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Pestana RC, Lopes David BB, Pires de Camargo V, Munhoz RR, Lopes de Mello CA, González Donna ML, Haro Varas JC, Zapata ML, Cunha Martins CL, Chacon M, Schmerling R, Jesus-Garcia R. Challenges and opportunities for sarcoma care and research in Latin America: a position paper from the LACOG sarcoma group. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100671. [PMID: 38259252 PMCID: PMC10801304 DOI: 10.1016/j.lana.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
As a developing region, Latin America faces unique cancer control and prevention challenges, which are intensified when considering rare cancers, including sarcomas. Sarcomas are a group of malignancies that arise in the connective tissues of the body-such as muscle, fat, nerves, blood vessels, and bones-accounting for a diverse range of tumours that, although rare, require specialized attention. Sarcoma care and research in Latin America require a comprehensive approach that includes deeper epidemiologic knowledge, diagnostic capacity building, access to innovative treatments, increased patient advocacy, and strengthening of clinical research capacity. This article will review current challenges and opportunities for treating patients with sarcoma in Latin America and outline a pathway toward improvement for regional collaborative groups.
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Affiliation(s)
- Roberto Carmagnani Pestana
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruna Bianca Lopes David
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Oncoclínicas, Rio de Janeiro, Brazil
- Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | - Veridiana Pires de Camargo
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Beneficência Portuguesa, São Paulo, Brazil
| | - Rodrigo Ramella Munhoz
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Celso Abdon Lopes de Mello
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- AC Camargo Cancer Center, São Paulo, Brazil
| | - María Lucila González Donna
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto Nacional del Cancer Paraguay, Capiata, Paraguay
| | - Juan Carlos Haro Varas
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Maycos L. Zapata
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto de Cancerologia las Americas AUNA, Medellin, Colombia
| | - Cicero Luiz Cunha Martins
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto Nacional do Câncer, Rio de Janeiro, Brazil
- Americas Oncologia, Rio de Janeiro, Brazil
| | - Matias Chacon
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Fleming Institute, Buenos Aires, Argentina
| | - Rafael Schmerling
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Dasa Oncologia, São Paulo, Brazil
| | - Reynaldo Jesus-Garcia
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Duncan FC, Al Nasrallah N, Nephew L, Han Y, Killion A, Liu H, Al-Hader A, Sears CR. Racial disparities in staging, treatment, and mortality in non-small cell lung cancer. Transl Lung Cancer Res 2024; 13:76-94. [PMID: 38405005 PMCID: PMC10891396 DOI: 10.21037/tlcr-23-407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/12/2024] [Indexed: 02/27/2024]
Abstract
Background Black race is associated with advanced stage at diagnosis and increased mortality in non-small cell lung cancer (NSCLC). Most studies focus on race alone, without accounting for social determinants of health (SDOH). We explored the hypothesis that racial disparities in stage at diagnosis and outcomes are associated with SDOH and influence treatment decisions by patients and providers. Methods Patients with NSCLC newly diagnosed at Indiana University Simon Comprehensive Cancer Center (IUSCCC) from January 1, 2000 to May 31, 2015 were studied. Multivariable regression analyses were conducted to examine the impact of SDOH (race, gender, insurance status, and marital status) on diagnosis stage, time to treatment, receipt of and reasons for not receiving guideline concordant treatment, and 5-year overall survival (OS) based on Kaplan-Meier curves. Results A total of 3,349 subjects were included in the study, 12.2% of Black race. Those diagnosed with advanced-stage NSCLC had a significantly higher odds of being male, uninsured, and Black. Five-year OS was lower in those of Black race, male, single, uninsured, Medicare/Medicaid insurance, and advanced stage. Adjusted for multiple variables, individuals with Medicare, Medicare/Medicaid, uninsured, widowed, and advanced stage at diagnosis, were associated with significantly lower OS time. Black, single, widowed, and uninsured individuals were less likely to receive stage appropriate treatment for advanced disease. Those uninsured [odds ratio (OR): 3.876, P<0.001], Medicaid insurance (OR: 3.039, P=0.0017), and of Black race (OR: 1.779, P=0.0377) were less likely to receive curative-intent surgery for early-stage NSCLC because it was not a recommended treatment. Conclusions We found racial, gender, and socioeconomic disparities in NSCLC diagnosis stage, receipt of stage-appropriate treatment, and reasons for guideline discordance in receipt of curative intent surgery for early-stage NSCLC. While insurance type and marital status were associated with worse OS, race alone was not. This suggests racial differences in outcomes may not be associated with race alone, but rather worse SDOH disproportionately affecting Black individuals. Efforts to understand advanced diagnosis and reasons for failure to receive stage-appropriate treatment by vulnerable populations is needed to ensure equitable NSCLC care.
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Affiliation(s)
- Francesca C. Duncan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nawar Al Nasrallah
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lauren Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Han
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew Killion
- Indiana Clinical and Translational Science Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hao Liu
- Department of Biostatistics and Epidemiology, Rutgers Cancer Institute of New Jersey, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Ahmad Al-Hader
- Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Catherine R. Sears
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Pulmonary Medicine, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
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Morante Z, Ferreyra Y, Pinto JA, Valdivieso N, Castañeda C, Vidaurre T, Valencia G, Rioja P, Fuentes H, Cotrina JM, Neciosup S, Gomez HL. Subpopulation treatment effect pattern plot analysis: a prognostic model for distant recurrence-free survival to estimate delayed adjuvant chemotherapy initiation effect in triple-negative breast cancer. Front Oncol 2023; 13:1193927. [PMID: 38023174 PMCID: PMC10657890 DOI: 10.3389/fonc.2023.1193927] [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: 03/26/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Triple-negative breast cancer (TNBC) is a heterogeneous disease associated with a poor prognosis. Delaying in time to start adjuvant chemotherapy (TTC) has been related to an increased risk of distant recurrence-free survival (DRFS). We aimed to develop a prognostic model to estimate the effects of delayed TTC among TNBC risk subgroups. Materials and methods We analyzed 687 TNBC patients who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). Database was randomly divided to create a discovery set (n=344) and a validation set (n=343). Univariate and multivariate Cox regression models were performed to identify prognostic factors for DRFS. Risk stratification was implemented through two models developed based on proportional hazard ratios from significant clinicopathological characteristics. Subpopulation treatment effect pattern plot (STEPP) analysis was performed to determine the best prognostic cut-off points for stratifying TNBC subgroups according to risk scores and estimate Kaplan-Meier differences in 10-year DRFS comparing TTC (≤30 vs.>30 days). Results In univariate analysis, patients aged ≥70 years (HR=4.65; 95% CI: 2.32-9.34; p=<0.001), those at stages pT3-T4 (HR=3.28; 95% CI: 1.57-6.83; p=0.002), and pN2-N3 (HR=3.00; 95% CI: 1.90-4.76; p=<0.001) were notably associated with higher risk. STEPP analysis defined three risk subgroups for each model. Model N°01 categorized patients into low (score: 0-31), intermediate (score:32-64), and high-risk (score: 65-100) cohorts; meanwhile, Model N°02: low (score: 0-26), intermediate (score: 27-55), and high (score: 56-100). Kaplan-Meier plots showed that in the discovery set, patients with TTC>30 days experienced a 17.5% decrease in 10-year DRFS rate (95%CI=6.7-28.3), and the impact was more remarkable in patients who belong to the high-risk subgroup (53.3% decrease in 10 years-DRFS rate). Similar results were found in the validation set. Conclusions We developed two prognostic models based on age, pT, and pN to select the best one to classify TNBC. For Model N°02, delayed adjuvant chemotherapy conferred a higher risk of relapse in patients ≥70 years and who were characterized by pT3/T4 and pN2/N3. Thus, more efforts should be considered to avoid delayed TTC in TNBC patients, especially those in high-risk subgroups.
