1
|
Sharifzadeh Y, Breen WG, Harmsen WS, Amundson AC, Garda AE, Routman DM, Waddle MR, Merrell KW, Hallemeier CL, Laack NN, Kollengode A, Corbin KS. Integration of Telemedicine Consultation Into a Tertiary Radiation Oncology Department: Predictors of Use, Treatment Yield, and Effects on Patient Population. JCO Clin Cancer Inform 2024; 8:e2300239. [PMID: 38630957 DOI: 10.1200/cci.23.00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/01/2024] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The COVID-19 pandemic led to rapid expansion of telemedicine. The implications of telemedicine have not been rigorously studied in radiation oncology, a procedural specialty. This study aimed to evaluate the characteristics of in-person patients (IPPs) and virtual patients (VPs) who presented to a large cancer center before and during the pandemic and to understand variables affecting likelihood of receiving radiotherapy (yield) at our institution. METHODS A total of 17,915 patients presenting for new consultation between 2019 and 2021 were included, stratified by prepandemic and pandemic periods starting March 24, 2020. Telemedicine visits included video and telephone calls. Area deprivation indices (ADIs) were also compared. RESULTS The overall population was 56% male and 93% White with mean age of 63 years. During the pandemic, VPs accounted for 21% of visits, were on average younger than their in-person (IP) counterparts (63.3 years IP v 62.4 VP), and lived further away from clinic (215 miles IP v 402 VP). Among treated VPs, living closer to clinic was associated with higher yield (odds ratio [OR], 0.95; P < .001). This was also seen among IPPs who received treatment (OR, 0.96; P < .001); however, the average distance from clinic was significantly lower for IPPs than VPs (205 miles IP v 349 VP). Specialized radiotherapy (proton and brachytherapy) was used more in VPs. IPPs had higher ADI than VPs. Among VPs, those treated had higher ADI (P < .001). CONCLUSION Patient characteristics and yield were significantly different between IPPs and VPs. Telemedicine increased reach to patients further away from clinic, including from rural or health care-deprived areas, allowing access to specialized radiation oncology care. Telemedicine has the potential to increase the reach of other technical and procedural specialties.
Collapse
Affiliation(s)
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - William S Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Adam C Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Allison E Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
2
|
Ma B, Lu Y. Racial Disparities in the Clinical Prognosis of Gastrointestinal Cancer Patients with COVID-19: a Retrospective Study in UC CORDS. J Racial Ethn Health Disparities 2024; 11:216-225. [PMID: 36637614 PMCID: PMC9838534 DOI: 10.1007/s40615-023-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cancer patients are highly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Few studies have examined racial disparities of clinical prognosis among gastrointestinal (GI) cancer patients with COVID-19, especially after the approval of COVID-19 vaccines. METHODS We conducted a retrospective study based on the University of California COVID Research Data Set (UC CORDS). Patients aged ≥ 18 with GI cancer as well as SARS-CoV-2 infection between March 10, 2020, and May 8, 2022, were included. We examined racial disparities using multivariable logistic regression. RESULTS Among the 1054 GI cancer cases included, 117 (11.1%) patients were Asian and Pacific Islander, 51 (4.8%) were Black patients, 377 (35.8%) were Hispanic patients, 403 (38.2%) were White patients, and 106 (10.1%) belonged to other or unknown races. Fully adjusted logistic models revealed a significantly increased risk of COVID-19-related hospitalization or emergency room visits among the Black (OR = 2.26, 95% CI = 1.08-4.70), the Hispanic (OR = 2.24, 95% CI = 1.48-3.39), and the patients of other or unknown races (OR = 1.80, 95% CI = 1.00-3.26) compared with the White patients. No significant racial disparities in 30-day all-cause mortality and mechanical ventilation rate were found. Vaccination, age, cancer type, recent cancer diagnoses in UC CORDS, metastatic cancer or secondary malignant neoplasm, and Charlson comorbidity index score were associated with the prognosis of GI cancer patients with COVID-19. CONCLUSIONS GI cancer patients belonging to racial minorities experience worse COVID-19 outcomes. Vaccination status is a crucial factor associated with GI cancer patients' prognosis among different race/ethnicity groups. Targeted communication in the context of cancer is needed to encourage vaccination uptake in this vulnerable population.
Collapse
Affiliation(s)
- Bingya Ma
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Yunxia Lu
- Department of Population Health and Disease Prevention, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA.
| |
Collapse
|
3
|
Doshi SD, Bange EM, Daly B, Kuperman G, Panageas KS, Morris MJ. Telemedicine and Cancer Care: Barriers and Strategies to Optimize Delivery. Cancer J 2024; 30:8-15. [PMID: 38265920 PMCID: PMC10832391 DOI: 10.1097/ppo.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
ABSTRACT Telemedicine holds the potential to transform cancer care delivery and optimize value, access, and quality of care. A transformed regulatory environment coupled with the need to continue medical care despite operational limitations led to the rapid expansion of telemedicine in cancer care during the COVID-19 pandemic. Its utilization has since varied, and it has faced significant challenges. In this review, we will explore the state of telemedicine in cancer care delivery, the challenges it faces, and strategies to enhance its successful implementation.
Collapse
Affiliation(s)
| | - Erin M. Bange
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | |
Collapse
|
4
|
Iasiello JA, Rajan A, Zervos E, Parikh AA, Snyder RA. Racial Differences in Patient-Reported Access to Telehealth: An Important and Unmeasured Social Determinant of Health. JCO Oncol Pract 2023; 19:1215-1223. [PMID: 37844269 DOI: 10.1200/op.23.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/20/2023] [Accepted: 08/14/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE The COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify barriers that might limit access to telehealth video services. METHODS First, retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center during the pandemic (March 2020 to April 2022). Second, a prospective, cross-sectional study was conducted of patients with known or suspected malignancy over a 6-month period (November 2021 to April 2022). A survey regarding video telehealth accessibility was verbally administered to patients at their clinic visit. RESULTS Administrative data demonstrated that although Black patients comprised 43% (n = 9,021) of all patient visits (n = 20,953), the proportion of telehealth visits conducted among Black patients was significantly lower compared with White patients (29% v 71%; P < .0001). Of the prospective, cross-sectional study cohort (n = 148), 51.4% of patients (n = 76) were Black, 38.5% (n = 57) resided in a rural county, and 8.1% (n = 12) were Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% v 90.4%; P < .01) and were less likely to report having access to or actively using a patient portal (29.0% v 47.2%; P < .001) compared with White patients. The independent association of race and internet access (P < .05) and patient portal use (P = .001) persisted after multivariable analysis. CONCLUSION Black patients disproportionately underparticipated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal compared with White patients. Ensuring equal internet access and digital literacy will be critical to reduce disparities in cancer care among racial minorities.
