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Sharma A, Jasrotia S, Kumar A. Effects of Chemotherapy on the Immune System: Implications for Cancer Treatment and Patient Outcomes. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:2551-2566. [PMID: 37906273 DOI: 10.1007/s00210-023-02781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
Chemotherapy is a cornerstone of cancer treatment, but it can also induce immune suppression, which can have significant implications for patient outcomes. This review paper aims to give a general overview of how chemotherapy affects the immune system and how it affects cancer treatment. Chemotherapy can directly affect immune cells, leading to cytotoxic effects, cell differentiation and function alterations, and cell communication and signaling pathways disruptions. Such immune suppression can weaken the anti-tumor immune response and increase the risk of immune-related toxicities. Understanding the mechanisms of chemotherapy-induced immune suppression is crucial for optimizing treatment strategies. Strategies to mitigate immune suppression include immunomodulatory agents as adjuvants to chemotherapy, combination therapies to enhance immune function, and supportive care measures of the immune system. Additionally, identifying potential biomarkers to predict immune suppression and guide treatment decisions holds promise for personalized cancer medicine. Future directions in this field involve further elucidating underlying mechanisms, exploring novel combination therapies, and developing targeted interventions to minimize immune suppression. By understanding and addressing chemotherapy-induced immune suppression, we can optimize cancer treatment strategies, enhance the anti-tumor immune response, and improve patient outcomes.
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Affiliation(s)
- Anirudh Sharma
- Department of Biosciences (UIBT), Chandigarh University, Mohali, Punjab, 140413, India
| | - Shivam Jasrotia
- Department of Biosciences (UIBT), Chandigarh University, Mohali, Punjab, 140413, India.
| | - Ajay Kumar
- University Center for Research & Development (UCRD), Chandigarh University, Gharuan, Mohali, Punjab, 140413, India
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Cinza-Sanjurjo S, Mazón-Ramos P, Rey-Aldana D, Garcia-Vega D, Portela-Romero M, Rodríguez-Mañero M, Sestayo-Fernández M, Lage-Fernández R, López-López R, González-Juanatey JR. Enhancing patient outcomes: Integrating electronic cardiology consultation in primary care for cancer patients. Eur J Clin Invest 2024:e14197. [PMID: 38519859 DOI: 10.1111/eci.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The prevalence of cancer patients with concomitant cardiovascular (CV) disease is on the rise due to improved cancer prognoses. The aim of this study is to evaluate the long-term outcomes of cancer patients referred to a cardiology department (CD) via primary care using e-consultation. METHODS We analysed data from cancer patients with prior referrals to a CD between 2010 and 2021 (n = 6889) and compared two care models: traditional in-person consultations and e-consultations. In e-consultation model, cardiologists reviewed electronic health records (e-consultation) to determine whether the demand could be addressed remotely or necessitated an in-person consultation. We used an interrupted time series regression model to assess outcomes during the two periods: (1) time to cardiology consultation, (2) rates of all-cause and CV related hospital admissions and (3) rates of all-cause and CV-related mortality within the first year after the initial consultation or e-consultation at the CD. RESULTS Introduction of e-consultation for cancer patients referred to cardiology care led to a 51.8% reduction (95%CI: 51.7%-51.9%) in waiting times. Furthermore, we observed decreased 1-year incidence rates, with incidence rate ratios (iRRs) [IC95%] of .75 [.73-.77] for CV-related hospitalizations, .43 [.42-.44] for all-cause hospitalizations, and .87 [.86-.88] for all-cause mortality. CONCLUSIONS Compared to traditional in-person consultations, an outpatient care program incorporating e-consultation for cancer patients significantly reduced waiting times for cardiology care and demonstrated safety, associated with lower rates of hospital admissions.