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Affiliation(s)
- Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Oncosalud, AUNA, Lima, Peru
| | - Yomali Ferreyra
- Departamento de Bioingeniería, Universidad de Ingeniería y Tecnología, Lima, Peru
| | - Joseph A. Pinto
- Centro de Investigación Básica y traslacional, Auna Ideas, Lima, Peru
| | - Natalia Valdivieso
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Carlos Castañeda
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Tatiana Vidaurre
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Guillermo Valencia
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Patricia Rioja
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Hugo Fuentes
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - José M. Cotrina
- Departamento de Cirugía en Mamas y Tejidos Blandos, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Silvia Neciosup
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Henry L. Gomez
- Oncosalud, AUNA, Lima, Peru
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima, Peru
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de Oliveira RP, de Moraes PHR, Drummond-Lage AP. Impact of the SARS-CoV-2 on the journey of high-risk colon cancer patients within the scope of the Unified Health System in Brazil. BMC Health Serv Res 2023; 23:1102. [PMID: 37845707 PMCID: PMC10580526 DOI: 10.1186/s12913-023-10083-9] [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: 03/31/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Colon cancer is an important cause of mortality related to cancer. During the COVID-19 pandemic, an important reallotment of assistance resources was necessary to tackle the crisis, directly impacting medical practice all over the globe. OBJECTIVE To assess the impact of the Sars-Cov-2 pandemic on the time between diagnosis and the beginning of systemic treatment in patients diagnosed with high-risk colon neoplasia. METHODS This is a retrospective study based on the analysis of medical records of patients diagnosed with colon neoplasia who required systemic treatment and were treated between March 2019 and March 2022, in a reference Oncology unit of the Brazilian Unified Health System. The study's population was divided into two groups: (I) Pre-COVID-19: diagnoses made between March 2019 and February 2020, (II) COVID-19: diagnoses made between March 2020 and March 2022. RESULTS The sample consisted of 228 patients, 108 (47.97%) of whom were diagnosed during pre-COVID-19 and 118 (52.21%) diagnosed during the two years-period of COVID-19. Regarding the time between colonoscopy and surgery, the time between surgery and first consultation in clinical oncology, and the time between requesting and beginning of systemic treatment, a statistically significant reduction was observed during the COVID-19 period. CONCLUSION A decrease in time between diagnosis and systemic treatment of patients with colorectal cancer during the COVID-19 pandemic was observed. Yet, even with this improvement, the time to begin treatment remains greater than the recommended by the current guidelines, regardless of the time of diagnosis (before or after the pandemic), which negatively impacts the disease outcome.
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Affiliation(s)
- Raquel Pucci de Oliveira
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Belo Horizonte, 30.130.110, Brazil
| | | | - Ana Paula Drummond-Lage
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Belo Horizonte, 30.130.110, Brazil.
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do Nascimento JHF, da Silva CN, Gusmão-Cunha A, Neto MMS, de Andrade AB. Effects of the COVID-19 pandemic on delays in diagnosis-to-treatment initiation for breast cancer in Brazil: a nationwide study. Ecancermedicalscience 2023; 17:1570. [PMID: 37533939 PMCID: PMC10393311 DOI: 10.3332/ecancer.2023.1570] [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: 04/16/2023] [Indexed: 08/04/2023] Open
Abstract
Background Short period from diagnosis to breast cancer (BC) treatment initiation remains challenging for the public health system in Brazil, which may have been further affected by the coronavirus disease-2019 (COVID-19) pandemic. This study assessed BC diagnosis-to-treatment intervals (DTi) in Brazil and the possible effects of the COVID-19 outbreak on delays. Methods The Painel de Monitoramento de Tratamento Oncológico database was queried to obtain the number of Brazilian patients with a BC confirmed diagnosis and initiating cancer treatment in the pre-COVID-19 (2013-2019) and during the COVID-19 (2020-2021) periods, adopting a 60-day limit as timely treatment. A p-value of <0.05 was considered significant. Results A total of 315,951 cases were included (females: 99.3% and males: 0.7%), of which 251,667 and 64,284 records were computed before and during the COVID-19 years, respectively. Most patients failed to perform the first cancer treatment within 60 days (>60: 51.8%). We observed an upward trend in the number of BC treatments provided in the pre-COVID-19 years (r2 = 0.9575; p < 0.05), but the volume of treatments exhibited an average reduction of 24.6% yearly during the COVID-19 pandemic. The average DTi in days was 122.4, 122.5 and 122.3 in the total period studied, before and during the COVID-19 outbreak, respectively. The arrival of COVID-19 in Brazil increased the chances of treatment delay (OR = 1.043; p < 0.05) and inverted the proportion of early/advanced stages at BC diagnosis (55.8%/44.2%-48.4%/51.6%). Conclusion COVID-19 has imposed changes in BC care in Brazil, reducing the number of treatments provided by the Brazilian public health system, increasing the chances of delayed treatment initiation despite no differences in DTi averages being identified, and raising the proportion of advanced-stage diagnoses.
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Affiliation(s)
| | - Cleonice Nascimento da Silva
- Life Sciences Department, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Brazil
- https://orcid.org/0000-0002-8356-6426
| | - André Gusmão-Cunha
- Life Sciences Department, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Brazil
- Anesthesiology and Surgery Department, Universidade Federal da Bahia (UFBA), Salvador 40026-010, Brazil
- https://orcid.org/0000-0001-7762-168X
| | - Marinho Marques Silva Neto
- Life Sciences Department, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Brazil
- https://orcid.org/0000-0002-9728-7268
| | - André Bouzas de Andrade
- Life Sciences Department, Universidade do Estado da Bahia (UNEB), Salvador 41150-000, Brazil
- Hospital Santa Izabel (HSI), Bahia Cancer Institute, Salvador 40050-410, Brazil
- https://orcid.org/0000-0002-4010-0415
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Itkin B, Straminsky S, Cáceres H, Onassis M, García AE, Avanzi L, Kaminszczik L, Serna Sejas R, Rapaccioli M, Billordo G, Lavaccara D, Lanzavecchia J, Gibbons L, Settecase E, Bardach A. Comparison of mortality in patients on chemotherapy or immunotherapy during and before COVID-19 pandemic. Multicenter matched cohort study in Argentina. Rev Peru Med Exp Salud Publica 2023; 40:161-169. [PMID: 38232262 PMCID: PMC10953664 DOI: 10.17843/rpmesp.2023.402.12519] [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: 01/09/2023] [Accepted: 06/14/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVES. Motivation for the study. The impact of the COVID-19 pandemic on the risk of death in cancer patients on chemotherapy and immunotherapy is controversial. Published studies mainly compared patients on anti-cancer therapy to those off treatment or COVID-19 positive cancer patients to COVID-19 negative ones. Few studies were conducted in developing countries. Main findings. Mortality didn't increase in unvaccinated outpatients on active intravenous oncology treatment during the COVID-19 pandemic. Implications. This is the first propensity score-matched cohort study evaluating the impact of the COVID-19 pandemic on the population of unvaccinated oncology patients receiving intravenous anticancer therapy. . To compare all-cause mortality of unvaccinated oncology patients who received chemotherapy or immunotherapy during the pandemic with those treated before the pandemic. MATERIALS AND METHODS. We conducted a cohort study in four tertiary hospitals in Argentina. Outpatients with a solid neoplasm of any stage under-going cytotoxic or intravenous immunotherapy were eligible. The pandemic cohort was enrolled during the initial phase of the outbreak and compared with a pre-pandemic cohort using propensity score matching (PSM). Subjects were matched for age, sex, health insurance, risk factors for severe COVID-19 complications, performance status, cancer type and treatment, line of treatment, and body mass index. All-cause mortality was estimated for both cohorts after 6 months of follow-up. RESULTS. A total of 169 patients were recruited between April and August 2020 for the pandemic cohort and 377 for the pre-pandemic cohort in the same months of 2019; 168 patients were matched. After PSM, all-cause mortality was 17.9% in the pandemic cohort and 18.5% in the pre-pandemic cohort; the Relative Risk was 0.97 (95 % confidence interval: 0.61-1.52; p=0.888). In the pandemic cohort, 30/168 patients died, but none from COVID-19. CONCLUSIONS. Our findings show that the mortality rate of unvaccinated ambulatory patients on active intravenous oncology treatment during the COVID-19 pandemic did not increase.
