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Wall J, Gadsby‐Davis K, Mistry K, Levell NJ, Venables ZC. Impact of the COVID-19 pandemic on international cutaneous squamous cell carcinoma incidence: A systematic review and meta-analysis. SKIN HEALTH AND DISEASE 2024; 4:e405. [PMID: 39104659 PMCID: PMC11297431 DOI: 10.1002/ski2.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 08/07/2024]
Abstract
Background Non-melanoma skin cancer (NMSC) is the most common cancer globally in white ethinicity populations, and cutaneous squamous cell carcinoma (cSCC) is the second most common subtype. The COVID-19 pandemic severely impacted public and private healthcare systems. Many studies have reported reduced cancer diagnoses during the pandemic. The impact of the COVID-19 pandemic on global cSCC and NMSC incidence is poorly reported. Objectives The aim was to conduct a systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on global cSCC and NMSC incidence rates, compared with 2019 incidence rates. Two primary outcome measures were used: crude incidence rate ratios (CIRR) and age-standardised incidence rate ratios (ASIRR). Methods A structured search was undertaken on 23 March 2023 using grey literature and four electronic databases: MEDLINE, CINAHL, EMBASE and Web of Science. Studies published before January 2020 were excluded. A quality assessment was undertaken using A. Lomas quality assessment tool. CIRR outcomes were synthesised in a meta-analysis, while ASIRR outcomes were narratively synthesised. Results Fourteen cancer registries were included, capturing data from 13 countries across Europe. Variation was observed in NMSC and cSCC incidence across the cancer registries. Pooled cSCC crude incidence rates in 2020 were equal to crude incidence rates in 2019 (cSCC-CIRR 1.00 (95% confidence interval (CI) 0.94-1.06). In 2021, the pooled result indicated a non-significant 8% increase in cSCC crude incidence rates, compared with 2019 (cSCC-CIRR 1.08 (95% CI 0.98-1.19). Significant reductions were reported in NMSC incidence across all meta-analyses in 2020 and 2021 compared with 2019. Heterogeneity was observed across most pooled estimates (I 2>75%). Conclusion There was a lack of high quality data on cSCC incidence rates recorded during the pandemic outside of Europe. The COVID-19 pandemic resulted in no significant changes in cSCC incidence across Europe. By contrast, NMSC incidence fell across Europe following the pandemic. Significant reductions in pooled NMSC incidence rates may reflect a delay in basal cell carcinoma presentation, diagnosis and treatment. Although annual incidence rates for cSCC were not affected by the pandemic, delays in treatment may still have occurred, which may result in poorer outcomes yet to be fully understood.
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Affiliation(s)
- James Wall
- University of East AngliaNorwich Medical SchoolNorwichUK
| | | | - Khaylen Mistry
- University of East AngliaNorwich Medical SchoolNorwichUK
- DermatologyNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
| | - Nick J. Levell
- University of East AngliaNorwich Medical SchoolNorwichUK
- DermatologyNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
| | - Zoe C. Venables
- University of East AngliaNorwich Medical SchoolNorwichUK
- DermatologyNorfolk and Norwich University Hospitals NHS Foundation TrustNorwichUK
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2
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Price S, Bailey S, Hamilton W, Jones D, Mounce L, Abel G. The effects of the first UK lockdown for the COVID-19 pandemic on primary-care-recorded cancer and type-2 diabetes mellitus records: A population-based quasi-experimental time series study. Cancer Epidemiol 2024; 91:102605. [PMID: 38959588 DOI: 10.1016/j.canep.2024.102605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND COVID-19 disrupted consulting behaviour, healthcare delivery and cancer diagnostic services. This study quantifies the cancer incidence coded in UK general practice electronic health records and deviations from historical trends after the March 2020 national lockdown. For comparison, we study the coded incidence of type-2 diabetes mellitus, which is diagnosed almost entirely within primary care. METHODS Poisson interrupted time series models investigated the coded incidence of diagnoses in adults aged ≥ 18 years in the