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Affiliation(s)
- Sergio Cinza-Sanjurjo
- CS Milladoiro, Área Sanitaria Integrada Santiago de Compostela, A Coruña, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medicine Department, Santiago de Compostela University, Santiago de Compostela, Spain
| | - Pilar Mazón-Ramos
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medicine Department, Santiago de Compostela University, Santiago de Compostela, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Daniel Rey-Aldana
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- CS A Estrada, Área Sanitaria Integrada Santiago de Compostela, Pontevedra, Spain
| | - David Garcia-Vega
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuel Portela-Romero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- CS Concepción Arenal, Área Sanitaria Integrada Santiago de Compostela, Rúa de Santiago León de Caracas, Santiago de Compostela, A Coruña, Spain
| | - Moisés Rodríguez-Mañero
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuela Sestayo-Fernández
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Ricardo Lage-Fernández
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael López-López
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José R González-Juanatey
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medicine Department, Santiago de Compostela University, Santiago de Compostela, Spain
- Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Attieh S, Loiselle CG. Cancer Care Team Functioning during COVID-19: A Narrative Literature Review and Synthesis. Curr Oncol 2024; 31:335-349. [PMID: 38248107 PMCID: PMC10814830 DOI: 10.3390/curroncol31010022] [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: 11/28/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Amid pandemics, health care teams face unprecedented challenges, requiring significant efforts to sustain optimal functioning and navigate rapid practice changes. It is therefore crucial to identify factors affecting team functioning in these contexts. The present narrative review more specifically summarizes the literature on key elements of cancer teams' functioning during COVID-19. The search strategy involved four main databases (i.e., Medline OVID, EMBASE, PsycINFO, and CINAHL), as well as Google Scholar, from January 2000 to September 2022. Twenty-three publications were found to be relevant. Each was read thoroughly, and its content summarized. Across publications, three key themes emerged: (1) swiftly adopting virtual technology for communication and interprofessional collaboration, (2) promoting team resilience, and (3) encouraging self-care and optimizing team support. Our findings underscore key team functioning elements to address in future pandemics. More research is needed to document the perspectives of broader-based team members (such as patients and lay carers) to inform more comprehensive evidence-based team functioning guidelines.
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Affiliation(s)
- Samar Attieh
- Department of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3J1, Canada
| | - Carmen G. Loiselle
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3A 2M7, Canada;
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H4A 3T2, Canada
- Segal Cancer Center, CIUSSS Centre-Ouest, Montreal, QC H3T 1E2, Canada
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Barefah A, Bahashwan S, Alahwal H, Almohammadi A, Radhwi O, Khan S. Impact of COVID-19 Pandemic on Treatment Decisions of Patients Treated by Hematologists in Saudi Arabia. JOURNAL OF APPLIED HEMATOLOGY 2023. [DOI: 10.4103/joah.joah_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Predictors of Covid-19 Vaccination Response After In-Vivo T-Cell–Depleted Stem Cell Transplantation. Transplant Cell Ther 2022; 28:618.e1-618.e10. [PMID: 35724850 PMCID: PMC9213029 DOI: 10.1016/j.jtct.2022.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/26/2022] [Accepted: 06/13/2022] [Indexed: 01/06/2023]
Abstract
Covid-19 vaccination is recommended in allogeneic transplant recipients, but many questions remain regarding its efficacy. Here we studied serologic responses in 145 patients who had undergone allogeneic transplantation using in vivo T-cell depletion. Median age was 57 (range 21-79) at transplantation and 61 (range 24-80) at vaccination. Sixty-nine percent were Caucasian. One third each received transplants from HLA-identical related (MRD), adult unrelated (MUD), or haploidentical-cord blood donors. Graft-versus-host disease (GVHD) prophylaxis involved in-vivo T-cell depletion using alemtuzumab for MRD or MUD transplants and anti-thymocyte globulin for haplo-cord transplants. Patients were vaccinated between January 2021 and January 2022, an average of 31 months (range 3-111 months) after transplantation. Sixty-one percent received the BNT162b2 (bioNtech/Pfizer) vaccine, 34% received mRNA-1273 (Moderna), and 5% received JNJ-78436735 (Johnson & Johnson). After the initial vaccinations (2 doses for BNT162b2 and mRNA-1273, 1 dose for JNJ-7843673), 124 of the 145 (85%) patients had a detectable SARS-CoV-2 spike protein (S) antibody, and 21 (15%) did not respond. Ninety-nine (68%) had high-level responses (≥100 binding antibody units [BAU]/mL)m and 25 (17%) had a low-level response (<100 BAU/mL). In multivariable analysis, lymphocyte count less than 1 × 109/ mL, having chronic GVHD, and being vaccinated in the first year after transplantation emerged as independent predictors for poor response. Neither donor source nor prior exposure to rituximab was predictive of antibody response. SARS-CoV-2 vaccination induced generally high response rates in recipients of allogeneic transplants including recipients of umbilical cord blood transplants and after in-vivo T cell depletion. Responses are less robust in those vaccinated in the first year after transplantation, those with low lymphocyte counts, and those with chronic GVHD.
