cancer incidence rates were 55% higher in Black women than White women. Conclusion Distant-stage breast cancer incidence rates at presentation have increased significantly in U.S. women overall; in age groups 20-39 years, 40-74 years, and 75 years or older; and in Asian, Black, Hispanic, and Native American women. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Kim and Moy in this issue.

Impact of the COVID-19 pandemic on lung cancer diagnoses and mortality: A nationwide study in France

BACKGROUND

During the first wave of the COVID-19 pandemic, a reduction in the number of newly diagnosed cases of lung cancer has been reported worldwide, often associated with a higher proportion of cases diagnosed at an advanced stage compared with previous years.

METHODS

Using the French National Hospital Database, we investigated incident lung cancer cases and their mortality during pandemic years 2020 and 2021, compared to predictions based on pre-pandemic years 2013-2019. Mortality was assessed up to 24 months following incidence date. Expected numbers of incident cases and all-cause deaths during the pandemic were estimated using Poisson regression models and survival was analyzed using Cox regressions.

RESULTS

The database included 397,092 incident lung cancer cases in total, 20 % of whom underwent thoracic surgery. During the first pandemic wave (March-June 2020), there were 12 % i.e., 1940 fewer incident lung cancer cases than the expected figure (16,325), while no significant difference was found thereafter. Survival at 6 and 24 months improved steadily from 2013 to 2019 and continued to improve during pandemic years 2020-2021. However, during the first wave, a slight excess mortality was observed compared with predictions based on pre-pandemic trends.

CONCLUSIONS

The lower incidence observed during the first wave with no catch-up in the following periods could be explained by deaths among yet undiagnosed patients, either from COVID-19 or as a result of barriers to accessing healthcare. The excess mortality observed for both operated and non-operated patients may be attributable to delayed diagnosis, as well as to COVID-19-related deaths.

The COVID-19 Pandemic's Effect on Preventive Imaging

Introduction

This study assessed the effect of the COVID-19 pandemic on preventive care imaging and potential disparities because preventive care may be perceived as nonurgent. The objective was to identify the associations between the COVID-19 pandemic and changes in preventive imaging volumes for patients in general and as affected by race and ethnicities.

Methods

The authors performed a retrospective observational study by extracting the weekly volumes of all imaging studies between January 7, 2019 and May 1, 2022 from a radiology data warehouse at a tertiary care medical center (n=92,105 preventive imaging studies and 3,493,063 total radiology imaging studies) and compared preshutdown with postshutdown periods using a 2-sample t-test. Additional comparisons stratified by race and ethnicity were performed for mammograms and bone density examinations using interrupted time series models with negative binomial error distribution to assess the immediate level change and trends over time of preventive imaging volumes after shutdown.

Results

The authors found a significant decrease in bilateral mammograms, bone density examinations, and aortic ultrasound examinations in the postshutdown period compared with those in the preshutdown period (p<0.001, p=0.003, and p=0.001, respectively). There were no significant changes in low-dose computed tomography chest examinations (p=0.46). The shutdown was associated with a significant immediate decrease in mammograms in the Hispanic and Latino group to approximately three quarters of its preshutdown level (p=0.04). For bone density examinations, postshutdown weekly volumes tripled compared with the preshutdown volumes for Hispanic or Latino patients and doubled for non-Hispanic Black patients (p<0.0001 for both). In comparison, a significant decrease was seen for Other patients (reduced to nearly a fifth of preshutdown volume) (p<0.0001).

Conclusions

There was a significant decrease in overall volume of bilateral mammograms, bone density examinations, and aortic ultrasound examinations after pandemic shutdown. For mammograms, some of this decreasing trend was already seen before shutdown (such as for patients with Other race), so the shutdown was only specifically associated with an immediate decrease in mammogram levels in the Hispanic and Latino group. For bone density examinations, the shutdown was unexpectedly associated with an increase in volumes for Hispanic or Latino patients and non-Hispanic Black patients, which was countered by a significant steep decrease in volumes only for patients of Other race. Health systems should carefully explore their preventive screening examination volumes to determine which patients should be actively engaged to assure catch up on recommended care.

Evaluation of the Relationship Between Colorectal Cancer Incidence and Colonoscopy: The Importance of Early Diagnosis

Objective The present study evaluated the relationship between the incidence of colorectal cancer and colonoscopy in Santa Catarina from 2018 to 2022.

Methods Observational study of ecological type, which includes all confirmed cases of CRC in the state of Santa Catarina from 2018 to 2022, across health macro-regions. The data were obtained from SINAN, through TABNET/DATASUS. The variables gender, age group, race, type of care, average cost per hospitalization, days of stay, deaths, and mortality rates were evaluated.

Results In the period from 2018 to 2022, there were more than 28,000 cases of CRC in the state of Santa Catarina, with the Grande Oeste region being responsible for the highest incidence throughout the studied period. The main age group is between 70 and 79 years old; As for gender, most cases are predominantly male; about race, white ethnicity is predominant; the nature of service is, for the most part, elective; the average value per hospital stay is 2,355.41; total hospital stay days are 120,924; the number of deaths is 1553 and the mortality rate is (5.44/100.00). Regarding colonoscopy, the largest number of colonoscopies performed was in Grande Florianópolis.

Conclusion There is a high incidence of CRC cases in the state of Santa Catarina. Males and those aged 70 to 79 are the most affected by CRC in Santa Catarina. The Grande Oeste region has a higher incidence of cases compared with other health macro-regions.