Clinical Practice Research Datalink before (01/03/2017-29/02/2020) and after (01/03/2020-28/02/2022) the first lockdown. Datasets were stratified by age, sex, and general practice per 28-day aggregation period. Models captured incidence changes associated with lockdown, both immediately and over time based on historical trends. RESULTS We studied 189,457 incident cancer and 191,915 incident diabetes records in 1480 general practices over 52,374,197 person-years at risk. During 01/03/2020-28/02/2022, there were fewer incident records of cancer (n = 22,199, 10.49 %, 10.44-10.53 %) and diabetes (n = 15,709, 7.57 %, 7.53-7.61 %) than expected. Within cancers, impacts ranged from no effect (e.g. unknown primary, pancreas, and ovary), to small effects for lung (n = 773, 3.11 %, 3.09-3.13 % fewer records) and female breast (n = 2686, 6.77 %, 6.73-6.81 %), to the greatest effect for bladder (n = 2874, 31.15 %, 31.00-31.31 %). Diabetes and cancer records recovered maximally to 86 % (95 %CI 80.3-92.7 %) and 74 % (95 %CI 70.3-78.6 %) in July 2021 and May 2021, respectively, of their expected values, declining again until the study end. CONCLUSION The "missing" cancer and diabetes diagnoses in primary care may comprise delayed or missed diagnoses, reduced incidence associated with excess deaths from COVID-19, and potentially increased non-coded recording of diagnoses. Future validation studies must quantify the concordance between primary care and National Cancer Registration Data and Hospital Episode Statistics over the pandemic era.
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Affiliation(s)
- Sarah Price
- Smeall Building, University of Exeter Medical School, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.
| | - Sarah Bailey
- Smeall Building, University of Exeter Medical School, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.
| | - Willie Hamilton
- Smeall Building, University of Exeter Medical School, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.
| | - Dan Jones
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Luke Mounce
- Smeall Building, University of Exeter Medical School, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.
| | - Gary Abel
- Smeall Building, University of Exeter Medical School, University of Exeter, Heavitree Road, Exeter EX1 2LU, UK.
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Shanmugam R, Fulton L, Kruse CS, Beauvais B, Betancourt J, Pacheco G, Pradhan R, Sen K, Ramamonjiarivelo Z, Sharma A. The effect of COVID-19 on cancer incidences in the U.S. Heliyon 2024; 10:e28804. [PMID: 38601551 PMCID: PMC11004761 DOI: 10.1016/j.heliyon.2024.e28804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Fundamental data analysis assists in the evaluation of critical questions to discern essential facts and elicit formerly invisible evidence. In this article, we provide clarity into a subtle phenomenon observed in cancer incidences throughout the time of the COVID-19 pandemic. We analyzed the cancer incidence data from the American Cancer Society [1]. We partitioned the data into three groups: the pre-COVID-19 years (2017, 2018), during the COVID-19 years (2019, 2020, 2021), and the post-COVID-19 years (2022, 2023). In a novel manner, we applied principal components analysis (PCA), computed the angles between the cancer incidence vectors, and then added lognormal probability concepts in our analysis. Our analytic results revealed that the cancer incidences shifted within each era (pre, during, and post), with a meaningful change in the cancer incidences occurring in 2020, the peak of the COVID-19 era. We defined, computed, and interpreted the exceedance probability for a cancer type to have 1000 incidences in a future year among the breast, cervical, colorectal, uterine corpus, leukemia, lung & bronchus, melanoma, Hodgkin's lymphoma, prostate, and urinary cancers. We also defined, estimated, and illustrated indices for other cancer diagnoses from the vantage point of breast cancer in pre, during, and post-COVID-19 eras. The angle vectors post the COVID-19 were 72% less than pre-pandemic and 28% less than during the pandemic. The movement of cancer vectors was dynamic between these eras, and movement greatly differed by type of cancer. A trend chart of cervical cancer showed statistical anomalies in the years 2019 and 2021. Based on our findings, a few future research directions are pointed out.
