Silver linings: a qualitative study of desirable changes to cancer care during the COVID-19 pandemic

Perspectives of patients undergoing neoadjuvant chemotherapy for breast cancer during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic resulted in a lapse in routine health care and cancer screenings for many individuals. This study sought to improve our understanding of the impact of the COVID-19 pandemic on women being treated for breast cancer, both in general, and specifically related to their diagnosis.

METHODS

Semi-structured interviews were conducted between August 2021 and February 2022 with women who were receiving neoadjuvant chemotherapy for early-stage breast cancer at the Stefanie Spielman Comprehensive Breast Center in Columbus, Ohio. Interviews were recorded and transcribed verbatim. Transcripts were coded using deductive dominant thematic analysis and inductive coding that allowed for categorization of data as well as identification of emergent themes.

RESULTS

Data collected from our 19 interviews revealed that the COVID-19 pandemic posed important challenges for breast cancer patients including fear of COVID-19 infection and feelings of isolation. Most interviewees noted they had been vaccinated against COVID-19 because of a desire to protect themselves and others from getting sick. Some women also expressed concerns about having delayed their screening mammograms due to the pandemic. Several patients described unexpected positive aspects of the pandemic such as being able to spend more time with family and having the ability to continue working because of the option to work from home during their cancer treatment.

CONCLUSIONS

Our findings provide important insight about the impact of COVID-19 on breast cancer patients. We highlight the positives that have been reported because of the pandemic, as well as the need to address delayed breast cancer screening.

Early survival for patients newly diagnosed with cancer during COVID-19 in Ontario, Canada: A population-based cohort study

BACKGROUND

Little is known about the association between the COVID-19 pandemic and early survival among newly diagnosed cancer patients.

METHODS

This retrospective population-based cohort study used linked administrative datasets from Ontario, Canada. Adults (≥18 years) who received a cancer diagnosis between March 15 and December 31, 2020, were included in a pandemic cohort, while those diagnosed during the same dates in 2018/2019 were included in a pre-pandemic cohort. All patients were followed for one full year after the date of diagnosis. Cox proportional hazards regression models were used to assess survival in relation to the pandemic, patient characteristics at diagnosis, and the modality of first cancer treatment as a time-varying covariate. Interaction terms were explored to measure the pandemic association with survival for each cancer type.

RESULTS

Among 179,746 patients, 53,387 (29.7%) were in the pandemic cohort and 37,741 (21.0%) died over the first post-diagnosis year. No association between the pandemic and survival was found when adjusting for patient characteristics at diagnosis (HR 0.99 [95% CI 0.96-1.01]), while marginally better survival was found for the pandemic cohort when the modality of treatment was additionally considered (HR 0.97 [95% CI 0.95-0.99]). When examining each cancer type, only a new melanoma diagnosis was associated with a worse survival in the pandemic cohort (HR 1.25 [95% CI 1.05-1.49]).

CONCLUSIONS

Among patients able to receive a cancer diagnosis during the pandemic, one-year overall survival was not different than those diagnosed in the previous 2 years. This study highlights the complex nature of the COVID-19 pandemic impact on cancer care.

Experiences of cancer care in COVID-19: A longitudinal qualitative study

PURPOSE

This study aimed to explore the cancer care experiences of people living with and beyond cancer during COVID-19 in Ireland.

METHODS

The study adopted a longitudinal qualitative design using semi-structured interviews with sixteen participants. Interviews were undertaken on three occasions over six months (January-June 2021). The National Comprehensive Cancer Network Distress Thermometer (NCCN DT), and Connor-Davidson-Resilience Scale (CD-RISC2) were also used as part of the interviews to measure distress and resilience. Thematic analysis of interview data was conducted and participants' self-rating for distress and resilience was analysed using descriptive statistics.