Collapse
Affiliation(s)
- John A Iasiello
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Arvind Rajan
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Emmanuel Zervos
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Alexander A Parikh
- Department of Surgery, The University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
5
|
Chen S, James SA, Hall S, Dang JH, Campbell JE, Chen MS, Doescher MP. Avoidance of medical care among American Indians with a history of cancer during the coronavirus pandemic. Front Public Health 2023; 11:1265071. [PMID: 38026426 PMCID: PMC10664709 DOI: 10.3389/fpubh.2023.1265071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Assess the percentage of cancer-related appointment delays, cancelations, and the unavailability of medications experienced by American Indian participants during the COVID-19 pandemic. Methods This cross-sectional survey study was completed between October 2020 and July 2021 by 360 individuals with cancer who lived in California and Oklahoma. Binary and multivariate logistic regression analysis was completed in SAS 9.4. Results During the initial Covid-19 pandemic, almost one-third (30%) of respondents delayed cancer-related appointments, 42% canceled cancer-related appointments, and one-quarter (24%) were unable to access prescription medications or over-the-counter medications (27%) due to COVID-19. People who underwent testing for COVID-19 were five times more likely to delay a medical appointment [adjusted odds ratio (aOR) = 5.3, 95% CI:2.4, 11.7] and people who followed three or more social distancing measures were more than six times more likely to cancel medical appointments (aOR:6.3, 95% CI:2.9, 13.9). Conclusion This study identifies delays, cancelations, and medication inaccessibility people identifying as American Indian faced during the coronavirus pandemic. Disparities in healthcare delivery could contribute to increased morbidity and mortality rates of cancer.
Collapse
Affiliation(s)
- Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Shirley A. James
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Spencer Hall
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Julie H. Dang
- UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, United States
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Moon S. Chen
- UC Davis Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, United States
| | - Mark P. Doescher
- Stephenson Cancer Center, College of Medicine, University of Oklahoma, Oklahoma City, OK, United States
| |
Collapse
|
6
|
Mak VP, White K, Wilkens LR, Cheng I, Haiman CA, Le Marchand L. The impact of COVID-19 on cancer screening and treatment in older adults: The Multiethnic Cohort Study. eLife 2023; 12:e86562. [PMID: 37366344 PMCID: PMC10642961 DOI: 10.7554/elife.86562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Background The Coronavirus Disease of 2019 (COVID-19) has impacted the health and day-to-day life of individuals, especially the elderly and people with certain pre-existing medical conditions, including cancer. The purpose of this study was to investigate how COVID-19 impacted access to cancer screenings and treatment, by studying the participants in the Multiethnic Cohort (MEC) study. Methods The MEC has been following over 215,000 residents of Hawai'i and Los Angeles for the development of cancer and other chronic diseases since 1993-1996. It includes men and women of five racial and ethnic groups: African American, Japanese American, Latino, Native Hawaiian, and White. In 2020, surviving participants were sent an invitation to complete an online survey on the impact of COVID-19 on their daily life activities, including adherence to cancer screening and treatment. Approximately 7,000 MEC participants responded. A cross-sectional analysis was performed to investigate the relationships between the postponement of regular health care visits and cancer screening procedures or treatment with race and ethnicity, age, education, and comorbidity. Results Women with more education, women with lung disease, COPD, or asthma, and women and men diagnosed with cancer in the past 5 years were more likely to postpone any cancer screening test/procedure due to the COVID-19 pandemic. Groups less likely to postpone cancer screening included older women compared to younger women and Japanese American men and women compared to White men and women. Conclusions This study revealed specific associations of race/ethnicity, age, education level, and comorbidities with the cancer-related screening and healthcare of MEC participants during the COVID-19 pandemic. Increased monitoring of patients in high-risk groups for cancer and other diseases is of the utmost importance as the chance of undiagnosed cases or poor prognosis is increased as a result of delayed screening and treatment. Funding This research was partially supported by the Omidyar 'Ohana Foundation and grant U01 CA164973 from the National Cancer Institute.
Collapse
Affiliation(s)
- Victoria P Mak
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at ManoaHonoluluUnited States
| | - Kami White
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at ManoaHonoluluUnited States
| | - Lynne R Wilkens
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at ManoaHonoluluUnited States
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San FranciscoSan FranciscoUnited States
| | - Christopher A Haiman
- Center for Genetic Epidemiology, University of Southern CaliforniaLos AngelesUnited States
| | - Loic Le Marchand
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at ManoaHonoluluUnited States
| |
Collapse
|
7
|
Demanelis K, Rosenzweig M, Robertson LB, Low CA, Daniels S, Abujaradeh H, Simon B, Bovbjerg DH, Diergaarde B. Impact of the COVID-19 pandemic on cancer patients in western Pennsylvania: rural-urban disparities. Cancer Causes Control 2023; 34:595-609. [PMID: 37129763 PMCID: PMC10153039 DOI: 10.1007/s10552-023-01696-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Disparities in cancer care persist between patients living in rural versus urban areas. The COVID-19 pandemic may have impacted concerns related to care and personal health differently in rural cancer patients. Using survey data collected from cancer patients in western Pennsylvania, we examined pandemic-related distress, concerns related to cancer care, impact on personal health, and the extent to which these differed by urban-rural residence. METHODS Patients filled out an initial survey in August-December 2020; a second survey was completed in March 2021. The following patient concerns related to the pandemic were evaluated: threat of COVID-19 to their health, pandemic-related distress, perceptions of cancer care, and vaccine hesitancy. Multivariable logistic regression models were used to examine relationships between these outcomes and urban-rural residence as well as patient-related factors, including anxiety symptoms and social support. RESULTS The study sample included 1,980 patients, 17% resided in rural areas. COVID-19 represented a major or catastrophic threat to personal health for 39.7% of rural and 49.0% of urban patients (p = 0.0017). Patients with high general anxiety were 10-times more likely to experience pandemic-related distress (p < 0.001). In the follow-up survey (n = 983), vaccine hesitancy was twice as prevalent among rural patients compared to urban (p = 0.012). CONCLUSIONS The extent to which perceptions of the threat of COVD-19 to personal health and vaccine hesitancy exacerbates rural-urban disparities in cancer care and prognosis warrants further study. Cancer patients may be vulnerable to heightened anxiety and distress triggered by the pandemic.
Collapse
Affiliation(s)
- Kathryn Demanelis
- School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA.
| | - Margaret Rosenzweig
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
- School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda B Robertson
- School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Carissa A Low
- School of Medicine, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Shayla Daniels
- School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiba Abujaradeh
- School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth Simon
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
| | - Dana H Bovbjerg
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brenda Diergaarde
- UPMC Hillman Cancer Center, 5114 Centre Ave, Pittsburgh, PA, 15232, USA
- School of Public Health, Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
8
|
Patel KB, Tabriz AA, Turner K, Gonzalez BD, Oswald LB, Jim HS, Nguyen OT, Hong YR, Aldawoodi N, Cao B, Wang X, Rollison DE, Robinson EJ, Naso C, Spiess PE. Telemedicine Adoption in an NCI-Designated Cancer Center During the COVID-19 Pandemic: A Report on Patient Experience of Care. J Natl Compr Canc Netw 2023; 21:496-502.e6. [PMID: 37156477 PMCID: PMC10777340 DOI: 10.6004/jnccn.2023.7008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 02/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Patients with cancer require timely access to care so that healthcare providers can prepare an optimal treatment plan with significant implications for quality of life and mortality. The COVID-19 pandemic spurred rapid adoption of telemedicine in oncology, but study of patient experience of care with telemedicine in this population has been limited. We assessed overall patient experience of care with telemedicine at an NCI-designated Comprehensive Cancer Center during the COVID-19 pandemic and examined changes in patient experience over time. PATIENTS AND METHODS This was a retrospective study of outpatient oncology patients who received treatment at Moffitt Cancer Center. Press Ganey surveys were used to assess patient experience. Data from patients with appointments between April 1, 2020, and June 30, 2021, were analyzed. Patient experience was compared between telemedicine and in-person visits, and patient experience with telemedicine over time was described. RESULTS A total of 33,318 patients reported Press Ganey data for in-person visits, and 5,950 reported Press Ganey data for telemedicine visits. Relative to patients with in-person visits, more patients with telemedicine visits gave higher satisfaction ratings for access (62.5% vs 75.8%, respectively) and care provider concern (84.2% vs 90.7%, respectively) (P<.001). When adjusted for age, race/ethnicity, sex, insurance, and clinic type, telemedicine visits consistently outperformed in-person visits over time regarding access and care provider concern (P<.001). There were no significant changes over time in satisfaction with telemedicine visits regarding access, care provider concern, telemedicine technology, or overall assessment (P>.05). CONCLUSIONS In this study, a large oncology dataset showed that telemedicine resulted in better patient experience of care in terms of access and care provider concern compared with in-person visits. Patient experience of care with telemedicine visits did not change over time, suggesting that implementing telemedicine was effective.