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Affiliation(s)
- Ramalingam Shanmugam
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Larry Fulton
- Boston College, Woods College of Advancing Studies, St. Mary's Hall South, Chestnut Hill, MA, 02467, USA
| | - C. Scott Kruse
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Brad Beauvais
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Jose Betancourt
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Gerardo Pacheco
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Rohit Pradhan
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Keya Sen
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Zo Ramamonjiarivelo
- Texas State University, School of Health Administration, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX, 78666, USA
| | - Arvind Sharma
- Boston College, Woods College of Advancing Studies, St. Mary's Hall South, Chestnut Hill, MA, 02467, USA
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Price G, Peek N, Eleftheriou I, Spencer K, Paley L, Hogenboom J, van Soest J, Dekker A, van Herk M, Faivre-Finn C. An Overview of Real-World Data Infrastructure for Cancer Research. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00108-0. [PMID: 38631976 DOI: 10.1016/j.clon.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
AIMS There is increasing interest in the opportunities offered by Real World Data (RWD) to provide evidence where clinical trial data does not exist, but access to appropriate data sources is frequently cited as a barrier to RWD research. This paper discusses current RWD resources and how they can be accessed for cancer research. MATERIALS AND METHODS There has been significant progress on facilitating RWD access in the last few years across a range of scales, from local hospital research databases, through regional care records and national repositories, to the impact of federated learning approaches on internationally collaborative studies. We use a series of case studies, principally from the UK, to illustrate how RWD can be accessed for research and healthcare improvement at each of these scales. RESULTS For each example we discuss infrastructure and governance requirements with the aim of encouraging further work in this space that will help to fill evidence gaps in oncology. CONCLUSION There are challenges, but real-world data research across a range of scales is already a reality. Taking advantage of the current generation of data sources requires researchers to carefully define their research question and the scale at which it would be best addressed.
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Affiliation(s)
- G Price
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - N Peek
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK; The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - I Eleftheriou
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - K Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK; National Disease Registration Service, NHS England, UK
| | - L Paley
- National Disease Registration Service, NHS England, UK
| | - J Hogenboom
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J van Soest
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands; Brightlands Institute for Smart Society (BISS), Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - A Dekker
- Department of Radiation Oncology (Maastro), GROW-School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - M van Herk
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
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5
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Bowers JM, Seidenberg AB, Kemp JM. Skin Cancer Diagnosis Among People With Disabilities. Am J Prev Med 2023; 65:896-900. [PMID: 37062527 PMCID: PMC10576008 DOI: 10.1016/j.amepre.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION People with disabilities face unique challenges that may affect skin cancer prevention, diagnosis, and access to treatment. These challenges could be exacerbated by the COVID-19 pandemic. In 2022, the prevalence of self-reported skin cancer diagnoses, delayed medical care because of the coronavirus disease 2019 (COVID-19) pandemic, and skin cancer risk factors among people with disabilities were estimated. METHODS Data from the 2020 National Health Interview Survey (N=31,568 U.S. adults) were analyzed. Skin cancer diagnosis, age at the time of skin cancer diagnosis, skin cancer risk factors (e.g., sun protection), and delayed medical care because of the COVID-19 pandemic were included. Disability status was measured using the Washington Group Short Set on Functioning, which includes vision, hearing, mobility, communication, self-care, and cognitive disabilities. RESULTS Although 8.8% of U.S. adults reported having a disability, people with disabilities accounted for 14.7% of all self-reported skin cancer diagnoses, including 17.5% of melanoma diagnoses. Notably, people with disabilities were on average, older (mean age=59.8 years) than people without disabilities (mean age=46.8 years). Models that adjusted for age and other demographics revealed that people with disabilities had higher odds of delaying medical care because of the COVID-19 pandemic (OR=1.65, 95% CI=1.41, 1.94); people with disabilities reported being diagnosed with skin cancer later in life (age 61.5 vs 54.0 years; p<0.001) but had odds of reporting any skin cancer (OR=1.11, 95% CI=0.93, 1.32) or melanoma diagnosis (OR=1.33, 95% CI=0.95, 1.87) similar to those of people without disabilities. CONCLUSIONS Because of disability-related challenges, older age, and delaying medical care during the pandemic, people with disabilities may be at increased risk for inequitable skin cancer outcomes.