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Affiliation(s)
- Boris Itkin
- Hospital Juan A. Fernández, Buenos Aires, Argentina.Hospital Juan A. FernándezBuenos AiresArgentina
| | - Samanta Straminsky
- Hospital Juan A. Fernández, Buenos Aires, Argentina.Hospital Juan A. FernándezBuenos AiresArgentina
| | - Hernán Cáceres
- Sanatorio Luis Pasteur, Catamarca, Argentina.Sanatorio Luis PasteurCatamarcaArgentina
| | - Mariana Onassis
- Sanatorio Luis Pasteur, Catamarca, Argentina.Sanatorio Luis PasteurCatamarcaArgentina
| | - Agustín Emilio García
- Sanatorio Dr. Julio Méndez, Buenos Aires, Argentina.Sanatorio Dr. Julio MéndezBuenos AiresArgentina
| | - Laura Avanzi
- Policlínico Modelo de Cipolletti, Rio Negro, Argentina.Policlínico Modelo de CipollettiRio NegroArgentina
| | - Lucia Kaminszczik
- Hospital Juan A. Fernández, Buenos Aires, Argentina.Hospital Juan A. FernándezBuenos AiresArgentina
| | - Richard Serna Sejas
- Hospital Juan A. Fernández, Buenos Aires, Argentina.Hospital Juan A. FernándezBuenos AiresArgentina
| | - Mara Rapaccioli
- Sanatorio Dr. Julio Méndez, Buenos Aires, Argentina.Sanatorio Dr. Julio MéndezBuenos AiresArgentina
| | - Gustavo Billordo
- Sanatorio Dr. Julio Méndez, Buenos Aires, Argentina.Sanatorio Dr. Julio MéndezBuenos AiresArgentina
| | - Damián Lavaccara
- Policlínico Modelo de Cipolletti, Rio Negro, Argentina.Policlínico Modelo de CipollettiRio NegroArgentina
| | - Julián Lanzavecchia
- Policlínico Modelo de Cipolletti, Rio Negro, Argentina.Policlínico Modelo de CipollettiRio NegroArgentina
| | - Luz Gibbons
- Center for Research in Epidemiology and Public Health (CIESP) Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina.Center for Research in Epidemiology and Public Health (CIESP)Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET)Buenos AiresArgentina
| | - Eugenia Settecase
- Center for Research in Epidemiology and Public Health (CIESP) Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina.Center for Research in Epidemiology and Public Health (CIESP)Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET)Buenos AiresArgentina
| | - Ariel Bardach
- Center for Research in Epidemiology and Public Health (CIESP) Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina.Center for Research in Epidemiology and Public Health (CIESP)Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET)Buenos AiresArgentina
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Frisardi V, Brunetti O, Abbinante V, Ardigò M, Caolo G, Di Turi A, Torsello A, Napoli C, Mancini R, Belleudi V, Addis A, Di Bella O, Ciliberto G, Neri A, Corsini R, Ruggieri P, Pollorsi C, Silvestris N. Impact of COVID-19 pandemic on outpatient visit volume in cancer patients: Results of COMETA multicenter retrospective observational study. Front Public Health 2023; 11:1077103. [PMID: 36866103 PMCID: PMC9971950 DOI: 10.3389/fpubh.2023.1077103] [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: 10/22/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
Objective To evaluate the impact of the COVID-19 pandemic on first and follow-up visits for cancer outpatients. Methods This is a multicenter retrospective observational study involving three Comprehensive Cancer Care Centers (CCCCs): IFO, including IRE and ISG in Rome, AUSL-IRCCS of Reggio Emilia, and IRCCS Giovanni Paolo II in Bari) and one oncology department in a Community Hospital (Saint'Andrea Hospital, Rome). From 1 January 2020 and 31 December 2021, we evaluated the volume of outpatient consultations (first visits and follow-up), comparing them with the pre-pandemic year (2019). Results were analyzed by quarter according to the Rt (real-time indicator used to assess the evolution of the pandemic). IFO and IRCCS Giovanni Paolo II were "COVID-free" while AUSL-IRCCS RE was a "COVID-mixed" Institute. Depending on the Rt, Sain't Andrea Hospital experienced a "swinging" organizational pathway (COVID-free/ COVID-mixed). Results Regarding the "first appointments", in 2020 the healthcare facilities operating in the North and Center of Italy showed a downward trend. In 2021, only AUSL-IRCCS RE showed an upward trend. Regarding the "follow-up", only AUSL IRCCS RE showed a slight up-trend in 2020. In 2021, IFO showed an increasing trend, while S. Andrea Hospital showed a negative plateau. Surprisingly, IRCCS Giovanni Paolo II in Bari showed an uptrend for both first appointment and follow-ups during pandemic and late pandemic except for the fourth quarter of 2021. Conclusions During the first pandemic wave, no significant difference was observed amongst COVID-free and COVID-mixed Institutes and between CCCCs and a Community Hospital. In 2021 ("late pandemic year"), it has been more convenient to organize COVID-mixed pathway in the CCCCs rather than to keep the Institutions COVID-free. A swinging modality in the Community Hospital did not offer positive results in term of visit volumes. Our study about the impact of COVID-19 pandemic on visit volume in cancer outpatients may help health systems to optimize the post-pandemic use of resources and improve healthcare policies.
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Affiliation(s)
- Vincenza Frisardi
- Department of Neuromotor Diseases, Geriatric Unit, AUSL IRCCS of Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Vincenza Frisardi ✉
| | - Oronzo Brunetti
- Istituto Tumori “Giovanni Paolo II” of Bari, IRCCS, Bari, Italy
| | | | - Marco Ardigò
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | | | | | | | - Christian Napoli
- Sapienza University of Rome, Saint'Andrea Hospital, Rome, Lazio, Italy
| | - Rita Mancini
- Sapienza University of Rome, Saint'Andrea Hospital, Rome, Lazio, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Antonio Addis
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | | | - Antonino Neri
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Romina Corsini
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Patrizia Ruggieri
- Scientific Directorate, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Chiara Pollorsi
- Department of Neuromotor Diseases, Geriatric Unit, AUSL IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy
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Mojsak D, Dębczyński M, Kuklińska B, Minarowski Ł, Kasiukiewicz A, Moniuszko-Malinowska A, Czupryna P, Mróz RM. Impact of COVID-19 in Patients with Lung Cancer: A Descriptive Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1583. [PMID: 36674340 PMCID: PMC9866646 DOI: 10.3390/ijerph20021583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic poses a challenge to health systems worldwide. Limiting healthcare availability may delay early diagnosis and worsen the treatment effects of various diseases, including oncological diseases. We analyzed patients presenting to the 2nd Department of Lung Diseases and Tuberculosis in Białystok, Poland, with suspicion of lung cancer 12 months prior to the COVID-19 pandemic (pre-COVID-19) and, similarly, 12 months after the outbreak of the pandemic (mid-COVID). In total, 320 patients were analyzed-132 prior to and 188 after the COVID-19 outbreak. During the COVID-19 period, there was a lower percentage of patients presenting with ECOG performance status 0-1, with a noticeably increased percentage of patients with ECOG PS ≥2. The disease's clinical stage (CS) was higher on admission during COVID-19. We observed more use of immunotherapy and more deaths before the start of treatment during the COVID-19 period. These results provide insight into the early effects of the COVID-19 pandemic on lung cancer patients and underscore the importance of conducting further studies to assess the long-term effects of the COVID-19 pandemic on this population.