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Use of Telemedicine in Care of Hematologic Malignancy Patients: Challenges and Opportunities. Curr Hematol Malig Rep 2022; 17:25-30. [PMID: 35015256 PMCID: PMC8749341 DOI: 10.1007/s11899-021-00642-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 01/28/2023]
Abstract
Purpose of Review For nearly 20 years, oncology specialty practices have been working to integrate telemedicine technologies into standard patient care models. However, hematology practices have been slower to adopt telemedicine due to traditional care models that rely on interdisciplinary regional care centers and their ability to provide comprehensive and centralized services. Patients have traditionally been able to access high-quality medical care, diagnostics, supportive care, and clinical trials from these regional care centers, but they are required to attend frequent in-person visits to access these services. Rural and underserved patients experience more barriers than their urban counterparts to access the same level of care. Recent Findings The COVID-19 pandemic has elevated telemedicine into the forefront of care, highlighting both promise and limitations to incorporating telemedicine into specialty hematology care. Summary Hematologists should consider the benefits of incorporating telemedicine technologies into standard-of-care practices to promote patient-centered care and provide equal access to all patient populations.
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Shaya J, Cabal A, Nonato T, Torriani F, Califano J, Lippman S, Sacco A, McKay RR. Asymptomatic detection of SARS-CoV-2 among cancer patients receiving infusional anti-cancer therapy. Cancer Med 2021; 10:8763-8767. [PMID: 34708934 PMCID: PMC8646446 DOI: 10.1002/cam4.4373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Little is known regarding the rate and clinical outcomes of asymptomatic carriers of SARS-CoV-2 among patients with cancer. Detection of asymptomatic carriers is important in this population given the use of myelosuppressive and immunomodulating therapies. Understanding the asymptomatic carrier rate will help to develop mitigation strategies in this high-risk cohort. METHODS Retrospective cohort analysis of an asymptomatic screening protocol which required patients receiving infusional anti-cancer therapy to undergo a symptom/exposure screen and SARS-CoV-2 PCR testing 24-96 h prior to their infusion. The primary outcome of this analysis was the rate of asymptomatic SARS-CoV-2 infection. Secondary outcomes included the rate of COVID-19-related hospitalization and mortality and delays in oncologic therapy. RESULTS Among a cohort of 2691 cancer patients who underwent asymptomatic screening, 1.6% (N = 43/2691) of patients were found to be SARS-CoV-2 positive on asymptomatic screening. 11.6% (N = 5/43) of the cohort ultimately developed COVID-19-related symptoms. Four patients required hospitalization for complications of COVID-19 infection. No patient died from COVID-related complications. 97.7% (N = 42/43) had their anti-cancer therapy delayed or deferred with a median delay of 21 days (range: 7-77 days). CONCLUSIONS Overall, among a cohort of active cancer patients receiving anti-cancer therapy, an asymptomatic SARS-CoV2 PCR-based screening protocol detected a small cohort of asymptomatic carriers. The majority of these patients remained asymptomatic on long-term follow-up and outcomes were much more favorable compared to previously described outcomes of cancer patients with symptomatic COVID-19 infection.