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Affiliation(s)
- Jennifer M Bowers
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Andrew B Seidenberg
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD; Truth Initiative Schroeder Institute, Washington, DC
| | - Jacqueline M Kemp
- Massachusetts Dermatology Associates, Beverly, MA; Department of Dermatology, Harvard Medical School, Boston, MA
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6
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Aw K, Lau R, Nessim C. Prioritizing Melanoma Surgeries to Prevent Wait Time Delays and Upstaging of Melanoma during the COVID-19 Pandemic. Curr Oncol 2023; 30:8328-8337. [PMID: 37754519 PMCID: PMC10528302 DOI: 10.3390/curroncol30090604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
Prompt diagnosis and surgical management of melanoma strongly impact prognosis. Considering the limited resources, emergency closures, and staffing shortages during the COVID-19 pandemic in Canada, our institution implemented a dedicated care pathway to prioritize cancer surgeries. We aim to assess whether this strategy was effective at preventing surgical wait time delays and upstaging of melanoma. We retrospectively collected data of patients aged ≥18 years with biopsy-proven primary melanoma who underwent wide local excision (WLE) ± sentinel lymph node biopsy (SLNB) between 1 March 2018-29 February 2020 (pre-pandemic) and 1 March 2020-22 March 2022 (pandemic). Patients with distant metastasis, recurrence, in situ disease, and unknown primary were excluded. Wait time from consult to surgery, tumour (T) and nodal (N) stage, and overall stage were collected. Results: We included 419 patients [pre-pandemic (n = 204) and pandemic (n = 215)]. Median wait time (days) [interquartile range] to surgery was 36 [22-48] pre-pandemic and 35 [24-49] during the pandemic (p = 0.888). There were no differences found in T stage (p = 0.060), N stage (p = 0.214), or overall melanoma stage (p = 0.192). We highlight the importance of streamlining melanoma surgery during a pandemic. As the need arises to meet surgical backlogs including benign surgery, dedicated cancer surgery should maintain a priority to not negatively affect cancer outcomes.
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Affiliation(s)
- Katherine Aw
- Faculty of Medicine, University of Ottawa, 541 Smyth Road, Ottawa, ON K1H 8M5, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Rebecca Lau
- Faculty of Medicine, University of Ottawa, 541 Smyth Road, Ottawa, ON K1H 8M5, Canada
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Carolyn Nessim
- The Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
- Department of General Surgery, Division of Surgical Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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Demaerel PG, Leloup A, Brochez L, Van Eycken L, Garmyn M. Impact of the COVID-19 Pandemic on the Incidence and Thickness of Cutaneous Melanoma in Belgium. Biomedicines 2023; 11:1645. [PMID: 37371740 DOI: 10.3390/biomedicines11061645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: COVID-19 had a major impact on cancer diagnostics and treatment. Delays in diagnosis of cutaneous melanoma were particularly feared, given the impact on survival and morbidity that comes with advanced stages. Moreover, its incidence in Belgium has been rapidly increasing in recent decades. This Belgian population-level study quantifies the pandemic effect on the number of melanoma diagnoses and Breslow thickness in 2020 and 2021. (2) Methods: In using an automated algorithm, the number of cutaneous melanoma diagnoses and Breslow thickness were extracted from all pathology protocols from 2017-2021 by the Belgian Cancer Registry. Monthly variations, as well as year-to-year differences, were studied. (3) Results: Annual incidence of cutaneous melanoma fell by 1% in 2020, compared to 2019, mainly due to a diagnostic deficit in March, April, and May 2020. An 8% incidence increase occurred in 2021, primarily reflecting an increase in the number of the thinnest melanomas (≤1 mm). Both the mean and median Breslow thicknesses were higher in spring 2020, resulting from an underrepresentation of thinner tumors. However, no particulars stood out on a full-year basis in either 2020 or 2021. (4) Conclusions: Considering the expected incidence increase, we estimate almost 210 melanoma diagnoses were missed in Belgium in 2020, corresponding to 6% of the expected number. This deficit occurred mainly during the first COVID-19 wave. Despite some rebound, the 2021 total was still 3% short of the expected number, leaving around 325 diagnoses remaining pending in 2020 and 2021, corresponding to a two-year deficit of 4.35%. Fortunately, mainly thin melanomas were missed, without any detectable shift toward thicker tumors later in 2020 and or 2021.