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Affiliation(s)
- Damian Mojsak
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Białystok,14 Żurawia Street, 15-540 Bialystok, Poland
| | - Michał Dębczyński
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Białystok,14 Żurawia Street, 15-540 Bialystok, Poland
| | - Beata Kuklińska
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Białystok,14 Żurawia Street, 15-540 Bialystok, Poland
| | - Łukasz Minarowski
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Białystok,14 Żurawia Street, 15-540 Bialystok, Poland
| | - Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Białystok, 27 Fabryczna Street, 15-471 Bialystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neurology, Medical University of Białystok, 14 Żurawia Street, 15-540 Bialystok, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neurology, Medical University of Białystok, 14 Żurawia Street, 15-540 Bialystok, Poland
| | - Robert Marek Mróz
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Białystok,14 Żurawia Street, 15-540 Bialystok, Poland
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9
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Rocha AFBM, Freitas-Junior R, Ferreira GLR, Rodrigues DCN, Rahal RMS. COVID-19 and Breast Cancer in Brazil. Int J Public Health 2023; 68:1605485. [PMID: 36938303 PMCID: PMC10020228 DOI: 10.3389/ijph.2023.1605485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives: This study aimed to evaluate COVID-19 effects on breast cancer screening and clinical stage at diagnosis in patients of 50-69 years of age receiving care within the public healthcare network (SUS) in 2013-2021 in Brazil and its macro-regions. Methods: This ecological study used Poisson regression to analyze trends in screening and staging. A secondary database was formed using SUS sources: outpatient data system of the SUS network and Oncology-Brazil Panel. Results: There was a reduction in screening, with an annual percent change of -5.9 (p < 0.022). The number of notified cases fell by 31.5% in 2020-2021 compared to 2018-2019. There was a 10.7% increase in the proportion of stage III/IV cases (p < 0.001) in 2020-2021 compared to 2013-2019, now surpassing the number of cases of early stage breast cancer. Conclusion: COVID-19 led to a reduction in breast cancer screening and an expressive increase in advanced tumors in users of the public healthcare network. Urgent interventions in public policies are required as the negative effects of the pandemic on the diagnosis/treatment of breast cancer are becoming apparent even earlier than expected.
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Affiliation(s)
- Aline Ferreira Bandeira Melo Rocha
- Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Brazil
- *Correspondence: Aline Ferreira Bandeira Melo Rocha,
| | - Ruffo Freitas-Junior
- Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás, Goiânia, Brazil
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de Bock E, Herman ES, Bastian OW, Filipe MD, Vriens MR, Richir MC. Systematic review and meta-analysis determining the effect of implemented COVID-19 guidelines on surgical oncology volumes and clinical outcomes. Surg Oncol 2022; 45:101859. [PMID: 36242979 PMCID: PMC9529677 DOI: 10.1016/j.suronc.2022.101859] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND To provide for Coronavirus Disease 2019 (COVID-19) healthcare capacity, (surgical oncology) guidelines were established, forcing to alter the timing of performing surgical procedures. It is essential to determine whether these guidelines have led to disease progression. This study aims to give an insight into the number of surgical oncology procedures performed during the pandemic and provide information on short-term clinical outcomes. MATERIALS AND METHODS A systematic literature search was performed on all COVID-19 articles including operated patients, published before March 21, 2022. Meta-analysis was performed to visualize the number of performed surgical oncology procedures during the pandemic compared to the pre-pandemic period. Random effects models were used for evaluating short-term clinical outcomes. RESULTS Twenty-four studies containing 6762 patients who underwent a surgical oncology procedure during the pandemic were included. The number of performed surgical procedures for an oncological pathology decreased (-26.4%) during the pandemic. The number of performed surgical procedures for breast cancer remained stable (+0.3%). Moreover, no difference was identified in the number of ≥T2 (OR 1.00, P = 0.989), ≥T3 (OR 0.95, P = 0.778), ≥N1 (OR 1.01, P = 0.964) and major postoperative complications (OR 1.55, P = 0.134) during the pandemic. CONCLUSION The number of performed surgical oncology procedures during the COVID-19 pandemic decreased. In addition, the number of performed surgical breast cancer procedures remained stable. Oncological staging and major postoperative complications showed no significant difference compared to pre-pandemic practice. During future pandemics, the performed surgical oncology practice during the first wave of the COVID-19 pandemic seems appropriate for short-term results.
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Affiliation(s)
- Ellen de Bock
- Corresponding author. PO Box 85500, 3508, GA, Utrecht, the Netherlands
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11
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Demarchi PKH, Maurer E, Pierini NI, Lammel BL, Sirqueira ACV, Maggi LS, Santos KL, Shama SDFMS. O Impacto da Pandemia da Covid-19 no Volume de Mamografias no Brasil: uma Análise de Previsão Baseada nos Números Históricos. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Introdução: A neoplasia mamaria constitui a primeira causa de óbito por câncer em mulheres brasileiras. Dados sobre o real impacto da pandemia na política de rastreamento e diagnostico do câncer de mama no Brasil ainda são desconhecidos. Objetivo: Avaliar o efeito da pandemia da covid-19 no número de mamografias realizadas no Sistema Único de Saúde (SUS). Método: Estudo epidemiológico, quantitativo e de delineamento transversal. Foram selecionadas mamografias mensais realizadas no SUS após consulta ao Departamento de Informática do SUS (DATASUS). Foi avaliado o volume histórico, de janeiro de 2017 a marco de 2020, mês seguinte ao primeiro caso de covid-19 diagnosticado no Brasil, para se construir um modelo de previsão das mamografias esperadas de marco de 2020 até dezembro de 2021. Resultado: No ano de 2020, 1.705.475 mamografias deixaram de ser realizadas no Brasil em relação ao ano anterior, segundo o DATASUS. O modelo de previsão, com base nos valores históricos, mostrou um déficit de 1.635.42 mamografias. Em maio de 2020, ocorreu a maior queda na realização dos exames, representando apenas 20,69% das mamografias realizadas no mesmo mês do ano anterior. Conclusão: A detecção precoce do câncer de mama foi uma das áreas medicas impactadas pela política de restrição e isolamento impostos no ano de 2020. Nesse sentido, esforços governamentais futuros serão necessários para oferecer tratamento a eventuais pacientes com diagnostico tardio de câncer de mama, além das mamografias que não puderam ser realizadas.
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Cuadrado C, Vidal F, Pacheco J, Flores-Alvarado S. Acceso a la atención del cáncer en los grupos vulnerables de Chile durante la pandemia de COVID-19. Rev Panam Salud Publica 2022; 46:e77. [PMID: 35990523 PMCID: PMC9384893 DOI: 10.26633/rpsp.2022.77] [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] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Objetivo.
