Impact of severe acute respiratory syndrome on patient access to palliative radiation therapy

Assessing the impact of COVID-19 on outpatient and inpatient revenues: A comparative analysis of large and small hospitals in Taiwan

BACKGROUND

The COVID-19 pandemic has had profound effects on healthcare systems worldwide, not only by straining medical resources but also by significantly impacting hospital revenues. These economic repercussions have varied across different hospital departments and facility sizes. This study posits that outpatient (OPD) revenues experienced greater reductions than inpatient (IPD) revenues and that the financial impact was more profound in larger hospitals than in smaller hospitals.

METHODS

We collected data on patient case numbers and associated revenues for 468 hospitals from the Taiwan government-run National Health Insurance Administration website. We then employed Microsoft Excel to construct scatter plots using the trigonometric function (=DEGREES (Atan (growth rate))) for each hospital. Our analysis scrutinized 4 areas: the case numbers and the revenues (represented by medical fees) submitted to the Taiwan government-run National Health Insurance Administration in both March and April of 2019 and 2020 for OPD and IPD departments. The validity of our hypotheses was established through correlation coefficients (CCs) and chi-square tests. Moreover, to visualize and substantiate the hypothesis under study, we utilized the Kano diagram. A higher CC indicates consistent counts and revenues between 2019 and 2020.

RESULTS

Our findings indicated a higher impact on OPDs, with CCs of 0.79 and 0.83, than on IPDs, which had CCs of 0.40 and 0.18. Across all hospital types, there was a consistent impact on OPDs (P = .14 and 0.46). However, a significant variance was observed in the impact on IPDs (P < .001), demonstrating that larger hospitals faced greater revenue losses than smaller facilities, especially in their inpatient departments.

CONCLUSION

The two hypotheses confirmed that the COVID-19 pandemic impacted outpatient departments more than inpatient departments. Larger hospitals in Taiwan faced greater financial challenges, especially in inpatient sectors, underscoring the pandemic's varied economic effects. The COVID-19 pandemic disproportionately affected outpatient departments and larger hospitals in Taiwan. Policymakers must prioritize support for these areas to ensure healthcare resilience in future epidemics. The research approach used in this study can be utilized as a model for similar research in other countries affected by COVID-19.

Global Association of COVID-19 Pandemic Measures with Cancer Treatment: A Systematic Review and Meta-Analysis

IMPORTANCE

The COVID-19 pandemic has put a serious strain on health services, including cancer treatment.

OBJECTIVE

This study aimed to investigate the changes in cancer treatment worldwide during the first phase of the SARS-CoV-2 outbreak.

DATA SOURCES

Pubmed, Proquest, and Scopus databases were searched comprehensively for articles published between 1 January 2020 and 12 December 2021, in order to perform a systematic review and meta-analysis conducted following the PRISMA statement.

STUDY SELECTION

Studies and articles that reported data on the number of or variation in cancer treatments between the pandemic and pre-pandemic periods, comprising oncological surgery, radiotherapy, and systemic therapies, were included.

DATA EXTRACTION AND SYNTHESIS

Data were extracted from two pairs of independent reviewers. The weighted average of the percentage variation was calculated between the two periods to assess the change in the number of cancer treatments performed during the pandemic. Stratified analyses were performed by type of treatment, geographic area, time period, study setting, and type of cancer.

RESULTS

Among the 47 articles retained, we found an overall reduction of -18.7% (95% CI, -24.1 to -13.3) in the total number of cancer treatments administered during the COVID-19 pandemic compared to the previous periods. Surgical treatment had a larger decrease compared to medical treatment (-33.9% versus -12.6%). For all three types of treatments, we identified a U-shaped temporal trend during the entire period January-October 2020. Significant decreases were also identified for different types of cancer, in particular for skin cancer (-34.7% [95% CI, -46.8 to -22.5]) and for all geographic areas, in particular, Asia (-42.1% [95% CI, -49.6 to -34.7]).

CONCLUSIONS AND RELEVANCE

The interruption, delay, and modifications to cancer treatment due to the COVID-19 pandemic are expected to alter the quality of care and patient outcomes.

Impact of the early phase of the COVID pandemic on cancer treatment delivery and the quality of cancer care: a scoping review and conceptual model

BACKGROUND

The disruption of health services due to coronavirus disease (COVID) is expected to dramatically alter cancer care; however, the implications for care quality and outcomes remain poorly understood.

OBJECTIVE

We undertook a scoping review to evaluate what is known in the literature about how cancer treatment has been modified as a result of the COVID pandemic in patients receiving treatment for solid tumours, and what domains of quality of care are most impacted.