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Affiliation(s)
- Justin Shaya
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Angelo Cabal
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Taylor Nonato
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Francesca Torriani
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
- Division of Infectious DiseaseUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Joseph Califano
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Scott Lippman
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Assuntina Sacco
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Rana R. McKay
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
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Mukherji R, Marshall JL. Lessons Learned in Managing Patients with Colorectal Cancer During the COVID-19 Pandemic. Curr Treat Options Oncol 2021; 22:93. [PMID: 34424418 PMCID: PMC8381863 DOI: 10.1007/s11864-021-00888-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT The COVID-19 pandemic forced us to rapidly and dramatically shift our medical priorities and decision making. With little literature or experience to rely on, the initial priority was to minimize patient exposure to the hospital and to others. It remains unclear whether cancer patients are at higher risk of infection or serious complications, or if it is our traditional therapies that place them to be at higher risk. By far, the greatest negative impact was on screening. Routine colonoscopies were considered elective, and as a result, delays in diagnosis will be felt for years to come. The most positive changes were the incorporation of tele-visits, increased use of oral therapies, alterations in treatment schedules of both chemotherapy and radiation, and an increased emphasis on neoadjuvant therapy. These too will be felt for years to come. The colorectal cancer medical community has responded collaboratively and effectively to maintain treatment and to optimize outcomes for our patients during the COVID-19 pandemic.
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Affiliation(s)
- Reetu Mukherji
- Department of Hematology and Oncology, Georgetown University Medical Center, Washington, DC, 20057, USA
| | - John L Marshall
- Department of Hematology and Oncology, Georgetown University Medical Center, Washington, DC, 20057, USA.
- Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road, Washington, DC, 20057, USA.
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Granberg RE, Heyer A, Rising KL, Handley NR, Gentsch AT, Binder AF. Medical Oncology Patient Perceptions of Telehealth Video Visits. JCO Oncol Pract 2021; 17:e1333-e1343. [PMID: 34288697 DOI: 10.1200/op.21.00086] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Telehealth in medical oncology has expanded secondary to the COVID-19 pandemic. However, quantitative research on medical oncology telehealth use shows conflicting results on patient satisfaction, whereas qualitative data are sparse. Our qualitative study aimed to identify the factors influencing patient acceptability of video visits for medical oncology care before and at the onset of the expansion of telehealth because of the COVID-19 pandemic. METHODS Semi-structured interviews were conducted between November 2019 and April 2020 with 20 patients who participated in a telehealth visit with a medical oncology provider at Thomas Jefferson University. RESULTS Of the 20 participants, 13 (65%) were female and 15 (75%) were White, with a mean (standard deviation) age of 60.5 years (11.8). Patients identified convenience, anxiety, COVID-19, and provider preference as positively influencing the acceptability of video visits; however, some patients noted limitations in provider connection, physical examinations, and visit length as disadvantages. Regarding receipt of serious or bad news, some preferred video visits for privacy, immediacy of results, news processing, and family comfort. Others preferred in-person encounters for provider support and the ability to receive written information and in-person referrals. CONCLUSION Patient-perceived factors influencing general acceptability, appropriateness of serious and bad news delivery, and future uses of telehealth were unique to each individual, but shared common themes. Understanding each patient's perspective of telehealth acceptability and tailoring use to their preferences is critical for continued utilization. Further research is needed to understand and address reasons for lack of telehealth uptake among certain patients.
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Affiliation(s)
| | | | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.,College of Nursing, Thomas Jefferson University, Philadelphia, PA
| | - Nathan R Handley
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Alexzandra T Gentsch
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Adam F Binder
- Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Banerjee R, Kelkar AH, Logan AC, Majhail NS, Pemmaraju N. The Democratization of Scientific Conferences: Twitter in the Era of COVID-19 and Beyond. Curr Hematol Malig Rep 2021; 16:132-139. [PMID: 33788125 PMCID: PMC8011363 DOI: 10.1007/s11899-021-00620-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
Purpose of Review The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts upon scientific discourse in our field, most prominently through the abrupt transition of malignant hematology conferences to all-digital formats. These virtual components will likely be incorporated into future iterations of these conferences even as in-person attendance is reincorporated. In this review, we discuss ways in which usage of the social networking platform Twitter has expanded in the past year during virtual conferences as a method to facilitate—and, in some ways, democratize—information flow and professional networking. Recent Findings Emerging Twitter-based tools in malignant hematology include presenter-developed #tweetorials, conference-specific “poster walks,” and disease-specific online journal clubs. Twitter is also increasingly being used for networking across institutional and international lines, allowing for conversations to continue year-round as a first step toward multicenter collaborations as well as in-person #tweetups at subsequent meetings. Summary The ability of Twitter to enable uninterrupted information exchange has reinforced its central role in medical and scientific communication in a way that will certainly outlive the COVID-19 pandemic.