Collapse
Affiliation(s)
- Krupal B. Patel
- Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa, Florida
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Heather S.L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | | | - Biwei Cao
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Dana E. Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Edmondo J. Robinson
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida
- Center for Digital Health, Moffitt Cancer Center, Tampa, Florida
| | - Cristina Naso
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
| | - Philippe E. Spiess
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
| |
Collapse
|
9
|
Yeoh K, Wu Y, Chakraborty S, Elhusseiny G, Gondhowiardjo S, Joseph N, Lee AWM, Loong HH, Msadabwe-Chikuni SC, Tan BF, Ospina AV, Roques T, Shum HM, Yeoh EK. Global Health System Resilience during Encounters with Stressors - Lessons Learnt from Cancer Services during the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2023; 35:e289-300. [PMID: 36764875 DOI: 10.1016/j.clon.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
AIMS The protracted COVID-19 pandemic has overwhelmed health systems globally, including many aspects of cancer control. This has underscored the multidimensional nature of cancer control, which requires a more comprehensive approach involving taking a wider perspective of health systems. Here, we investigated aspects of health system resilience in maintaining cancer services globally during the COVID-19 pandemic. This will allow for health systems to be resilient to different types of system stressors/shocks in the future, to allow cancer care to be maintained optimally. MATERIALS AND METHODS Using the World Health Organization health system framework (capturing aspects of service delivery, health workforce, information, medical products, vaccines and technologies, financing and governance and leadership), we carried out a comparative analysis of the impact of COVID-19 and the synthesis of the findings in responses in cancer care in 10 countries/jurisdictions across four continents comprising a wide diversity of health systems, geographical regions and socioeconomic status (China, Colombia, Egypt, Hong Kong SAR, Indonesia, India, Singapore, Sri Lanka, UK and Zambia). A combination of literature and document reviews and interviews with experts was used. RESULTS Our study revealed that: (i) underlying weaknesses of health systems before the pandemic were exacerbated by the pandemic (e.g. economic issues in low- and middle-income countries led to greater shortage of medication and resource constraints compounded by inadequacies of public financing and issues of engagement with stakeholders and leadership/governance); (ii) no universal adaptive strategies were applicable to all the systems, highlighting the need for health systems to design emergency plans based on local context; (iii) despite the many differences between health systems, common issues were identified, such as the lack of contingency plan for pandemics, inadequate financial policies for cancer patients and lack of evidence-based approaches for competing priorities of cancer care/pandemic control. CONCLUSION We identified four key points/recommendations to enhance the resilient capacity of cancer care during the COVID-19 pandemic and other system stressors: (i) effective pandemic control approaches in general are essential to maintain the continuity of cancer care during the emergency health crises; (ii) strong health systems (with sufficient cancer care resources, e.g. health workforce, and universal health coverage) are fundamental to maintain quality care; (iii) the ability to develop response strategies and adapt to evolving evidence/circumstances is critical for health system resilience (including introducing systematic, consistent and evidence-based changes, national support and guidance in policy development and implementation); (iv) preparedness and contingency plans for future public health emergencies, engaging the whole of society, to achieve health system resilience for future crises and to transform healthcare delivery beyond the pandemic.
Collapse
|
10
|
Llanos AAM, Ashrafi A, Ghosh N, Tsui J, Lin Y, Fong AJ, Ganesan S, Heckman CJ. Evaluation of Inequities in Cancer Treatment Delay or Discontinuation Following SARS-CoV-2 Infection. JAMA Netw Open 2023; 6:e2251165. [PMID: 36637818 PMCID: PMC9856904 DOI: 10.1001/jamanetworkopen.2022.51165] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE There is a disproportionately greater burden of COVID-19 among Hispanic and non-Hispanic Black individuals, who also experience poorer cancer outcomes. Understanding individual-level and area-level factors contributing to inequities at the intersection of COVID-19 and cancer is critical. OBJECTIVE To evaluate associations of individual-level and area-level social determinants of health (SDOH) with delayed or discontinued cancer treatment following SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This retrospective, registry-based cohort study used data from 4768 patients receiving cancer care who had positive test results for SARS-CoV-2 and were enrolled in the American Society for Clinical Oncology COVID-19 Registry. Data were collected from April 1, 2020, to September 26, 2022. EXPOSURES Race and ethnicity, sex, age, and area-level SDOH based on zip codes of residence at the time of cancer diagnosis. MAIN OUTCOMES AND MEASURES Delayed (≥14 days) or discontinued cancer treatment (any cancer treatment, surgery, pharmacotherapy, or radiotherapy) and time (in days) to restart pharmacotherapy. RESULTS A total of 4768 patients (2756 women [57.8%]; 1558 [32.7%] aged ≥70 years at diagnosis) were included in the analysis. There were 630 Hispanic (13.2%), 196 non-Hispanic Asian American or Pacific Islander (4.1%), 568 non-Hispanic Black (11.9%), and 3173 non-Hispanic White individuals (66.5%). Compared with non-Hispanic White individuals, Hispanic and non-Hispanic Black individuals were more likely to experience a delay of at least 14 days or discontinuation of any treatment and drug-based treatment; only estimates for non-Hispanic Black individuals were statistically significant, with correction for multiple comparisons (risk ratios [RRs], 1.35 [95% CI, 1.22-1.49] and 1.37 [95% CI, 1.23-1.52], respectively). Area-level SDOH (eg, geography, proportion of residents without health insurance or with only a high school education, lower median household income) were associated with delayed or discontinued treatment. In multivariable Cox proportinal hazards regression models, estimates suggested that Hispanic (hazard ratio [HR], 0.87 [95% CI, 0.71-1.05]), non-Hispanic Asian American or Pacific Islander (HR, 0.79 [95% CI, 0.46-1.35]), and non-Hispanic Black individuals (HR, 0.81 [95% CI, 0.67-0.97]) experienced longer delays to restarting pharmacotherapy compared with non-Hispanic White individuals. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that race and ethnicity and area-level SDOH were associated with delayed or discontinued cancer treatment and longer delays to the restart of drug-based therapies following SARS-CoV-2 infection. Such treatment delays could exacerbate persistent cancer survival inequities in the United States.