Estudiar la repercusión de la pandemia de COVID-19 en el acceso a la atención del cáncer en Chile, analizando los efectos diferenciales por tipo de seguro, sexo y edad.
Métodos.
Se llevó a cabo un estudio cuasiexperimental mediante análisis de series temporales interrumpidas. Se recurrió a fuentes de datos múltiples con el fin de lograr una evaluación amplia de la utilización de la atención del cáncer de enero del 2017 a diciembre del 2020. Se ajustaron modelos binomiales negativos en función de los grupos de población para una diversidad de servicios y diagnósticos.
Resultados.
Tras una disminución considerable de la utilización de la atención oncológica en marzo, se observó una recuperación lenta e incompleta durante el 2020. Los servicios de atención del cáncer, las confirmaciones diagnósticas y las licencias por enfermedad acumulados se redujeron en un tercio en el 2020; la disminución fue más pronunciada en las mujeres y las personas afiliadas al seguro de enfermedad público. No se hizo un diagnóstico temprano en 5132 personas con cuatro tipos frecuentes de cáncer.
Conclusiones.
La pandemia sobrecargó el sistema de salud chileno y provocó una disminución del acceso a los servicios básicos, con una repercusión profunda en la atención del cáncer. La reducción de los servicios de oncología precedió los confinamientos a gran escala y las interrupciones por parte de los prestadores. Cabe destacar que no todos los grupos de la población se vieron afectados por igual y se observaron pautas que indican un agravamiento de las desigualdades por situación socioeconómica y sexo.
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Affiliation(s)
- Cristóbal Cuadrado
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
| | - Francisca Vidal
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
| | - Jorge Pacheco
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
| | - Sandra Flores-Alvarado
- Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile
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Cuadrado C, Vidal F, Pacheco J, Flores-Alvarado S. Cancer Care Access in Chile's Vulnerable Populations During the COVID-19 Pandemic. Am J Public Health 2022; 112:S591-S601. [PMID: 35977338 PMCID: PMC9382144 DOI: 10.2105/ajph.2021.306587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the COVID-19 pandemic's impact on cancer care access in Chile, analyzing differential effects by insurance type, gender, and age. Methods. We conducted a quasi-experimental study using interrupted time series analysis. We used multiple data sources for a broad evaluation of cancer-related health care utilization from January 2017 to December 2020. We fit negative binomial models by population groups for a range of services and diagnoses. Results. A sharp drop in oncology health care utilization in March was followed by a slow, incomplete recovery over 2020. Cumulative cancer-related services, diagnostic confirmations, and sick leaves were reduced by one third in 2020; the decrease was more pronounced among women and the publicly insured. Early diagnosis was missed in 5132 persons with 4 common cancers. Conclusions. The pandemic stressed the Chilean health system, decreasing access to essential services, with a profound impact on cancer care. Oncology service reductions preceded large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting that gender and socioeconomic inequalities were exacerbated. (Am J Public Health. 2022;112(S6):S591-S601. https://doi.org/10.2105/AJPH.2021.306587).
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Affiliation(s)
- Cristóbal Cuadrado
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Francisca Vidal
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Jorge Pacheco
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Sandra Flores-Alvarado
- Cristóbal Cuadrado, Francisca Vidal, Jorge Pacheco, and Sandra Flores-Alvarado are with Escuela de Salud Pública, Universidad de Chile, Independencia, Región Metropolitana, Chile. Cristóbal Cuadrado is also with the Centre for Health Economics, University of York, York, UK. Jorge Pacheco is also with Facultad de Medicina, Universidad de Concepción, Concepción, Chile
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New Challenges in Surgical Approaches for Colorectal Cancer during the COVID-19 Pandemic. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
(1) Background: The COVID-19 pandemic put a great burden on national healthcare systems, causing delays and disruptions in the medical care of non-COVID-19 patients. This paper aims to analyze the COVID-19 pandemic impact upon the quality of care in colorectal surgery. (2) Materials and Methods: We performed a retrospective study on the colorectal cancer cases operated in the Fourth Department of General Surgery, Emergency Hospital Bucharest Romania, over the period March 2020–February 2021 (pandemic group) vs. March 2019–February 2020 (non-pandemic group). (3) Results: The number of patients in the pandemic group decreased by 70% (36 vs. 118 patients), with lower accessibility from rural areas (11.1% vs. 37.2%, p = 0.035). Most cases in the pandemic group were emergencies (69% vs. 37.3%, p = 0.009), admitted for bowel obstruction (63.8% vs. 27.9%, p = 0.008). There was no in-hospital COVID-19 infection in patients operated for colorectal cancer. The 30-day mortality was significantly higher in the pandemic group (25% vs. 6.7%, p = 0.017), mostly due to septic shock (36.1% vs. 5%, p = 0.0001). (4) Conclusions: Colorectal cancer surgery may be performed safely during the COVID-19 pandemic, with strict adherence to the SARS-CoV-2 prevention protocols. However, the significant increase in colorectal cancers in the emergency was associated with worse outcomes and higher mortality during the COVID-19 pandemic.
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Murphy A, Kirby A, Lawlor A, Drummond FJ, Heavin C. Mitigating the Impact of the COVID-19 Pandemic on Adult Cancer Patients through Telehealth Adoption: A Systematic Review. SENSORS 2022; 22:s22093598. [PMID: 35591287 PMCID: PMC9105995 DOI: 10.3390/s22093598] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
During the first wave of the COVID-19 pandemic, the delivery of life-saving and life-prolonging health services for oncology care and supporting services was delayed and, in some cases, completely halted, as national health services globally shifted their attention and resources towards the pandemic response. Prior to March 2020, telehealth was starting to change access to health services. However, the onset of the global pandemic may mark a tipping point for telehealth adoption in healthcare delivery. We conducted a systematic review of literature published between January 2020 and March 2021 examining the impact of the COVID-19 pandemic on adult cancer patients. The review's inclusion criteria focused on the economic, social, health, and psychological implications of COVID-19 on cancer patients and the availability of telehealth services emerged as a key theme. The studies reviewed revealed that the introduction of new telehealth services or the expansion of existing telehealth occurred to support and enable the continuity of oncology and related services during this extraordinary period. Our analysis points to several strengths and weaknesses associated with telehealth adoption and use amongst this cohort. Evidence indicates that while telehealth is not a panacea, it can offer a "bolstering" solution during a time of disruption to patients' access to essential cancer diagnostic, treatment, and aftercare services. The innovative use of telehealth has created opportunities to reimagine the delivery of healthcare services beyond COVID-19.
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Affiliation(s)
- Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, T12 CY82 Cork, Ireland; (A.M.); (A.K.); (A.L.)
| | - Ann Kirby
- Department of Economics, Cork University Business School, University College Cork, T12 CY82 Cork, Ireland; (A.M.); (A.K.); (A.L.)
| | - Amy Lawlor
- Department of Economics, Cork University Business School, University College Cork, T12 CY82 Cork, Ireland; (A.M.); (A.K.); (A.L.)
| | | | - Ciara Heavin
- Department of Business Information Systems, Cork University Business School, University College Cork, T12 CY82 Cork, Ireland
- Correspondence:
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16
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Santos LG, da Silva RV, Leal TC, Xavier JE, Figueiredo EVMDS, de Paiva JPS, da Silva LF, Rocha CADO, Nunes BEBR, Santana GBDA, Fernandes TRMDO, Costa FDA, Bezerra-Santos M, Feliciano do Carmo R, Armstrong ADC, de Souza CDF. Impact of the COVID-19 pandemic on hospital admissions and in-hospital lethality from cardiovascular diseases in Brazil: an ecological and time series study COVID-19 and cardiovascular diseases. Curr Probl Cardiol 2022:101216. [PMID: 35460687 PMCID: PMC9021219 DOI: 10.1016/j.cpcardiol.2022.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Since the onset of the coronavirus disease 2019 (COVID-19) pandemic in Brazil, several government policies have been taken. Herein, we aimed to assess the impact of the COVID-19 pandemic on hospital admissions and in-hospital lethality for cardiovascular diseases (CVD) in Brazil in 2020. METHODS An ecological and time-series study on hospitalizations and deaths from CVD in Brazil was conducted from January 2018 to December 2020. RESULTS The hospital admission rate for CVD reduced by 17.1%, with a significantly decreasing trend between January and May 2020 (Annual Percent Change: -8,7%; p-value <0.001). The in-hospital lethality rate increased from 8.2% in 2018 to 9.3% in 2020. During this period, Brazil totaled 21.8 million days of hospital stay. CONCLUSION Indicators of hospital admissions and lethality from CVD in Brazil were impacted by the emergence of the COVID-19 pandemic in different ways in the regions and depending on the nature of the indicator.