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Affiliation(s)
- Rahul Banerjee
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Amar H Kelkar
- Division of Hematology/Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Aaron C Logan
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Unit 428, PO BOX 301402, Houston, TX, 77230, USA.
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Kumar P, Aggarwal M, Dhawan R, Dass J, Kumar G, Sharma V, Mirza S, Senapati J, Ganju N, Vaid T, Vijayran M, Panda T, Pragna GS, Krishna SS, Khandelwal A, Verghese R, Tyagi S, Seth T, Mahapatra M. Tele-Medicine Services in Hematological Practice During Covid Pandemic: Its Feasibility and Difficulties. Indian J Hematol Blood Transfus 2020; 37:528-533. [PMID: 33250594 PMCID: PMC7678769 DOI: 10.1007/s12288-020-01385-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
In COVID 19 pandemic, delivery and access of health care services have become challenging. Telemedicine services can be considered for management of patients with hematological diseases. This study included all patients who enrolled for telemedicine facility for hematology from May 15 to July 15, 2020. Patient’s demographic and disease related parameters were recorded during the teleconsultation call. Overall satisfaction of attending doctor and patients were also recorded. A total of 1187 teleconsultation appointments were taken, of which 944 (79.6%) were successfully attended. Median age of patients was 38 years (range- 0.5–78 years), with 38% females. 55% of successful calls were from patients suffering a malignant hematological disorder. 24% had an active complaint pertaining to their disease or treatment. Of these, 162 (17%) were asked for a physical consultation. A significant association was found between the requirement of physical consultation and diagnosis (p < 0.001), absence of active complaint (< 0.0001) and education level of responder (p = 0.008). Patients understand that teleconsultation is helpful in preventing COVID-19 infection (71.4%) and avoids outpatient department rush (14.5%) associated with physical appointments; and around 80% patients were satisfied with the teleconsult. With the emergence of COVID 19, many localities under partial lockdown with constant fear of contacting virus amongst patients and health care providers, we can clearly see the advantages as well as feasibility of telemedicine services for our patients. The acute surge in telemedicine could be harnessed in the future to provide comprehensive and integrated care to patients of hematological disorders.
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Affiliation(s)
- Pradeep Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukul Aggarwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Dhawan
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Jasmita Dass
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Ganesh Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishnu Sharma
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Saleem Mirza
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Jayastu Senapati
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Ganju
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tejasvini Vaid
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Mona Vijayran
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tribikram Panda
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - G Stitha Pragna
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Sahitya Sri Krishna
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Khandelwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Renjith Verghese
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Tyagi
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Sperotto A, Candoni A, Petruzzellis G, Mullai R, Patriarca F, Tascini C, Fanin R. Screening procedure for SARS-CoV-2 infection combining triage, nasopharyngeal swab and serological test in allogeneic stem cell transplantation recipients undergoing outpatient posttransplant follow-up. J Med Virol 2020; 93:1244-1246. [PMID: 33030745 PMCID: PMC7675581 DOI: 10.1002/jmv.26586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Alessandra Sperotto
- Division of Hematology and SCT, ASUFC, University Hospital of Udine, Udine, Italy
| | - Anna Candoni
- Division of Hematology and SCT, ASUFC, University Hospital of Udine, Udine, Italy
| | | | - Rikard Mullai
- Division of Hematology and SCT, ASUFC, University Hospital of Udine, Udine, Italy
| | - Francesca Patriarca
- Division of Hematology and SCT, ASUFC, University Hospital of Udine, Udine, Italy.,Dipartimento Area Medica (DAME), University of Udine, Udine, Italy
| | - Carlo Tascini
- Dipartimento Area Medica (DAME), University of Udine, Udine, Italy.,Division of Infectious Diseases, ASUFC, University Hospital of Udine, Udine, Italy
| | - Renato Fanin
- Division of Hematology and SCT, ASUFC, University Hospital of Udine, Udine, Italy.,Dipartimento Area Medica (DAME), University of Udine, Udine, Italy
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13
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Yang S, Dong D, Gu H, Gale RP, Ma J, Huang X. Impact of stopping therapy during the SARS-CoV-2 pandemic in persons with lymphoma. J Cancer Res Clin Oncol 2020; 147:1469-1479. [PMID: 33078214 PMCID: PMC7571863 DOI: 10.1007/s00432-020-03426-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/10/2020] [Indexed: 12/24/2022]