Collapse
Affiliation(s)
- Adana A. M. Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Adiba Ashrafi
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Nabarun Ghosh
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Jennifer Tsui
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Yong Lin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick
| | - Angela J. Fong
- Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine and Pharmacology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Carolyn J. Heckman
- Rutgers Cancer Institute of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
11
|
Bright K, Mills A, Bradford JP, Stewart DJ. RAPID framework for improved access to precision oncology for lethal disease: Results from a modified multi-round delphi study. Front Health Serv 2023; 3:1015621. [PMID: 36926496 PMCID: PMC10012713 DOI: 10.3389/frhs.2023.1015621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
Introduction Predictive oncology, germline technologies, and adaptive seamless trials are promising advances in the treatment of lethal cancers. Yet, access to these therapies is stymied by costly research, regulatory barriers, and structural inequalities worsened by the COVID-19 pandemic. Methods To address the need for a comprehensive strategy for rapid and more equitable access to breakthrough therapies for lethal cancers, we conducted a modified multi-round Delphi study with 70 experts in oncology, clinical trials, legal and regulatory processes, patient advocacy, ethics, drug development, and health policy in Canada, Europe, and the US. Semi-structured ethnographic interviews (n = 33) were used to identify issues and solutions that participants subsequently evaluated in a survey (n = 47). Survey and interview data were co-analyzed to refine topics for an in-person roundtable where recommendations for system change were deliberated and drafted by 26 participants. Results Participants emphasized major issues in patient access to novel therapeutics including burdens of time, cost, and transportation required to complete eligibility requirements or to participate in trials. Only 12% of respondents reported satisfaction with current research systems, with "patient access to trials" and "delays in study approval" the topmost concerns. Conclusion Experts agree that an equity-centered precision oncology communication model should be developed to improve access to adaptive seamless trials, eligibility reforms, and just-in-time trial activation. International advocacy groups are a key mobilizer of patient trust and should be involved at every stage of research and therapy approval. Our results also show that governments can promote better and faster access to life-saving therapeutics by engaging researchers and payors in an ecosystem approach that responds to the unique clinical, structural, temporal, and risk-benefit situations that patients with life-threatening cancers confront.
Collapse
Affiliation(s)
- Kristin Bright
- Department of Anthropology, Middlebury College, Middlebury, VT, United States.,Department of Anthropology, University of Toronto, Toronto, ON, Canada
| | - Anneliese Mills
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David J Stewart
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
12
|
Niyigena A, Cubaka VK, Uwamahoro P, Mutsinzi RG, Uwizeye B, Mukamasabo B, Shyirambere C, Bigirimana BJ, Mubiligi J, Barnhart DA. Impact of facilitating continued accessibility to cancer care during COVID-19 lockdown on perceived wellbeing of cancer patients at a rural cancer center in Rwanda. PLOS Glob Public Health 2023; 3:e0001534. [PMID: 36963043 PMCID: PMC10021873 DOI: 10.1371/journal.pgph.0001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/01/2023] [Indexed: 03/03/2023]
Abstract
During the COVID-19 pandemic in Rwanda, Partners In Health Inshuti Mu Buzima collaborated with the Butaro Cancer Center of Excellence (BCCOE) to mitigate disruptions to cancer care by providing patients with free transportation to treatment sites and medication delivery at patients' local health facilities. We assessed the relationship between facilitated access to care and self-reported wellbeing outcomes. This cross-sectional telephone survey included cancer patients enrolled at BCCOE in March 2020. We used linear regression to compare six dimensions of quality of life (EORTC QLQ-C30), depression (PHQ-9), anxiety (GAD-7), and financial toxicity (COST) among patients who did and did not receive facilitated access to care. We also assessed access to cancer care and whether patient wellbeing and its association with facilitated access to care differed by socioeconomic status. Of 214 respondents, 34.6% received facilitated access to care. Facilitated patients were more likely to have breast cancer and be on chemotherapy. Facilitation was significantly associated with more frequent in-person clinical encounters, improved perceived quality of cancer care, and reduced transportation-related barriers. Facilitated patients had significantly better global health status (β = 9.14, 95% CI: 2.3, 16.0, p <0.01) and less financial toxicity (β = 2.62, 95% CI: 0.2,5.0, p = 0.03). However, over half of patients reported missing or delaying appointment. Patient wellbeing was low overall and differed by patient socioeconomic status, with poor patients consistently showing worse outcomes. Socioeconomic status did not modify the association between facilitated access to care and wellbeing indicators. Further, facilitation did not lead to equitable wellbeing outcomes between richer and poorer patients. Facilitated access to care during COVID-19 pandemic was associated with some improvements in access to cancer care and patient wellbeing. However, cancer patients still experienced substantial disruptions to care and reported low overall levels of wellbeing, with socioeconomic disparities persisting despite facilitated access to care. Implementing more robust, equity-minded facilitation and better patient outreach programs during health emergencies may promote better care and strengthen patient care overall and effect better patients' outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dale A Barnhart
- Partners In Health, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
13
|
Petrillo LA, El-Jawahri A, Heuer LB, Post K, Gallagher ER, Trotter C, Elyze M, Vyas C, Plotke R, Turk YR, Han J, Temel JS, Greer JA. Health-Related Quality of Life and Depression Symptoms in a Cross Section of Patients with Advanced Lung Cancer before and during the COVID-19 Pandemic. J Palliat Med 2022; 25:1639-1645. [PMID: 35588200 PMCID: PMC9836683 DOI: 10.1089/jpm.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Adults with advanced lung cancer experience reduced health-related quality of life (HRQOL) and psychological symptoms at diagnosis. Objective: This study aimed to evaluate whether the COVID-19 pandemic worsened HRQOL among patients recently diagnosed with cancer. Design: We analyzed baseline data from two randomized controlled trials of early palliative care to compare HRQOL and depression symptoms among those enrolled during the pandemic (January 2020 to January 2021) versus prepandemic (March 2018 to January 2019). Setting/Subjects: This cohort included patients recently diagnosed with advanced lung cancer in two multisite studies. Measurements: We used analysis of covariance to calculate adjusted mean differences between groups with the timeframe as an independent variable and HRQOL (using the Functional Assessment of Cancer Therapy-General) and depression symptoms (using the Patient Health Questionnaire-9) as dependent variables, adjusting for age, gender, relationship status, performance status, symptoms, and time since diagnosis. We tested for an interaction between the COVID-19 timeframe and relationship status. Results: Neither HRQOL (adjusted mean difference -1.78; p = 0.137) nor depression symptoms (0.06; p = 0.889) differed between patients enrolled pre-COVID-19 (n = 665) relative to those enrolled during COVID-19 (n = 191) in adjusted analyses. Relationship status moderated the effect of the COVID-19 timeframe on HRQOL; unmarried patients experienced worse HRQOL during COVID-19 (adjusted mean difference: -5.25; p = 0.011). Conclusions: The COVID-19 pandemic did not further reduce HRQOL or increase depression symptoms among patients recently diagnosed with lung cancer, but did worsen HRQOL for unmarried patients in moderation analysis. Psychosocial evaluation and supportive care are important for all patients, particularly those with limited social support. Clinical trial registration numbers: NCT03337399 and NCT03375489.