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Affiliation(s)
| | | | - Lieve Brochez
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Marjan Garmyn
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
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8
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Borg T, Eisold J, Miyanjo Y, Pappa E. The effect of COVID‐19 on surgical management of skin cancers of the head, face and neck in elderly patients. SKIN HEALTH AND DISEASE 2023; 3:e175. [PMID: 37025367 PMCID: PMC10071305 DOI: 10.1002/ski2.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 03/30/2023]
Abstract
Background The Corona Virus (COVID-19) has had a profound impact on healthcare systems worldwide, with interruptions to medical practices including the delivery of cancer treatment. Skin cancer is one of the leading causes of malignancy worldwide, with later stages of disease correlating to poorer prognosis. Immunocompromized and elderly patients represent populations that are at higher risk for adverse outcomes related to skin cancer, treatment delay and COVID-19 infection. Methodology Patients aged 65 and above who underwent surgical management of skin cancers from 31 January 2020 to 31 January 2021 were included in this study then compared with samples pre- and post-pandemic. Retrospective analysis was performed regarding: date of referral to date of surgery, skin cancer type, location of cancer, surgery performed, anaesthesia used, sutures used and outcomes. Data was compared to national guidelines. Results Five hundred and twenty skin cancers were included in this analysis, of which 340 were treated during the COVID-19 pandemic. Of the cohort treated during the pandemic, 44.2% (n = 111) received excision and direct closure, 13.1% (n = 33) underwent reconstruction by integra dermal substitute, 3.2% (n = 8) by split thickness skin graft, 6.4% (n = 16) by full thickness skin grafts and 33.1% (n = 83) by local flaps. Complete excision was achieved in 88.5% of cases (n = 301). The mean time from referral to surgery was 119 days. There were no deaths associated with COVID-19. Conclusion Safe and prompt treatment of head and neck skin cancers is achievable despite the COVID-19 pandemic. Measures to minimize infection risk include the use of teledermatology, reliable COVID-19 testing, Green Pathways and a reduction in the mean referral to surgery time.
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Affiliation(s)
| | | | - Yusuf Miyanjo
- Department of Oral and Maxillofacial SurgeryQueen's HospitalLondonUK
| | - Elena Pappa
- Department of Oral and Maxillofacial SurgeryQueen's HospitalLondonUK
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Ungureanu L, Apostu AP, Vesa ȘC, Cășeriu AE, Frățilă S, Iancu G, Bejinariu N, Munteanu M, Șenilă SC, Vasilovici A. Impact of the COVID-19 Pandemic on Melanoma Diagnosis in Romania-Data from Two University Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15129. [PMID: 36429847 PMCID: PMC9690697 DOI: 10.3390/ijerph192215129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic affected the healthcare system in our country and led non-COVID patients to postpone medical visits that were not urgent. The purpose of this study was to investigate the impact of the first year of the COVID-19 pandemic on the trends in melanoma diagnosis and to compare the pathological characteristics of melanoma patients before and during the pandemic. The number of primary cutaneous melanomas diagnosed each month between 1 March 2019 and 29 February 2020 (pre-COVID-19) and between 1 March 2020 and 28 February 2021 (COVID-19) in the North-Western Region of Romania (Cluj and Bihor counties) was determined. The pathological characteristics of melanomas diagnosed in the two intervals were compared. The number of melanoma diagnoses substantially decreased during the pandemic, with 66 (-19.3%) fewer cutaneous melanomas being diagnosed in the first year of the pandemic when compared with the previous year. The tumor thickness and mitotic rate were significantly higher in cases found during the COVID-19 pandemic. Our study suggests that COVID-19 has delayed diagnosis in patients with melanoma, leading to the detection of thicker melanomas that may increase morbidity and mortality. Further studies are needed to determine the consequences of this delay on outcomes.