Abstract
Introduction The severe acute respiratory syndrome-2 (SARS-CoV-2) pandemic disrupted medical care for persons with cancer including those with lymphoma. Many professional societies recommend postponing, decreasing, or stopping anti-cancer therapy in selected persons during the pandemic. Although seemingly sensible, these recommendations are not evidence-based and their impact on anxiety and health-related quality-of-life (HRQoL) is unknown. Methods We surveyed 2532 subjects including 1060 persons with lymphoma, 948 caregivers, and 524 normals using a purposed-designed questionnaire on a patient organization website. Respondents also completed the Zung Self-Rating Anxiety and patient respondents, the EORTC QLQ-C30 instruments to quantify anxiety, and HRQoL. We also evaluated caregiver support and an online education programme of the Chinese Society of Clinical Oncology (CSCO). Data of HRQoL from a 2019 pre-pandemic online survey of 1106 persons with lymphoma were a control. Results 33% (95% confidence interval [CI] 30, 36%) of lymphoma patients and 31% (28, 34%) of caregivers but only 21% (17, 24%) of normals had any level of anxiety (both pair-wise P < 0.001). Among lymphoma respondents, physical exercise and better caregiver support were associated with less anxiety, whereas female sex, receiving therapy, and reduced therapy intensity were associated with more anxiety. Paradoxically, lymphoma respondents during the pandemic had better HRQoL than pre-pandemic controls. Reduced therapy intensity was associated with worse HRQoL, whereas respondents who scored caregiver support and the online patient education programme high had better HRQoL. Conclusion During the SARS-CoV-2 pandemic, lymphoma patients and their caregivers had significantly higher incidences of anxiety compared with normals. Lymphoma respondents reported better HRQoL compared with pre-pandemic controls. Reduced therapy intensity in persons with cancer may have unanticipated adverse effects on anxiety and HRQoL. Regular and intense support by caregivers and online education programmes alleviate anxiety and improve HRQoL. Electronic supplementary material The online version of this article (10.1007/s00432-020-03426-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shenmiao Yang
- Peking University Peoples Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No.11, Xizhimen Nan Street, Beijing, 100044, China
| | - Dong Dong
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hongfei Gu
- Chinese Lymphoma Patients Organization, House086, Beijing, China
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Jun Ma
- Harbin Institute of Hematology and Oncology, Harbin, China
| | - Xiaojun Huang
- Peking University Peoples Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, No.11, Xizhimen Nan Street, Beijing, 100044, China.
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14
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Brar G, Pinheiro LC, Shusterman M, Swed B, Reshetnyak E, Soroka O, Chen F, Yamshon S, Vaughn J, Martin P, Paul D, Hidalgo M, Shah MA. COVID-19 Severity and Outcomes in Patients With Cancer: A Matched Cohort Study. J Clin Oncol 2020; 38:3914-3924. [PMID: 32986528 DOI: 10.1200/jco.20.01580] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE SARS-CoV-2 (COVID-19) is a systemic infection. Patients with cancer are immunocompromised and may be vulnerable to COVID-related morbidity and mortality. The objectives of this study were to determine if patients with cancer have worse outcomes compared with patients without cancer and to identify demographic and clinical predictors of morbidity and mortality among patients with cancer. METHODS We used data from adult patients who tested positive for COVID-19 and were admitted to two New York-Presbyterian hospitals between March 3 and May 15, 2020. Patients with cancer were matched 1:4 to controls without cancer in terms of age, sex, and number of comorbidities. Using Kaplan-Meier curves and the log-rank test, we compared morbidity (intensive care unit admission and intubation) and mortality outcomes between patients with cancer and controls. Among those with cancer, we identified demographic and clinical predictors of worse outcomes using Cox proportional hazard models. RESULTS We included 585 patients who were COVID-19 positive, of whom 117 had active malignancy, defined as those receiving cancer-directed therapy or under active surveillance within 6 months of admission. Presenting symptoms and in-hospital complications were similar between the cancer and noncancer groups. Nearly one half of patients with cancer were receiving therapy, and 45% of patients received cytotoxic or immunosuppressive treatment within 90 days of admission. There were no statistically significant differences in morbidity or mortality (P = .894) between patients with and without cancer. CONCLUSION We observed that patients with COVID-19 and cancer had similar outcomes compared with matched patients without cancer. This finding suggests that a diagnosis of active cancer alone and recent anticancer therapy do not predict worse COVID-19 outcomes and therefore, recommendations to limit cancer-directed therapy must be considered carefully in relation to cancer-specific outcomes and death.