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Affiliation(s)
- Lucas Gomes Santos
- Department of Medicine, Federal University of Alagoas, Arapiraca, AL, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | - Rodrigo Feliciano do Carmo
- College of Pharmaceutical Sciences, Federal University of the São Francisco Valley (UNIVASF), Petrolina, Pernambuco, Brazil; Department of Medicine, Federal University of Alagoas, Arapiraca, AL, Brazil
| | - Anderson da Costa Armstrong
- College of Medicine, Federal University of the São Francisco Valley (UNIVASF), Petrolina, Pernambuco, Brazil
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17
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Valdiviezo N, Alcarraz C, Castro D, Salas R, Begazo-Mollo V, Galvez-Villanueva M, Medina Aguirre L, Garcia-León E, Quispe-Santivañez I, Cornejo-Raymundo C, Paz-Cornejo E, Sanchez-Vilela L, Bermudez-Alfaro V, Vargas-Nina JC, Pérez-Ramos C, Meza-Hoces A, Valdez Barreto PR, Huaringa-Leiva R, Muro-Cieza J, Aguilar-Vásquez V, Cuenca EY, Neciosup-Delgado S, Poma-Nieto N, Chavez-Gavino S, Fernandez-Rosas L, Araujo JM, Payet E, Gomez HL. Oncological Care During First Peruvian National Emergency COVID-19 Pandemic: A Multicentric Descriptive Study. Cancer Manag Res 2022; 14:1075-1085. [PMID: 35300062 PMCID: PMC8922040 DOI: 10.2147/cmar.s350038] [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] [Received: 11/22/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Natalia Valdiviezo
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
- Correspondence: Natalia Valdiviezo, Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos 2520, Surquillo, Lima, 15038, Peru, Tel +51 992825055, Email
| | - Cindy Alcarraz
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Denisse Castro
- Departamento de Oncología Médica, Hospital Nacional Edgardo Rebagliati Martins, Lima, 15072, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, 15024, Peru
| | - Renzo Salas
- Departamento de Oncología Médica, Hospital Nacional Edgardo Rebagliati Martins, Lima, 15072, Peru
| | - Victor Begazo-Mollo
- Departamento de Medicina Oncológica, Instituto Regional de Enfermedades Neoplásicas Sur, Arequipa, Perú
| | - Marco Galvez-Villanueva
- Departamento de Medicina Oncológica, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú
| | - Luz Medina Aguirre
- Departamento de Medicina Oncológica, Hospital Goyeneche, Arequipa, 04600, Perú
| | - Elica Garcia-León
- Departamento de Medicina Oncológica, Hospital Regional de Lambayeque, Lambayeque, 14001, Perú
| | | | | | - Eduardo Paz-Cornejo
- Departamento de Medicina Oncológica, Hospital Nacional Alberto Sabogal Sologuren, Lima, Peru
| | - Luis Sanchez-Vilela
- Departamento de Medicina Oncológica, Hospital de Apoyo II Santa Rosa, Piura, Peru
| | - Vanessa Bermudez-Alfaro
- Departamento de Medicina Oncológica, Hospital Nacional Guillermo Almenara Irigoyen, Lima, 15033, Peru
| | | | - Carlos Pérez-Ramos
- Departamento de Medicina Oncológica, Hospital María Auxiliadora, Lima, Peru
| | - Andrea Meza-Hoces
- Departamento de Medicina Oncológica, Hospital II E de Lamas, San Martin, Peru
| | - Paolo R Valdez Barreto
- Departamento de Medicina Oncológica, Hospital de Alta complejidad Virgen de la Puerta, La Libertad, Peru
| | | | - Johanny Muro-Cieza
- Departamento de Medicina Oncológica, Hospital Regional Docente de Cajamarca, Cajamarca, Peru
| | - Valeria Aguilar-Vásquez
- Departamento de Promoción de la Salud, Prevención y Control del Cáncer, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú
| | - Eduardo Yache Cuenca
- Departamento de Epidemiología, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú
| | - Silvia Neciosup-Delgado
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
| | - Nathaly Poma-Nieto
- Departamento de Medicina Oncológica, Hospital Nacional Daniel Alcides Carrión, Lima, Perú
| | - Sheyla Chavez-Gavino
- Departamento de Medicina Oncológica, Hospital Regional Eleazar Guzmán Barrón, Ancash, Perú
| | - Lenin Fernandez-Rosas
- Departamento de Cirugía Oncológica, Hospital Regional Eleazar Guzmán Barrón, Ancash, Perú
| | - Jhajaira M Araujo
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Eduardo Payet
- Jefatura Institucional, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
| | - Henry L Gomez
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
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Salha LA, Silva JCS, Martins CA, Araújo CSDC, da Silva EAS, Alves AG, de Paula CR, de Lima FHA, de Moura VS, de Menezes JE, Brasil VV, Barbosa MA. Caregivers of Individuals with Cancer in the COVID-19 Pandemic: A Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010185. [PMID: 35010444 PMCID: PMC8751169 DOI: 10.3390/ijerph19010185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/15/2021] [Accepted: 12/21/2021] [Indexed: 05/22/2023]
Abstract
Caregivers of individuals with cancer in the COVID-19 pandemic are faced with the demands of cancer and the health needs produced by it, along with their own health and self-care needs, and the uncertainties of expectations and risks. A qualitative analytical phenomenological study with caregivers of individuals with cancer registered at the state referral hospital supplying medications, who answered the sociodemographic assessment questionnaires and semi-structured questions about their feelings and perceptions in the COVID-19 pandemic. Bardin's content analysis was used, with methodological quality assessed using SRQR Standards for Reporting Qualitative Research and the MAXQDA software. Most of the caregivers are women, married, Catholic, of low income and education, aged between 30 and 60 years, optimistic, comply with health guidelines regarding social distancing, use of masks, and routine hand hygiene, do not practice regular physical activities, mention concern for their own physical and financial survival, and that of their family. The main need identified in the affective sphere was to reframe contact with family members, seeking to strengthen the bonds of affection. The feeling of emotional vulnerability shows the importance of building effective public policies for social support consistent with the improvement of health care for this population.
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Affiliation(s)
- Leila Abou Salha
- Faculty of Medicine, Federal University of Goiás, Goiania 74605-050, Brazil; (J.C.S.S.); (C.A.M.); (E.A.S.d.S.); (F.H.A.d.L.); (V.S.d.M.); (M.A.B.)