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Affiliation(s)
- Loredana Ungureanu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Adina Patricia Apostu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Alexandra Elena Cășeriu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Simona Frățilă
- Faculty of Medicine and Pharmacy, University of Oradea, 410068 Oradea, Romania
- Clinical Emergency County Hospital, 410039 Oradea, Romania
| | - Gabriela Iancu
- Department of Dermatology, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 550169 Sibiu, Romania
- Clinic of Dermatology, County Emergency Hospital Sibiu, 550245 Sibiu, Romania
| | - Nona Bejinariu
- Santomar Oncodiagnostic Laboratory, 400350 Cluj-Napoca, Romania
| | - Maximilian Munteanu
- Department of Plastic and Reconstructive Surgery, “Prof Dr. I. Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Simona C. Șenilă
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Alina Vasilovici
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
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10
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Sangers TE, Wakkee M, Kramer‐Noels EC, Nijsten T, Louwman MW, Jaspars EH, Hollestein LM. Limited impact of COVID-19-related diagnostic delay on cutaneous melanoma and squamous cell carcinoma tumour characteristics: a nationwide pathology registry analysis. Br J Dermatol 2022; 187:196-202. [PMID: 35141890 PMCID: PMC9111693 DOI: 10.1111/bjd.21050] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic reduced the number of skin cancer diagnoses, potentially causing a progression to unfavourable tumour stages. OBJECTIVES To identify the impact of delayed diagnostics on primary invasive melanoma and cutaneous squamous cell carcinoma (cSCC) by comparing tumour (pT) stage, Breslow thickness and invasion depth from before to after the first and second lockdown periods. METHODS In this population-based cohort study, histopathology reports registered between 1 January 2018 and 22 July 2021 were obtained from the nationwide histopathology registry in the Netherlands. The Breslow thickness of melanomas, invasion depth of cSCCs, and pT stage for both tumour types were compared across five time periods: (i) pre-COVID, (ii) first lockdown, (iii) between first and second lockdowns, (iv) second lockdown and (v) after second lockdown. Breslow thickness was compared using an independent t-test. pT-stage groups were compared using a χ2 -test. Outcomes were corrected for multiple testing using the false discovery rate. RESULTS In total, 20 434 primary invasive melanomas and 68 832 cSCCs were included in this study. The mean primary melanoma Breslow thickness of the prepandemic era (period i) and the following time periods (ii-v) showed no significant difference. A small shift was found towards unfavourable pT stages during the first lockdown compared with the pre-COVID period: pT1 52·3% vs. 58·6%, pT2 18·9% vs. 17·8%, pT3 13·2% vs. 11·0%, pT4 9·1% vs. 7·3% (P = 0·001). No relevant changes were seen in subsequent periods. No significant change in pT stage distribution was observed between the pre-COVID (i) and COVID-affected periods (ii-v) for cSCCs. CONCLUSIONS To date, the diagnostic delay caused by COVID-19 has not resulted in relatively more unfavourable primary tumour characteristics of melanoma or cSCC. Follow-up studies in the coming years are needed to identify a potential impact on staging distribution and survival in the long term.
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Affiliation(s)
- Tobias E. Sangers
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Marlies Wakkee
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | | | - Tamar Nijsten
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | | | | | - Loes M. Hollestein
- Department of DermatologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
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11
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Micek A, Diehl K, Teuscher M, Schaarschmidt M, Sasama B, Ohletz J, Burbach G, Kiecker F, Hillen U, Harth W, Peitsch WK. Melanoma care during one year pandemic in Berlin: decreasing appointment cancellations despite increasing COVID-19 concern. J Dtsch Dermatol Ges 2022; 20:962-978. [PMID: 35665996 PMCID: PMC9348098 DOI: 10.1111/ddg.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic poses a great challenge for cancer patients. Our aim was to assess its influence on treatment and appointments of melanoma patients after one year of pandemic. METHODS Melanoma patients treated in the Vivantes Skin Cancer Centre in Berlin, Germany completed a postal survey on pandemic-related alterations in melanoma care. Impact factors on changes of appointments were examined with descriptive analyses and multivariate logistic regression. Data after one year of pandemic were compared to those after its first wave. RESULTS Among 366 participants (57.7 % males; mean age 69.2 years, response rate: 36.1 %), 38 (10.1 %) reported postponed or missed appointments, mostly on their own demand (71.1 %) due to fear of COVID-19 (52.6 %). Current treatment was associated with a lower risk of changing appointments (Odds Ratio [OR]: 0.194, p = 0.002), higher age (OR: 1.037, p = 0.039), longer disease duration (OR: 1.007, p = 0.028), and higher school degree (OR: 2.263, p = 0.043) with higher probability. Among 177 patients currently receiving therapy, only 1.7 % experienced pandemic-related treatment alterations. Concern about COVID-19 was significantly higher after one year of pandemic than after its first wave, but the number of missed appointments was lower. CONCLUSIONS Pandemic-related changes were rare in our cohort and decreased over time despite increasing concern.