Collapse
Affiliation(s)
- Laura A. Petrillo
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren B. Heuer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn Post
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily R. Gallagher
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chardria Trotter
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Madeleine Elyze
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Charu Vyas
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel Plotke
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yael R. Turk
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jacqueline Han
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer S. Temel
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph A. Greer
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
14
|
D'Amico RP, Schnell PM, Foraker R, Olayiwola JN, Jonas DE, Brill SB. Evolution of primary care telehealth disparities during COVID-19: a retrospective cohort study (Preprint). J Med Internet Res 2022; 25:e43965. [PMID: 37146176 DOI: 10.2196/43965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Telehealth has become widely utilized as a novel way to provide outpatient care during the coronavirus disease (COVID-19) pandemic, but data about telehealth use in primary care remains limited. Studies in other specialties raise concerns that telehealth may be widening existing healthcare disparities, requiring further scrutiny of trends in telehealth utilization. OBJECTIVE Our study aims to further characterize sociodemographic differences in primary care utilization via telehealth compared to in-person office visits before and during the COVID-19 pandemic, and determine if these disparities changed throughout 2020. METHODS We conducted a retrospective cohort study in a large U.S. academic center with 46 primary care practices from April-December 2019 and April-December 2020. Data were subdivided into calendar quarters and compared to determine evolving disparities throughout the year. We queried and compared billed outpatient encounters in General Internal Medicine and Family Medicine via binary logic mixed effects regression model and estimated odds ratios with 95% confidence intervals (OR, 95% CI). We used sex, race, and ethnicity of the patient attending each encounter as fixed effects. We analyzed socioeconomic status of patients in the institution's primary county based on the zip code the patient was residing in. RESULTS A total of 81,822 encounters in the pre-COVID-19 timeframe and 47,994 encounters in the intra-COVID-19 timeframe were analyzed; in the intra-COVID-19 timeframe, a total of 5,322 (11.1%) were telehealth encounters. Patients living in zip codes with high supplemental nutritional assistance usage were less likely to utilize primary care in the intra-COVID-19 timeframe (OR 0.94, 95% CI 0.90-0.98, P= .006). Encounters with the following patients were less likely to be via telehealth compared to in-person office visits- patients who self-identified as Asian (OR 0.74, 95% CI 0.63-0.86) and Nepali (OR 0.37, 95% CI 0.19-0.72), patients insured by Medicare (OR 0.77, 95% CI 0.68-0.88), and patients living in zip codes with high supplemental nutritional assistance usage (OR 0.84, 95% CI 0.71-0.99). Many of these disparities persisted throughout the year. While there was no statistically significant difference in telehealth utilization for patients insured by Medicaid throughout the whole year, sub analysis of quarter 4 found encounters with patients insured by Medicaid were less likely to be via telehealth (OR 0.73, 95% CI 0.55-0.97, P=.03). CONCLUSIONS Telehealth was not utilized equally by all patients within primary care throughout the first year of the COVID-19 pandemic, specifically by patients who self-identified as Asian and Nepali, were insured by Medicare, and lived in zip codes with low socioeconomic status. As the COVID-19 pandemic and telehealth infrastructure change, it is critical we continue to reassess the utilization of telehealth. Institutions should continue to monitor disparities in telehealth access, and advocate for policy changes that may improve equity. CLINICALTRIAL
Collapse
Affiliation(s)
- Rachel P D'Amico
- Department of Internal Medicine, The Ohio State University College of Medicine, 395 W 12th Ave, Columbus, US
| | - Patrick M Schnell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, US
| | - Randi Foraker
- Division of General Medical Sciences, Washington University in St. Louis School of Medicine, St Louis, US
| | | | - Daniel E Jonas
- Department of Internal Medicine, The Ohio State University College of Medicine, 395 W 12th Ave, Columbus, US
| | - Seuli Bose Brill
- Department of Internal Medicine, The Ohio State University College of Medicine, 395 W 12th Ave, Columbus, US
| |
Collapse
|
15
|
Abraham S, Manohar SA, Patel R, Saji AM, Dani SS, Ganatra S. Strategies for Cardio-Oncology Care During the COVID-19 Pandemic. Curr Treat Options Cardio Med 2022; 24:137-153. [PMID: 36090762 PMCID: PMC9446588 DOI: 10.1007/s11936-022-00965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
Abstract
Purpose of review The COVID-19 pandemic has disrupted healthcare and has disproportionately affected the marginalized populations. Patients with cancer and cardiovascular disease (cardio-oncology population) are uniquely affected. In this review, we explore the current data on COVID-19 vulnerability and outcomes in these patients and discuss strategies for cardio-oncology care with a focus on healthcare innovation, health equity, and inclusion. Recent findings The growing evidence suggest increased morbidity and mortality from COVID-19 in patients with comorbid cancer and cardiovascular disease. Additionally, de novo cardiovascular complications such as myocarditis, myocardial infarction, arrhythmia, heart failure, and thromboembolic events have increasingly emerged, possibly due to an accentuated host immune response and cytokine release syndrome. Summary Patient-centric policies are helpful for cardio-oncology surveillance like remote monitoring, increased use of biomarker-based surveillance, imaging modalities like CT scan, and point-of-care ultrasound to minimize the exposure for high-risk patients. Abundant prior experience in cancer therapy scaffolded the repurposed use of corticosteroids, IL-6 inhibitors, and Janus kinase inhibitors in the treatment of COVID-19 infection. COVID-19 vaccine timing and dose frequency present a challenge due to overlapping toxicities and immune cell depletion in patients receiving cancer therapies. The SARS-CoV-2 pandemic laid bare social and ethnic disparities in healthcare but also steered in innovation to combat problems of patient outreach, particularly with virtual care. In the recovery phase, the backlog in cardio-oncology care, interplay of cancer therapy-related side effects, and long COVID-19 syndrome are crucial issues to address.
Collapse
Affiliation(s)
- Sonu Abraham
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | | | - Rushin Patel
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | - Anu Mariam Saji
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA USA
| | - Sourbha S. Dani
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| | - Sarju Ganatra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805 USA
| |
Collapse
|
16
|
Sharma H, Pankratz VS, Demark-Wahnefried W, Pestak CR, Blair CK. Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors. Healthcare (Basel) 2022; 10:1421. [PMID: 36011078 PMCID: PMC9407773 DOI: 10.3390/healthcare10081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To examine potential factors associated with maintaining or improving self-reported physical function (PF) among older cancer survivors participating in a gardening intervention impacted by the Coronavirus 2019 (COVID-19) pandemic. Methods: Thirty cancer survivors completed a home-based gardening intervention to encourage a healthier diet and a more active lifestyle. Device-based measures of physical activity (PA) and surveys to evaluate quality of life (QOL; PROMIS-57 questionnaire) were administered at baseline, mid-intervention (6 months), and post-intervention (9 months). Results: Depression, fatigue, and sleeplessness at baseline were significantly associated with worse average PF scores across follow-up (2.3 to 4.9 points lower for every decrease of 5 points in the QOL score; p-values < 0.02). Worsening of these QOL domains during the intervention was also associated with an additional decrease of 2.1 to 2.9 points in PF over follow-up (p values < 0.01). Better social participation and PA at baseline were significantly associated with better average PF scores during the intervention (2.8 to 5.2 points higher for every 5-point increase in social participation or 30 min more of PA; p values < 0.05). Every 5-point increase in pain at baseline, or increases in pain during the intervention, was associated with decreases of 4.9 and 3.0 points, respectively, in PF. Conclusions: Worse QOL scores before and during the intervention were significantly associated with worse PF over follow-up. Encouraging social participation and PA through interventions such as home-based gardening may improve long-term health among older cancer survivors.