RESULTS

Sixteen patients participated. The findings revealed participants' constant fear of COVID-19 over time and efforts to stay safe by following the 'rules'. Isolation was a common experience as COVID-19 restrictions resulted in being alone when attending the hospital for treatment and limited support from family and friends. Telephone follow-up was limited in terms of support and patients' opportunity to ask questions. For a minority, COVID-19 restrictions meant they were 'not missing out'. On average, participants reported moderate to high levels of resilience at all time points. Distress scores were low but trended upwards from T1 to T2.

CONCLUSIONS

The findings highlight the need to avoid restrictions on carers accompanying their close relatives to the hospital for treatment. An evaluation of the effects of the rapid introduction of telephone follow-up on patient outcomes is warranted.

Contingency planning for cancer care in low- and middle-income countries during the COVID-19 pandemic: a rapid assessment for future disaster resilience

BACKGROUND

Many countries appear to be ill-prepared in their emergency responses towards the Corona Virus Disease 2019 (COVID-19) pandemic, particularly in managing chronic diseases such as cancer. We aimed to gain insight on the preparedness of health systems within low- and middle-income countries (LMICs) in maintaining delivery of cancer care amid the pandemic.

METHODS

We performed a rapid review of publications focusing on emergency contingency plans for cancer care during the pandemic in LMICs. An online desk research was conducted to identify relevant policy documents, guidelines or scientific publications.

RESULTS

Very few LMICs had readily accessible documents to ensure continuity in delivery of cancer care during the pandemic. A majority of publications were focused on delivery of cancer treatment whereas early detection, diagnosis and delivery of supportive and survivorship care received very little attention. Far fewer of the published guidelines appear to have been formulated at the national level by governmental agencies. A vast majority of publications constituted consensus guidelines from professional societies, followed by sharing of best practices from local institutions. Overall, three main strategies have been recommended to maintain delivery of cancer care amid the pandemic in LMICs: 1) Modification of cancer treatment regimens, 2) Changes in methods of administration of curative and supportive cancer care and 3) Implementation of generic measures to reduce the risk of COVID-19 infection in healthcare settings.

CONCLUSION

All LMICs should consider collating best practices from the current pandemic and translating them into an explicit cancer preparedness plan, which can be escalated during future disasters.

Healthcare Professional and Patient Perceptions of Changes in Colorectal Cancer Care Delivery During the COVID-19 Pandemic and Impact on Health Inequalities

BACKGROUND

The COVID-19 pandemic changed the way in which people were diagnosed and treated for cancer. We explored healthcare professional and patient perceptions of the main changes to colorectal cancer delivery during the COVID-19 pandemic and how they impacted on socioeconomic inequalities in care.

METHODS

In 2020, using a qualitative approach, we interviewed patients (n = 15) who accessed primary care with colorectal cancer symptoms and were referred for further investigations. In 2021, we interviewed a wide range of healthcare professionals (n = 30) across the cancer care pathway and gathered national and local documents/guidelines regarding changes in colorectal cancer care.

RESULTS

Changes with the potential to exacerbate inequalities in care, included: the move to remote consultations; changes in symptomatic triage, new COVID testing procedures/ways to access healthcare, changes in visitor policies and treatment (e.g., shorter course radiotherapy). Changes that improved patient access/convenience or the diagnostic process have the potential to reduce inequalities in care.

DISCUSSION

Changes in healthcare delivery during the COVID-19 pandemic have the ongoing potential to exacerbate existing health inequalities due to changes in how patients are triaged, changes to diagnostic and disease management processes, reduced social support available to patients and potential over-reliance on digital first approaches. We provide several recommendations to help mitigate these harms, whilst harnessing the gains.

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

Background

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently constitutes the leading and overwhelming health issue worldwide. In comparison with adults, children present milder symptoms, with most having an asymptomatic course. We hypothesized that COVID-19 infection has a negative impact on the continuation of chemotherapy and increases nonrelapse mortality.

Material and methods

This study was performed to assess the course of SARS-CoV-2 among children with hematological or oncological malignancies and its impact on cancer therapy. Records of SARS-CoV-2 infection in 155 children with malignancies from 14 Polish centers for pediatric hematology and oncology were collected and analyzed.