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Affiliation(s)
- Aleksandra Micek
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany,Faculty of Medicine, CharitéUniversity Medicine BerlinBerlinGermany
| | - Katharina Diehl
- Mannheim Institute of Public HealthSocial and Preventive MedicineMedical Faculty MannheimHeidelberg UniversityMannheimGermany,Department of Medical InformaticsBiometry and EpidemiologyFriedrich‐Alexander‐University Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Miriam Teuscher
- Department of Dermatology and PhlebologyVivantes Klinikum im FriedrichshainBerlinGermany
| | - Marthe‐Lisa Schaarschmidt
- Department of DermatologyVenereology and AllergologyUniversity Medical Center MannheimHeidelberg UniversityMannheimGermany
| | - Bianca Sasama
- Department of Dermatology and PhlebologyVivantes Klinikum im FriedrichshainBerlinGermany
| | - Jan Ohletz
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany
| | - Guido Burbach
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany
| | - Felix Kiecker
- Department of Dermatology and VenereologyVivantes Klinikum NeuköllnBerlinGermany
| | - Uwe Hillen
- Department of Dermatology and VenereologyVivantes Klinikum NeuköllnBerlinGermany
| | - Wolfgang Harth
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany
| | - Wiebke K. Peitsch
- Department of Dermatology and PhlebologyVivantes Klinikum im FriedrichshainBerlinGermany
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12
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Micek A, Diehl K, Teuscher M, Schaarschmidt ML, Sasama B, Ohletz J, Burbach G, Kiecker F, Hillen U, Harth W, Peitsch WK. Melanomversorgung während eines Jahres Pandemie in Berlin: abnehmende Terminstornierungen trotz zunehmender Besorgnis über COVID-19. J Dtsch Dermatol Ges 2022; 20:962-979. [PMID: 35881087 PMCID: PMC9350167 DOI: 10.1111/ddg.14799_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
HINTERGRUND UND ZIELE Die COVID-19-Pandemie stellt für Krebspatienten eine große Herausforderung dar. Unser Ziel war es, ihren Einfluss auf die Behandlung und auf Arzttermine von Melanompatienten nach einem Jahr Pandemie zu untersuchen. PATIENTEN UND METHODIK Melanompatienten, die im Vivantes Hauttumorzentrum in Berlin behandelt wurden, beantworteten eine postalische Umfrage zu Pandemie-bedingten Änderungen ihrer Melanomversorgung. Einflussfaktoren auf Terminänderungen wurden mit deskriptiven Analysen und multivariater logistischer Regression untersucht. Daten nach einem Jahr Pandemie wurden mit Daten nach der ersten Welle verglichen. ERGEBNISSE Von den 366 Teilnehmern (57,7 % Männer; Durchschnittsalter 69,2 Jahre, Rücklaufquote: 36,1 %) berichteten 38 (10,1 %) über verschobene oder verpasste Arzttermine, meist auf eigenen Wunsch (71,1 %) aus Angst vor COVID-19 (52,6 %). Eine aktuelle Therapie war mit einem geringeren Risiko, Termine zu verpassen, assoziiert (Odds Ratio [OR]: 0,194, p = 0,002), höheres Alter (OR: 1,037, p = 0,039), längere Krankheitsdauer (OR: 1,007, p = 0,028) und ein höherer Schulabschluss (OR: 2,263, p = 0,043) mit höherer Wahrscheinlichkeit. Von den 177 Patienten, die aktuell eine Therapie erhielten, erfuhren nur 1,7 % Pandemie-bedingte Behandlungsänderungen. Die Besorgnis über COVID-19 war nach einem Jahr Pandemie signifikant größer als nach der ersten Welle, die Zahl der verpassten Arzttermine jedoch niedriger. SCHLUSSFOLGERUNGEN Pandemie-bedingte Änderungen waren in unserer Kohorte selten und nahmen trotz zunehmender Besorgnis mit der Zeit ab.