Collapse
Affiliation(s)
- Harsh Sharma
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
| | - Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Claire R. Pestak
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| |
Collapse
|
17
|
Blomain E, Berta S, Hug N, Giao D, Meola A, Binkley M, Hui C, Churilla T, Shahsavari N, Desai K, Chang S, Soltys S, Pollom E. Radiotherapy for Brain Metastases from Thyroid Cancer: An Institutional and National Retrospective Cohort Study. Thyroid 2022; 32:781-788. [PMID: 35229625 DOI: 10.1089/thy.2021.0628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Stereotactic radiosurgery (SRS) is the standard of care for patients with a limited number of brain metastases. Despite the fact that the seminal studies regarding SRS for brain metastases were largely tissue agnostic, several current national guidelines do not uniformly recommend SRS in thyroid cancer. We therefore investigated oncological outcomes in a cohort of patients with brain metastases from thyroid cancer who received radiotherapy (RT) at our institution as well as those in a nationally representative cancer cohort, the National Cancer Database (NCDB). Materials and Methods: We identified patients with thyroid cancer and brain metastases treated with RT at our institution from 2002 through 2020. For the NCDB cohort, the national database of patients with thyroid cancer was screened on the basis of brain-directed RT or brain metastases. For the institutional cohort, the cumulative risk of local failure (LF), distant intracranial failure, and radiation necrosis were calculated, adjusted for the competing risk of death. Overall survival (OS) in both cohorts was analyzed using the Kaplan-Meier method. Univariate analysis was accomplished via clustered competing risks regression. Results: For the institutional cohort, we identified 33 patients with 212 treated brain metastases. OS was 6.6 months. The 1-year cumulative incidences of LF and distant intracranial failures were 7.0% and 38%, respectively. The 1-year risk of radiation necrosis was 3.3%. In the NCDB cohort, there were 289 patients, and the median survival was 10.2 months. NCDB national practice patterns analysis showed an increasing use of SRS over time in both the entire cohort and the subset of anaplastic patients. Univariate analysis was performed for OS, risk of LF, risk of regional intracranial failure, and risk of radiation necrosis. Conclusions: SRS is a safe, effective, and increasingly utilized treatment for thyroid cancer brain metastases of any histology and should be the standard of care treatment.
Collapse
Affiliation(s)
- Erik Blomain
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Scott Berta
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Nicholas Hug
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Duc Giao
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Michael Binkley
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Caressa Hui
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Thomas Churilla
- Northeast Radiation Oncology Center, Geisinger Commonwealth School of Medicine, Dunmore, Pennsylvania, USA
| | | | - Kaniksha Desai
- Department of Endocrinology, Stanford University, Stanford, California, USA
| | - Steven Chang
- Department of Neurosurgery, Stanford University, Stanford, California, USA
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| |
Collapse
|
18
|
Street RL, Treiman K, Wu Q, Kranzler EC, Moultrie R, Mack N, Garcia R. Managing uncertainty and responding to difficult emotions: Cancer patients' perspectives on clinician response during the COVID-19 pandemic. Patient Educ Couns 2022; 105:2137-2144. [PMID: 35393231 PMCID: PMC8968177 DOI: 10.1016/j.pec.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Patients undergoing cancer treatment during the COVID-19 pandemic have experienced stress and uncertainty with respect to disruptions in cancer care and COVID-19 related risks. We examined whether clinicians' responsiveness to patients' uncertainty and difficult emotions were associated with better health and well-being. METHODS Patients were recruited from cancer support communities and a market research firm. Respondents assessed clinicians communication that addressed uncertainty and difficult emotions. Health status measures included mental and physical health, coping during the pandemic, and psychological distress. RESULTS 317 respondents participated in the study. Patients' perceptions of their clinicians responsiveness to patient uncertainty and negative emotions were associated with better mental health, physical health, coping, and less psychological distress (all p-values <0.001). Respondents with greater self-efficacy and social support also reported better health. CONCLUSION Even when controlling for patients' personal and health-related characteristics, clinicians' communication addressing patients' uncertainty and difficult emotions predicted better health, better coping, and less psychological distress. Access to social support and self-efficacy also were associated with better health status. PRACTICE IMPLICATIONS Clinicians' communication focused on helping with uncertainty and difficult emotions is important to cancer patients, especially during the pandemic. Clinicians should also direct patients to resources for social support and patient empowerment.
Collapse
Affiliation(s)
| | | | | | - Elissa C Kranzler
- Cancer Support Community (Formerly), Currently Fors Marsh Group, USA
| | | | | | | |
Collapse
|
19
|
Waseem N, Boulanger M, Yanek LR, Feliciano JL. Disparities in Telemedicine Success and Their Association With Adverse Outcomes in Patients With Thoracic Cancer During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2220543. [PMID: 35797048 PMCID: PMC9264040 DOI: 10.1001/jamanetworkopen.2022.20543] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Disparities in access to telemedicine were identified at the onset of the COVID-19 pandemic, but the consequences of these disparities are not well characterized. OBJECTIVE To investigate factors associated with successfully accessing and completing telemedicine visits and the association between telemedicine visit success and clinical outcomes among patients with thoracic cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients who attended outpatient visits at the thoracic oncology division of Johns Hopkins Medical Institute in Baltimore, Maryland, from March 1 to July 17, 2020. MAIN OUTCOMES AND MEASURES Associations of age, sex, race, ethnicity, insurance status, marital status, zip code, type of cancer, cancer stage, and type of therapy with telemedicine visit success (defined as completed visits with synchronous audio-video connection) and of visit success status with changes in therapy and odds of emergency department and urgent care visits, hospitalizations, and death were assessed using χ2 and Fisher exact tests and are reported as odds ratios (ORs). RESULTS A total of 720 patients and 1940 visits with complete data were included in the analysis; the median patient age was 65.7 years (range, 54.7-76.7 years), and 384 (53.33%) were male. Of the 1940 visits, 679 (35.00%) were in person and 1261 (65.00%) were telemedicine. Of the telemedicine visits, 717 (56.86%) were successful and 544 (43.14%) were unsuccessful. Patients who were Black (OR, 0.62; 95% CI, 0.41-0.95), had Medicaid (OR, 0.38; 95% CI, 0.18-0.81), or were from a zip code with an elevated risk of cancer mortality (OR, 0.51; 95% CI, 0.29-0.90) were less likely to have successful telemedicine visits than to have unsuccessful visits. Patients with at least 1 unsuccessful telemedicine visit had higher likelihood of an emergency department (OR, 2.73; 95% CI, 1.42-5.22) or urgent care (OR, 4.50; 95% CI, 2.41-8.41) visit or hospitalization (OR, 2.37; 95% CI, 1.17-4.80). Similarly, patients who had no successful telemedicine visits and for whom more than 1 telemedicine visit was scheduled had a higher likelihood of an emergency department (OR, 3.43; 95% CI 1.80-6.52) or urgent care (OR, 4.24; 95% CI 2.24-8.03) visit or hospitalization (OR, 4.19; 95% CI 2.17-8.10). Patients with all successful telemedicine visits (OR, 0.52; 95% CI, 0.30-0.90) or only 1, unsuccessful visit (OR, 0.32; 95% CI, 0.13-0.75) had lower odds of death compared with patients seen in-person only. Starting a new therapy was associated with lower odds of having a telemedicine visit vs an in-person visit (OR, 0.49; 95% CI, 0.37-0.64) and higher odds of a successful telemedicine visit vs an unsuccessful telemedicine visit (OR, 1.90; 95% CI, 1.28-2.82). CONCLUSIONS AND RELEVANCE In this cohort study, patients with thoracic cancer who were Black, had Medicaid, or were from a zip code with a high risk of cancer mortality had increased odds of unsuccessful telemedicine visits compared with their counterparts and unsuccessful telemedicine visits were associated with worse clinical outcomes compared with successful visits. These findings suggest that more work is needed to improve telemedicine access for disadvantaged patients.