- Correspondence:
| | - Julio Cesar Souza Silva
- Faculty of Medicine, Federal University of Goiás, Goiania 74605-050, Brazil; (J.C.S.S.); (C.A.M.); (E.A.S.d.S.); (F.H.A.d.L.); (V.S.d.M.); (M.A.B.)
| | - Cleusa Alves Martins
- Faculty of Medicine, Federal University of Goiás, Goiania 74605-050, Brazil; (J.C.S.S.); (C.A.M.); (E.A.S.d.S.); (F.H.A.d.L.); (V.S.d.M.); (M.A.B.)
| | | | - Edinamar Aparecida Santos da Silva
- Faculty of Medicine, Federal University of Goiás, Goiania 74605-050, Brazil; (J.C.S.S.); (C.A.M.); (E.A.S.d.S.); (F.H.A.d.L.); (V.S.d.M.); (M.A.B.)
| | - Angela Gilda Alves
- Faculty of Nursing, Federal University of Goiás, Goiania 74605-080, Brazil; (C.S.d.C.A.); (A.G.A.); (V.V.B.)
| | | | - Flavio Henrique Alves de Lima
- Faculty of Medicine, Federal University of Goiás, Goiania 74605-050, Brazil; (J.C.S.S.); (C.A.M.); (E.A.S.d.S.); (F.H.A.d.L.); (V.S.d.M.); (M.A.B.)
| | - Veidma Siqueira de Moura
- Faculty of Medicine, Federal University of Goiás, Goiania 74605-050, Brazil; (J.C.S.S.); (C.A.M.); (E.A.S.d.S.); (F.H.A.d.L.); (V.S.d.M.); (M.A.B.)
| | - José Elmo de Menezes
- Federal Institute of Education, Science, and Technology of Goiás, Pontifical Catholic University of Goiás, Goiania 74605-900, Brazil;
| | - Virginia Visconde Brasil
- Faculty of Nursing, Federal University of Goiás, Goiania 74605-080, Brazil; (C.S.d.C.A.); (A.G.A.); (V.V.B.)
| | - Maria Alves Barbosa
- Faculty of Medicine, Federal University of Goiás, Goiania 74605-050, Brazil; (J.C.S.S.); (C.A.M.); (E.A.S.d.S.); (F.H.A.d.L.); (V.S.d.M.); (M.A.B.)
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19
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Mendonça AB, Pereira ER, Magnago C, da Silva PG, Morett Leão DC, Costa Rosa Andrade Silva RM, Meira KC. Distress and Spiritual Well-Being in Brazilian Patients Initiating Chemotherapy during the COVID-19 Pandemic-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413200. [PMID: 34948809 PMCID: PMC8702099 DOI: 10.3390/ijerph182413200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/27/2022]
Abstract
Social distancing and the priority given to COVID-19 patients in health services, which caused postponement of appointments and cancer treatment, may have triggered unprecedented levels of distress in cancer patients. The aim of this study was to analyze the prevalence of distress and the levels of spiritual well-being of people initiating chemotherapy during the COVID-19 pandemic, identifying the factors associated with distress, and determining if there is a relationship between distress and spiritual well-being. A cross-sectional study was conducted with 91 Brazilians. Data were collected by applying the Spiritual Well-Being Scale (SWBS) and the Distress Thermometer and Problem List for Patients. The prevalence of distress was 59.5%, and the average score of spiritual well-being was 106.54 (±9.06). Emotional issues were the most reported by patients with distress. The Poisson regression showed that male sex (PR = 0.588; 95% CI 0.392–0.881), age (PR = 0.985; 95% CI 0.973–0.996), and spiritual well-being score were predictors of distress (PR = 0.971; 95% CI 0.946–0.996). These findings indicate that distress relief involves implementation of public health programs capable of integrating spiritual interventions into cancer care.
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Affiliation(s)
| | | | - Carinne Magnago
- School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Pedro Gilson da Silva
- School of Health, Federal University of Rio Grande do Norte, Natal 59075-000, Brazil
| | | | | | - Karina Cardoso Meira
- School of Health, Federal University of Rio Grande do Norte, Natal 59075-000, Brazil
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20
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Jaime‐Pérez JC, González‐Treviño M, Meléndez‐Flores JD, Ramos‐Dávila EM, Colunga‐Pedraza JE, Colunga‐Pedraza PR, Jiménez‐Antolinez V, Gómez‐Almaguer D. Safety and feasibility of outpatient hematopoietic cell transplantation in pediatric patients during the COVID-19 pandemic: A single-center experience. Pediatr Blood Cancer 2021; 68:e29252. [PMID: 34291876 PMCID: PMC8441788 DOI: 10.1002/pbc.29252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022]
Affiliation(s)
- José Carlos Jaime‐Pérez
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Mariana González‐Treviño
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Jesús D. Meléndez‐Flores
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Eugenia M. Ramos‐Dávila
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Julia E. Colunga‐Pedraza
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Perla R. Colunga‐Pedraza
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Valentine Jiménez‐Antolinez
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - David Gómez‐Almaguer
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
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21
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Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Müller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutiérrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Cáceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474-e487. [PMID: 34735817 DOI: 10.1016/s1470-2045(21)00492-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.
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Affiliation(s)
- Carlos H Barrios
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Bettina G Müller
- Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Francisco Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cancer Tuxtla Gutiérrez, Chiapas, México; Latin American School of Oncology (ELO), México City, México
| | - Ji Seok Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dewpoint Therapeutics, Boston, MA, USA
| | | | - Lucia Delgado
- Faculty of Medicine, University of Uruguay, Montevideo, Uruguay; Honorary Commission for the Fight Against Cancer, Montevideo, Uruguay
| | - Luiz A Santini
- Center of Strategic Studies of FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
| | - Nelson Teich
- Teich Health Care Consulting, Rio de Janeiro, Brazil
| | - Pamela C Chavez
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Pedro E R Liedke
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Pesquisa Clínica em Oncologia, Porto Alegre, Brazil
| | - Pedro Exman
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Suyapa A Bejarano Cáceres
- Medicine Universidad Católica de Honduras, San Pedro Sula, Honduras; Department of Clinical Oncology, Liga Contra el Cáncer, San Pedro Sula, Honduras
| | | | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Yolanda Vargas
- Unidad de Cuidados Paliativos y Clínica de Alivio del Dolor Oncológico, Instituto Oncológico Nacional, Ciudad de Panamá, Panamá
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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22
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Estimating the impact of the COVID-19 pandemic on diagnosis and survival of five cancers in Chile from 2020 to 2030: a simulation-based analysis. Lancet Oncol 2021; 22:1427-1437. [PMID: 34487693 PMCID: PMC8415898 DOI: 10.1016/s1470-2045(21)00426-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 01/12/2023]
Abstract
Background The COVID-19 pandemic has strained health system capacity worldwide due to a surge of hospital admissions, while mitigation measures have simultaneously reduced patients' access to health care, affecting the diagnosis and treatment of other diseases such as cancer. We estimated the impact of delayed diagnosis on cancer outcomes in Chile using a novel modelling approach to inform policies and planning to mitigate the forthcoming cancer-related health impacts of the pandemic in Chile. Methods We developed a microsimulation model of five cancers in Chile (breast, cervix, colorectal, prostate, and stomach) for which reliable data were available, which simulates cancer incidence and progression in a nationally representative virtual population, as well as stage-specific cancer detection and survival probabilities. We calibrated the model to empirical data on monthly detected cases, as well as stage at diagnosis and 5-year net survival. We accounted for the impact of COVID-19 on excess mortality and cancer detection by month during the pandemic, and projected diagnosed cancer cases and outcomes of stage at diagnosis and survival up to 2030. For comparison, we simulated a no COVID-19 scenario in which the impacts of COVID-19 on excess mortality and cancer detection were removed. Findings Our modelling