Results

SARS-CoV-2 replication was observed in 155 patients. Forty-nine patients were symptomatic, with the following being the most common manifestations: fever (31 patients), gastrointestinal symptoms (10), coryza (13), cough (13) and headache (8). In children who were retested, the median time of a positive PCR result was 16 days (range 1–70 days), but 12.7% of patients were positive beyond day + 20. The length of viral PCR positivity correlated with the absolute neutrophil count at diagnosis. Seventy-six patients did not undergo further SARS-CoV-2 testing and were considered convalescents after completion of isolation. Antibiotic therapy was administered in 15 children, remdesivir in 6, convalescent plasma in 4, oxygen therapy in 3 (1—mechanical ventilation), steroids in 2, intravenous immunoglobulins in 2, and heparin in 4. Eighty patients were treated with chemotherapy within 30 days after SARS-CoV-2 infection diagnosis or were diagnosed with SARS-CoV-2 infection during 30 days of chemotherapy administration. Respiratory symptoms associated with COVID-19 and associated with oxygen therapy were present in 4 patients in the study population, and four deaths were recorded (2 due to COVID-19 and 2 due to progressive malignancy). The probability of 100-day overall survival was 97.3% (95% CI 92.9–99%). Delay in the next chemotherapy cycle occurred in 91 of 156 cases, with a median of 14 days (range 2–105 days).

Conclusions

For the majority of pediatric cancer patients, SARS-CoV-2 infection does not result in a severe, life-threatening course. Our data show that interruptions in therapy are common and can result in suboptimal therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13045-021-01181-4.

Experiences and coping strategies of women receiving treatment for breast and gynecological cancers during the COVID-19 pandemic: A qualitative study

Purpose

The aim of this study was to examine experiences and coping strategies of women receiving treatment for breast and gynecological cancers during the COVID-19 pandemic.

Methods

A descriptive, phenomenological approach was adopted. The study included 15 women receiving treatment for breast and gynecological cancers in the chemotherapy center of a university hospital. Data was collected with a descriptive characteristic form and semi-structured in-depth interviews.

Results

Data analysis revealed three main themes: Problems, protection and coping. The main theme of 'problems' was grouped into four categories: living with anxiety and fear, social isolation, physical difficulties, and financial difficulties. 'Protection' was grouped into four categories: decreased stigmatization, increased preventive measures, increased communication between family members, and keeping distance. Coping was grouped into four categories: religious practices, social support, positive thinking, and hobbies.

Conclusions

The participants were found to experience psychosocial, financial and physical difficulties. However, they also mentioned positive aspects of the pandemic: elimination of stigmatization due to the obligation for everyone to wear a mask, lack of visits due to the lockdown and enhanced communication with family members due to increased time spent at home. Religious practices, social support, positive thinking and spending time on hobbies were helpful to cope with the problems experienced during the pandemic. The results of this study can guide nurses in offering high-quality nursing care and counseling to women treated for breast and gynecological cancers during the pandemic.

The UK's contribution to cancer control in low-income and middle-income countries

Cancer mortality rates in low-income and middle-income countries (LMICs) are unacceptably high, requiring both collaborative global effort and in-country solutions. Experience has shown that working together in policy, clinical practice, education, training, and research leads to bidirectional benefit for LMICs and high-income countries. For over 60 years, the UK National Health Service has benefited from recruitment from LMICs, providing the UK with a rich diaspora of trained health-care professionals with links to LMICs. A grassroots drive to engage with partners in LMICs within the UK has grown from the National Health Service, UK academia, and other organisations. This drive has generated a model that rests on two structures: London Global Cancer Week and the UK Global Cancer Network, providing a high-value foundation for international discussion and collaboration. Starting with a historical perspective, this Series paper describes the UK landscape and offers a potential plan for the future UK's contribution to global cancer control. We also discuss the opportunities and challenges facing UK partnerships with LMICs in cancer control. The UK should harness the skills, insights, and political will from all partners to make real progress.