Collapse
Affiliation(s)
- Najeff Waseem
- Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland
| | - Mary Boulanger
- Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Lisa R. Yanek
- Department of Internal Medicine, Johns Hopkins University Hospital, Baltimore, Maryland
| | | |
Collapse
|
20
|
Schermerhorn MC, Grunvald MW, O'Donoghue CM, Rao RD, Becerra AZ. Factors Mediating Racial/Ethnic Disparities in Delayed Treatment of Breast Cancer. Ann Surg Oncol 2022; 29:7652-7658. [PMID: 35751007 PMCID: PMC9244454 DOI: 10.1245/s10434-022-12001-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite improvements, disparities in breast cancer care have led to an inequitable distribution of treatment delays and worse outcomes among patients with breast cancer. This study aimed to quantify the contribution of mediators that may explain racial/ethnic disparities in breast cancer treatment delays. PATIENTS AND METHODS We conducted a retrospective analysis of patients from the National Cancer Database with stage I-III breast cancer who underwent surgical resection. Mediation analyses estimated the extent to which racial/ethnic disparities in the distribution of patient characteristics account for racial/ethnic disparities in delayed treatment. RESULTS Of the 1,349,715 patients with breast cancer included, 10%, 5%, and 4% were Black, Hispanic, and other non-white race/ethnicity, respectively. Multivariable models showed that patients in these racial/ethnic groups had 73%, 81%, and 24% increased odds of having a treatment delay relative to white patients. Mediation analyses suggested that 15%, 19%, and 15% of the treatment delays among Black, Hispanic, and other non-white race/ethnicity patients, respectively, are explained by disparities in education, comorbidities, insurance, and facility type. Therefore, if these mediators had been distributed equally among all races/ethnicities, a reduction of 15-19% in the delayed treatment disparities experienced by minority patients would have been observed. Academic facility type was the factor that could yield the largest reduction in time to treatment disparities, contributing to 8-13% of racial/ethnic disparities. CONCLUSIONS Patients with breast cancer who identified as Black, Hispanic, and other non-white races/ethnicities are exposed to longer treatment delays relative to white patients. Efforts to equalize mediators could remove substantial portions of racial/ethnic disparities in delayed treatment.
Collapse
Affiliation(s)
| | - Miles W Grunvald
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Ruta D Rao
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
21
|
Bakouny Z, Labaki C, Bhalla S, Schmidt AL, Steinharter JA, Cocco J, Tremblay DA, Awad MM, Kessler A, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang H, Anderson-Keightly HM, El Zarif T, Alaiwi SA, Champagne C, Rosenbloom TD, Stewart PS, Johnson BE, Trinh Q, Tolaney SM, Galsky MD, Choueiri TK, Doroshow DB. Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study. Ann Oncol 2022; 33:836-844. [PMID: 35715285 PMCID: PMC9197329 DOI: 10.1016/j.annonc.2022.04.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct. Patients and methods This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations. Results The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (−46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from −23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded. Conclusions Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.
Collapse
Affiliation(s)
- Z Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - C Labaki
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - S Bhalla
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - A L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J Cocco
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - D A Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - M M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - A Kessler
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - R I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - F Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - C R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - B S Zimmerman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - G Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - T Jun
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - P V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Q Qin
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - L Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J Feld
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - K M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - D Seidman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - H Huang
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | | | - T El Zarif
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - S Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - C Champagne
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - T D Rosenbloom
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - P S Stewart
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - B E Johnson
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Q Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, USA
| | - S M Tolaney
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - T K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA.
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA.
| |
Collapse
|
22
|
De B, Fu S, Chen Y, Das P, Ku K, Maroongroge S, Woodhouse KD, Hoffman KE, Nguyen Q, Reed VK, Chen AB, Koong AC, Smith BD, Smith GL. Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care. Cancer Med 2022; 11:2096-2105. [PMID: 35297210 PMCID: PMC9119354 DOI: 10.1002/cam4.4555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer. METHODS Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes. RESULTS Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (ptrend < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national "Opening Up America Again" guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03-4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1-5 fractions (OR = 4.49, 95% CI 2.29-8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons). CONCLUSION Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount-and not exacerbate-barriers to quality cancer care.
Collapse
Affiliation(s)
- Brian De
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shuangshuang Fu
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ying‐Shiuan Chen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Prajnan Das
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kimberly Ku
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sean Maroongroge
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kristina D. Woodhouse
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Karen E. Hoffman
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Quynh‐Nhu Nguyen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Valerie K. Reed
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Aileen B. Chen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Albert C. Koong
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Benjamin D. Smith
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Grace L. Smith
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| |
Collapse
|
23
|
Mak IL, Wan EYF, Wong TKT, Lee WWJ, Chan EWY, Choi EPH, Chui CSL, Ip MSM, Lau WCS, Lau KK, Lee SF, Wong ICK, Yu EYT, Lam CLK. The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review. Public Health Rev 2022; 43:1604121. [PMID: 35574567 PMCID: PMC9091177 DOI: 10.3389/phrs.2022.1604121] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.
Collapse
Affiliation(s)
- Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- *Correspondence: Eric Yuk Fai Wan,
| | - Teenie Kwan Tung Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wendy Woo Jung Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Esther Wai Yin Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
| | - Edmond Pui Hang Choi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Mary Sau Man Ip
- Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wallace Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shing Fung Lee
- Department of Clinical Oncology, Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
24
|
Li C, Chen M, Li M, Wang H, Qiu X, Hu X, Wang Q, Sun J, Yang M, Zhu Y, Liao P, Zhou B, Chen M, Liu X, Zhao Y, Shen M, Huang J, Luo L, Wu H, Li YG. ECG Utilization Patterns of Patients With Arrhythmias During COVID-19 Epidemic and Post-SARS-CoV-2 Eras in Shanghai, China. Front Cardiovasc Med 2022; 9:829679. [PMID: 35571158 PMCID: PMC9091729 DOI: 10.3389/fcvm.2022.829679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic has led to concerns around its subsequent impact on global health. Objective To investigate the health-seeking behavior, reflected by ECG utilization patterns, of patients with non-COVID-19 diseases during and after COVID-19 epidemic. Methods Taking advantage of the remote ECG system covering 278 medical institutions throughout Shanghai, the numbers of medical visits with ECG examinations during the lockdown (between January 23 and April 7, 2020), post-lockdown (between April 8 and December 31, 2020) and post-SARS-CoV-2 (between January 23 and April 7, 2021) periods were analyzed and compared against those during the same periods of the preceding years (2018 and 2019). Results Compared with the same period during pre-COVID years, the number of medical visits decreased during the lockdown (a 38% reduction), followed by a rebound post-lockdown (a 17% increase) and a fall to the baseline level in post-SARS-CoV-2 period. The number of new COVID-19 cases announced on a given day significantly correlated negatively with the numbers of medical visits during the following 7 days. Medical visit dynamics differed for various arrhythmias. Whereas medical visits for sinus bradycardia exhibited a typical decrease-rebound-fallback pattern, medical visits for atrial fibrillation did not fall during the lockdown but did exhibit a subsequent increase during the post-lockdown period. By comparison, the volume for ventricular tachycardia remained constant throughout this entire period. Conclusion The ECG utilization patterns of patients with arrhythmias exhibited a decrease-rebound-fallback pattern following the COVID-19 lockdowns. Medical visits for diseases with more severe symptoms were less influenced by the lockdowns, showing a resilient demand for healthcare.