showed a sharp decrease in the number of diagnosed cancer cases during the COVID-19 pandemic, with a large projected short-term increase in future diagnosed cases. Due to the projected backlog in diagnosis, we estimated that in 2021 there will be an extra 3198 cases (95% uncertainty interval [UI] 1356–5017) diagnosed among the five modelled cancers, an increase of nearly 14% compared with the no COVID-19 scenario, falling to a projected 10% increase in 2022 with 2674 extra cases (1318–4032) diagnosed. As a result of delayed diagnosis, we found a worse stage distribution for detected cancers in 2020–22, which is estimated to lead to 3542 excess cancer deaths (95% UI 2236–4816) in 2022–30, compared with the no COVID-19 scenario, among the five modelled cancers, most of which (3299 deaths, 2151–4431) are projected to occur before 2025. Interpretation In addition to a large projected surge in diagnosed cancer cases, we found that delays in diagnosis will result in worse cancer stage at presentation, leading to worse survival outcomes. These findings can help to inform surge capacity planning and highlight the importance of ensuring appropriate health system capacity levels to detect and care for the increased cancer cases in the coming years, while maintaining the timeliness and quality of cancer care. Potential delays in treatment and adverse impacts on quality of care, which were not considered in this model, are likely to contribute to even more excess deaths from cancer than projected. Funding Harvard TH Chan School of Public Health. Translations For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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23
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Millar E, Gurney J, Beuker S, Goza M, Hamilton MA, Hardie C, Jackson CG, Mako M, Middlemiss T, Ruka M, Willis N, Sarfati D. Maintaining cancer services during the COVID-19 pandemic: the Aotearoa New Zealand experience. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 11:100172. [PMID: 34327369 PMCID: PMC8315642 DOI: 10.1016/j.lanwpc.2021.100172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
COVID-19 caused significant disruption to cancer services around the world. The health system in Aotearoa New Zealand has fared better than many other regions, with the country being successful, so far, in avoiding sustained community transmission. However, there was a significant initial disruption to services across the cancer continuum, resulting in a decrease in the number of new diagnoses of cancer in March and April 2020. Te Aho o Te Kahu, Aotearoa New Zealand's national Cancer Control Agency, coordinated a nationwide response to minimise the impact of COVID-19 on people with cancer. The response, outlined in this paper, included rapid clinical governance, a strong equity focus, development of national clinical guidance, utilising new ways of delivering care, identifying and addressing systems issues and close monitoring and reporting of the impact on cancer services. Diagnostic procedures and new cancer registrations increased in the months following the national lockdown, and the cumulative number of cancer registrations in 2020 surpassed the number of registrations in 2019 by the end of September. Cancer treatment services – surgery, medical oncology, radiation oncology and haematology – continued during the national COVID-19 lockdown in March and April 2020 and continued to be delivered at pre-COVID-19 volumes in the months since. We are cautiously optimistic that, in general, the COVID-19 pandemic does not appear to have increased inequities in cancer diagnosis and treatment for Māori in Aotearoa New Zealand.
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Affiliation(s)
- Elinor Millar
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Jason Gurney
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand.,Department of Public Health, University of Otago, Mein St, Wellington, New Zealand
| | - Suzanne Beuker
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Moahuia Goza
- Hei Āhuru Mōwai Māori Cancer Leadership, Victoria St, Hamilton, New Zealand
| | - Mary-Ann Hamilton
- Waikato District Health Board, Pembroke Street, Hamilton, New Zealand
| | - Claire Hardie
- Midcentral District Health Board, Ruahine Street, Palmerston North, New Zealand
| | | | - Michelle Mako
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Tom Middlemiss
- Hutt Valley District Health Board, Boulcott St, Lower Hutt, New Zealand.,Te Omanga Hospice, Woburn Road, Lower Hutt, New Zealand
| | - Myra Ruka
- Hei Āhuru Mōwai Māori Cancer Leadership, Victoria St, Hamilton, New Zealand.,Waikato District Health Board, Pembroke Street, Hamilton, New Zealand
| | - Nicole Willis
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu, Cancer Control Agency, Molesworth St, Wellington, New Zealand
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24
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Wang Y, Shi D, Liu F, Xu P, Ma M. Prognostic Value of Lung Ultrasound for Clinical Outcomes in Heart Failure Patients: A Systematic Review and Meta-Analysis. Arq Bras Cardiol 2021; 116:383-392. [PMID: 33566935 PMCID: PMC8159549 DOI: 10.36660/abc.20190662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is conflicting information about whether lung ultrasound assessed by B-lines has prognostic value in patients with heart failure (HF). OBJECTIVES To evaluate the prognostic value of lung ultrasound assessed by B-lines in HF patients. METHODS Four databases (PubMed, EMBASE, Cochrane Library, and Scopus) were systematically searched to identify relevant articles. We pooled the hazard ratio (HR) and 95% confidence interval (CI) from eligible studies and carried out heterogeneity, quality assessment, and publication bias analyses. Data were pooled using a fixed-effects or random-effect model. A p value < 0.05 was considered to indicate statistical significance. RESULTS Nine studies involving 1,212 participants were included in the systematic review. B-lines > 15 and > 30 at discharge were significantly associated with increased risk of combined outcomes of all-cause mortality or HF hospitalization (HR, 3.37, 95% CI, 1.52-7.47; p = 0.003; HR, 4.01, 95% CI, 2.29-7.01; p < 0.001, respectively). A B-line > 30 cutoff at discharge was significantly associated with increased risk of HF hospitalization (HR, 9.01, 95% CI, 2.80-28.93; p < 0.001). Moreover, a B-line > 3 cutoff significantly increased the risk for combined outcomes of all-cause mortality or HF hospitalization in HF outpatients (HR, 3.21, 95% CI, 2.09-4.93; I2 = 10%; p < 0.00001). CONCLUSION B-lines could predict all-cause mortality and HF hospitalizations in patients with HF. Further large randomized controlled trials are needed to explore whether dealing with B-lines would improve the prognosis in clinical settings.
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Affiliation(s)
- Yushu Wang
- Chengdu City First People’s HospitalChengduSichuanChina Chengdu City First People’s Hospital
,
Chengdu
,
Sichuan
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China
| | - Di Shi
- Chengdu City First People’s HospitalChengduSichuanChina Chengdu City First People’s Hospital
,
Chengdu
,
Sichuan
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China
| | - Fuqiang Liu
- Chengdu City First People’s HospitalChengduSichuanChina Chengdu City First People’s Hospital
,
Chengdu
,
Sichuan
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China
| | - Ping Xu
- Zigong Fourth People’s HospitalZigongSichuanChina Zigong Fourth People’s Hospital
,
Zigong
,
Sichuan
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China
| | - Min Ma
- Chengdu City First People’s HospitalChengduSichuanChina Chengdu City First People’s Hospital
,
Chengdu
,
Sichuan
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China ,Chengdu Sixth People’s HospitalChengduChina Chengdu Sixth People’s Hospital
,
Chengdu
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China
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25
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Cesena FHY. Avoidable Cardiovascular Events: A Serious Side Effect of the COVID-19 Pandemic. Arq Bras Cardiol 2021; 116:381-382. [PMID: 33909763 PMCID: PMC8159556 DOI: 10.36660/abc.20210113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Fernando H. Y. Cesena
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil,Correspondência: Fernando Cesena • Hospital Israelita Albert Einstein, Avenida Brasil, 953. CEP 01431-000, São Paulo, SP – Brasil, E-mail: ,
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