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Affiliation(s)
- Aleksandra Micek
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin.,Medizinische Fakultät, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Katharina Diehl
- Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim.,Institut für Medizininformatik, Biometrie und Epidemiologie, Professur für Epidemiologie und Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
| | - Miriam Teuscher
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin
| | - Marthe-Lisa Schaarschmidt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
| | - Bianca Sasama
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin
| | - Jan Ohletz
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin
| | - Guido Burbach
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin
| | - Felix Kiecker
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Wolfgang Harth
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin
| | - Wiebke K Peitsch
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin
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13
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Bowe S, Wolinska A, Murray G, Malone C, Feighery C, Roche M. The influence of the COVID-19 pandemic on Breslow thickness of tumours and provision of outpatient malignant melanoma services in an Irish dermatology centre. Clin Exp Dermatol 2022; 47:1193-1194. [PMID: 35187685 DOI: 10.1111/ced.15146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Stephanie Bowe
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Anna Wolinska
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Gregg Murray
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Ciara Malone
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Cliona Feighery
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Muireann Roche
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
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14
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Ricci F, Abeni D. Heterogeneity of reports about the impact of the COVID-19 pandemic on melanoma diagnosis. Br J Dermatol 2022; 187:135-136. [PMID: 35610054 PMCID: PMC9347993 DOI: 10.1111/bjd.21598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/27/2022]
Abstract
Linked Article:Sangers TE et al. Br J Dermatol 2022; 187:196–202.
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Affiliation(s)
- Francesco Ricci
- Melanoma Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata-IRCCS, Rome, Italy
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15
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Slotman E, Schreuder K, Nijsten T, Wakkee M, Hollestein L, Mooyaart A, Siesling S, Louwman M. The impact of the COVID‐19 pandemic on keratinocyte carcinoma in the Netherlands: trends in diagnoses and magnitude of diagnostic delays. J Eur Acad Dermatol Venereol 2022; 36:680-687. [DOI: 10.1111/jdv.17976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/22/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- E. Slotman
- Dept. Health Technology and Services Research Technical Medical Centre University of Twente Enschede
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - K. Schreuder
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - T.E.C. Nijsten
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - M. Wakkee
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - L. Hollestein
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - A. Mooyaart
- Erasmus MC Cancer Institute University Medical Center Rotterdam the Netherlands
| | - S. Siesling
- Dept. Health Technology and Services Research Technical Medical Centre University of Twente Enschede
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
| | - M.W.J. Louwman
- Dept. Research and Development Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
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16
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The incidence of melanoma during the COVID-19 pandemic in a Swedish health care region without lockdown. JAAD Int 2022; 6:82-83. [PMID: 34977816 PMCID: PMC8702400 DOI: 10.1016/j.jdin.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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17
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Nardin C, Senot L, Pernot P, Puzenat E, Aubin F, Morin L. Increase in American Joint Committee on Cancer Stage at Diagnosis for Patients with Skin Cancers after the COVID-19 Lockdown. Acta Derm Venereol 2021; 102:adv00630. [PMID: 34842933 PMCID: PMC9574687 DOI: 10.2340/actadv.v101.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
is missing (Short communication).
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Affiliation(s)
- Charlée Nardin
- Department of Dermatology, University Hospital, 3 Bd Fleming, FR-25000 Besançon.
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18
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Raza SA, Cannon D, Nuttall G, Ali FR. Exploring the implications of the first COVID-19 lockdown on patients with melanoma: a national survey. Clin Exp Dermatol 2021; 47:114-116. [PMID: 34236708 PMCID: PMC8444712 DOI: 10.1111/ced.14840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
The impact of the COVID‐19 pandemic upon care of malignant melanoma (MM) remains as yet poorly understood. We undertook a UK‐wide national survey, in conjunction with a patient support group (Melanoma UK), to explore patient perceptions of the impact of the pandemic upon treatment and outpatient care of their MM. Our findings suggest that following the onset of COVID‐19, a significant minority of treatments and appointments have been delayed, there has been a shift from face‐to‐face to virtual outpatient consultations and there may be a rise in psychological comorbidities in patients with MM. We would urge clinicians to consider mental health interventions as part of a holistic care package.
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Affiliation(s)
- S A Raza
- University of Birmingham Medical School, Birmingham, UK
| | - D Cannon
- Melanoma UK, Oldham, Greater Manchester, UK
| | - G Nuttall
- Melanoma UK, Oldham, Greater Manchester, UK
| | - F R Ali
- Melanoma UK, Oldham, Greater Manchester, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Mid Cheshire NHS Foundation Trust, Cheshire, UK
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