METHODS

Citations were retrieved from MEDLINE and EMBASE (from 1 January 2019 to 28 October 2020), utilizing search terms grouped by the key concept (oncology, treatment, treatment modifications and COVID). Articles were excluded if they dealt exclusively with management of COVID-positive patients, modifications to cancer screening, diagnosis or supportive care or were not in English. Articles reporting on guidelines, consensus statements, recommendations, literature reviews, simulations or predictive models, or opinions in the absence of accompanying information on experience with treatment modifications in practice were excluded. Treatment modifications derived from the literature were stratified by modality (surgery, systemic therapy (ST) and radiotherapy) and thematically grouped. To understand what areas of quality were most impacted, modifications were mapped against the Institute of Medicine's quality domains. Where reported, barriers and facilitators were abstracted and thematically grouped to understand drivers of treatment modifications. Findings were synthesized into a logic model to conceptualize the inter-relationships between different modifications, as well as their downstream impacts on outcomes.

RESULTS

In the 87 retained articles, reductions in outpatients visits (26.4%) and delays/deferrals were commonly reported across all treatment modalities (surgery: 50%; ST: 55.8% and radiotherapy: 56.7%), as were reductions in surgical capacity (57.1%), alternate systemic regimens with longer treatment intervals or use of oral agents (19.2%) and the use of hypofractionated radiotherapy regimens (40.0%). Delivery of effective, timely and equitable care was the quality domains found to be the most impacted. The most commonly reported facilitator of maintaining cancer care delivery levels was the shift to virtual models of care (62.1%), while patient-initiated deferrals and cancellations (34.8%), often due to fear of contracting COVID (60.9%), was a commonly reported barrier.

CONCLUSIONS

As it will take a considerable amount of time for the cancer system to resume capacity and adjust models of care in response to the pandemic, these treatment delays and modifications will likely be prolonged and will negatively impact the quality of care and patient outcomes.

[The Effects and Management of Viral Pneumonia on Lung Cancer Patients]

The worldwide epidemic of three coronaviruses and one influenza virus in 21st century have seriously threatened human health. Infection with these viruses can cause respiratory symptoms. The patients with lung cancer are more susceptible to viral infection and have a worse prognosis due to the advanced age and the systemic immunosuppressive state caused by malignancy itself and the anticancer treatments. In addition, without sufficient clinical awareness, a missed diagnosis of viral pneumonia may occur due to the fever and respiratory symptoms caused by lung cancer and its secondary diseases. Furthermore, control measures against viral outbreaks may interfere with routine diagnosis and treatment of lung cancer patients. Therefore, scientific protection and individualized management of lung cancer patients are particularly important during virus epidemic prevention and control. Here, we systematically reviewed the epidemiological and clinical characteristics of viral pneumonia, its impact on patients with lung cancer and the differential diagnosis of lung cancer-related respiratory manifestations, aiming to provide guidance for the individual management of lung cancer patients during the prevention and control of viral pneumonia epidemic.

Radiotherapy for oncologic emergencies on weekends: examining reasons for treatment and patterns of practice at a Canadian cancer centre

Purpose

Radiotherapy for oncologic emergencies is an important aspect of the management of cancer patients. These emergencies—which include malignant spinal cord compression, brain metastases, superior vena cava obstruction, and uncontrolled tumour hemorrhage —may require treatment outside of hospital hours, particularly on weekends and hospital holidays. To date, there remains no consensus among radiation oncologists regarding the indications and appropriateness of radiotherapy treatment on weekends, and treatment decisions remain largely subjective. The main aim of the present study was to document the incidence and indications for patients receiving emergency treatment on weekends or scheduled hospital holidays at a single institution. The secondary aim was to investigate the compliance of such treatment with the institution’s quality assurance policies, both local and provincial.

Methods

From September 1, 2002, to September 30, 2004, patients being treated over weekends (defined as commencing at 6 pm on a Friday and concluding at 8 am of the next scheduled workday) and hospital holidays were retrospectively identified using the Oncology Patient Information System scheduling module. Relevant patient data—including patient age, sex, primary cancer site, specific radiation field, rationale for treatment, referring hospital, total treatment dose, radiation dose fractionation, inpatient or outpatient status, and duration of treatment—were collected and subsequently analyzed. Comparison to local policy was performed subjectively.

Results

Over the 2-year period, 161 patients were prescribed urgent radiotherapy over a weekend or on a hospital holiday. Of this cohort, 68% were treated on both Saturday and Sunday, 22% on Saturday alone, and 10% on Sunday alone. Most patients presented with lung (31%), prostate (18%), and breast cancer (17%). The top reasons for referral for emergency weekend treatment included spinal cord compression (56%), brain metastases (15%), and superior vena cava obstruction (6%). Most of the indications for treatment generally followed the quality assurance policies implemented both locally and provincially.

Conclusions

Patients treated over a weekend or on a hospital holiday were generally found to be treated with appropriate intent. Most treatment indications within this study both complied with provincial policy and showed a pattern of care similar to that seen in other studies in the literature. Local policy appears to be robust; however, policy improvements may allow for more cohesiveness across radiation oncologists in patterns of care in this important group of patients. Comparisons with practice at other institutions would be valuable and also a key step in developing sound guidelines for all members of the radiotherapy community to follow.