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Affiliation(s)
- Gagandeep Brar
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Laura C Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Michael Shusterman
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Brandon Swed
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Evgeniya Reshetnyak
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Orysya Soroka
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Frank Chen
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Samuel Yamshon
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - John Vaughn
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Peter Martin
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Doru Paul
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Manuel Hidalgo
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
| | - Manish A Shah
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine/New York-Presbyterian, New York, NY
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15
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Shah MA, Emlen MF, Shore T, Mayer S, Leonard JP, Rossi A, Martin P, Ritchie E, Niesvizky R, Pastore R, Cigler T, De Sancho M, Scheff R, Van Besien K, Roboz G, Nanus D, Goldstein P, Scrimenti L, Hidalgo M. Hematology and oncology clinical care during the coronavirus disease 2019 pandemic. CA Cancer J Clin 2020; 70:349-354. [PMID: 32662880 PMCID: PMC7404745 DOI: 10.3322/caac.21627] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022] Open
Abstract
New York City has been at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic that has already infected over a million people and resulted in more than 70,000 deaths as of early May 2020 in the United States alone. This rapid and enormous influx of patients into the health care system has had profound effects on all aspects of health care, including the care of patients with cancer. In this report, the authors highlight the transformation they underwent within the Division of Hematology and Medical Oncology as they prepared for the COVID-19 crisis in New York City. Under stressful and uncertain conditions, some of the many changes they enacted within their division included developing a regular line of communication among division leaders to ensure the development and implementation of a restructuring strategy, completely reconfiguring the inpatient and outpatient units, rapidly developing the ability to perform telemedicine video visits, and creating new COVID-rule-out and COVID-positive clinics for their patients. These changes allowed them to manage the storm while minimizing the disruption of important continuity of care to their patients with cancer. The authors hope that their experiences will be helpful to other oncology practices about to experience their own individual COVID-19 crises.
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Affiliation(s)
- Manish A. Shah
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - M. Frances Emlen
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - John P. Leonard
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Adriana Rossi
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Peter Martin
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Ellen Ritchie
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Raymond Pastore
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Tessa Cigler
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Maria De Sancho
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Ronald Scheff
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Koen Van Besien
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Gail Roboz
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - David Nanus
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Paula Goldstein
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Lara Scrimenti
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Manuel Hidalgo
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
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16
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Shah MA, Mayer S, Emlen F, Sholle E, Christos P, Cushing M, Hidalgo M. Clinical Screening for COVID-19 in Asymptomatic Patients With Cancer. JAMA Netw Open 2020; 3:e2023121. [PMID: 32990737 PMCID: PMC7525345 DOI: 10.1001/jamanetworkopen.2020.23121] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This quality improvement study examines the efficacy of a repeated testing protocol for coronavirus disease 2019 (COVID-19) among patients with cancer.
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Affiliation(s)
- Manish A. Shah
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Francie Emlen
- Oncology Service Line, NewYork-Presbyterian Hospital, New York
| | - Evan Sholle
- Department of Information Technologies and Services, Weill Cornell Medicine, New York, New York
| | - Paul Christos
- Department of Medicine, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York
| | - Melissa Cushing
- Department of Anatomic and Clinical Pathology, Weill Cornell, New York, New York
| | - Manuel Hidalgo
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
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