Collapse
Affiliation(s)
- Cheng Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mohan Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haicheng Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiangjun Qiu
- Shanghai Siwei Medical Co. Ltd., Shanghai, China
| | - Xiaoliang Hu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qunshan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mei Yang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuling Zhu
- Medical Information Telemonitoring Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Liao
- School of Public Health, Fudan University, Shanghai, China
| | - Baohong Zhou
- Shanghai Siwei Medical Co. Ltd., Shanghai, China
| | - Min Chen
- Shanghai Siwei Medical Co. Ltd., Shanghai, China
| | - Xia Liu
- Medical Information Telemonitoring Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuelin Zhao
- Medical Information Telemonitoring Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingzhen Shen
- Medical Information Telemonitoring Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinkang Huang
- Medical Information Telemonitoring Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Luo
- School of Public Health, Fudan University, Shanghai, China
| | - Hong Wu
- Shanghai Health Commission, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Medical Information Telemonitoring Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yi-Gang Li
| |
Collapse
|
25
|
Neeman E, Lyon L, Sun H, Conell C, Reed M, Kumar D, Kolevska T, Kotak D, Sundaresan T, Liu R. Future of Teleoncology: Trends and Disparities in Telehealth and Secure Message Utilization in the COVID-19 Era. JCO Clin Cancer Inform 2022; 6:e2100160. [PMID: 35467963 PMCID: PMC9067360 DOI: 10.1200/cci.21.00160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The COVID-19 pandemic created an imperative to re-examine the role of telehealth in oncology. We studied trends and disparities in utilization of telehealth (video and telephone visits) and secure messaging (SM; ie, e-mail via portal/app), before and during the pandemic. METHODS Retrospective cohort study of hematology/oncology patient visits (telephone/video/office) and SM between January 1, 2019, and September 30, 2020, at Kaiser Permanente Northern California. RESULTS Among 334,666 visits and 1,161,239 SM, monthly average office visits decreased from 10,562 prepandemic to 1,769 during pandemic, telephone visits increased from 5,114 to 8,663, and video visits increased from 40 to 4,666. Monthly average SM increased from 50,788 to 64,315 since the pandemic began. Video visits were a significantly higher fraction of all visits (P < .01) in (1) younger patients (Generation Z 48%, Millennials 46%; Generation X 40%; Baby Boomers 34.4%; Silent Generation 24.5%); (2) patients with commercial insurance (39%) compared with Medicaid (32.7%) or Medicare (28.1%); (3) English speakers (33.7%) compared with those requiring an interpreter (24.5%); (4) patients who are Asian (35%) and non-Hispanic White (33.7%) compared with Black (30.1%) and Hispanic White (27.5%); (5) married/domestic partner patients (35%) compared with single/divorced/widowed (29.9%); (6) Charlson comorbidity index ≤ 3 (36.2%) compared with > 3 (31.3%); and (7) males (34.6%) compared with females (32.3%). Similar statistically significant SM utilization patterns were also seen. CONCLUSION In the pandemic era, hematology/oncology telehealth and SM use rapidly increased in a manner that is feasible and sustained. Possible disparities existed in video visit and SM use by age, insurance plan, language, race, ethnicity, marital status, comorbidities, and sex.
Collapse
Affiliation(s)
- Elad Neeman
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA
| | - Liisa Lyon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Hongxin Sun
- The Permanente Medical Group Consulting Services, Oakland, CA
| | - Carol Conell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Deepika Kumar
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA
| | - Tatjana Kolevska
- Napa/Solano Medical Center, Kaiser Permanente Northern California, Napa, CA
| | - Dinesh Kotak
- San Rafael Medical Center, Kaiser Permanente Northern California, San Rafael CA
| | - Tilak Sundaresan
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA
| | - Raymond Liu
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA.,Division of Research, Kaiser Permanente Northern California, Oakland, CA
| |
Collapse
|
26
|
Seneghini M, Rüfenacht S, Babouee-flury B, Flury D, Schlegel M, Kuster SP, Kohler PP. It is complicated: Potential short- and long-term impact of coronavirus disease 2019 (COVID-19) on antimicrobial resistance—An expert review. ASHE 2022; 2. [PMID: 36310817 PMCID: PMC9614949 DOI: 10.1017/ash.2022.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
As of December 2021, the coronavirus disease 2019 (COVID-19) pandemic has claimed millions of deaths and caused disruptions in health systems around the world. The short- and long-term effects of COVID-19 on antimicrobial resistance (AMR), which was already a global threat before the pandemic, are manifold and complex. In this expert review, we summarize how COVID-19 might be affecting AMR in the short term (by influencing the key determinants antibiotic use, infection control practices and international/local mobility) and which additional factors might play a role in the long term. Whereas reduced outpatient antibiotic use in high-income countries, increased awareness for hand hygiene, and reduced mobility have likely mitigated the emergence and spread of AMR in the short term, factors such as overuse of antibiotics in COVID-19 patients, shortage of personal protective equipment, lack of qualified healthcare staff, and patient overcrowding have presumably facilitated its propagation. Unsurprisingly, international and national AMR surveillance data for 2020 show ambiguous trends. Although disruptions in antibiotic stewardship programs, AMR surveillance and research might promote the spread of AMR, other developments could prove beneficial to the cause in the long term. These factors include the increased public awareness for infectious diseases and infection control issues, the strengthening of the One Health perspective as outlined by the Centers for Disease Control and Prevention, and the unprecedented number of international research collaborations and platforms. These factors could even serve as leverage and provide opportunities to better combat AMR in the future.
Collapse
|
27
|
Ibrahim NK, Eraky A, Eggers J, Steiert TA, Sebens S, Jünemann KP, Hendricks A, Bang C, Stanulla M, Franke A, Hamann C, Röcken C, Arnold N, Hinze L, Forster M. Detection of Cancer Mutations by Urine Liquid Biopsy as a Potential Tool in the Clinical Management of Bladder Cancer Patients. Cancers (Basel) 2022; 14:969. [PMID: 35205727 DOI: 10.3390/cancers14040969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary The management of bladder cancer faces multiple challenges concerning the diagnostic and follow-up approaches. The standard diagnostic examination comprises invasive cystoscopy. Urine cytology and recently proposed urine-based biomarkers have been unable to replace cystoscopy, thus prompting calls for improvements. Here, we explore urine liquid biopsy to detect cancer mutations and subsequently evaluate the utility of urine as a suitable specimen for diagnosing bladder cancer. Our results show that the analysis of pre- and postoperative urine with a cost-effective 127-gene panel enables the characterization of tumor mutations. These findings provide cumulative evidence in support of the results of previous studies that testing urine for mutations is a useful strategy to complement the clinical management of bladder cancer patients. Abstract The standard diagnostic and follow-up examination for bladder cancer is diagnostic cystoscopy, an invasive test that requires compliance for a long period. Urine cytology and recent biomarkers come short of replacing cystoscopy. Urine liquid biopsy promises to solve this problem and potentially allows early detection, evaluation of treatment efficacy, and surveillance. A previous study reached 52–68% sensitivity using small-panel sequencing but could increase sensitivity to 68–83% by adding aneuploidy and promoter mutation detection. Here, we explore whether a large 127-gene panel alone is sufficient to detect tumor mutations in urine from bladder cancer patients. We recruited twelve bladder cancer patients, obtained preoperative and postoperative urine samples, and successfully analyzed samples from eleven patients. In ten patients, we found at least one mutation in bladder-cancer-associated genes, i.e., a promising sensitivity of 91%. In total, we identified 114 variants, of which 90 were predicted as nonbenign, 30% were associated with cancer, and 13% were actionable according to the CIViC database. Sanger sequencing of the patients’ formalin-fixed, paraffin-embedded (FFPE) tumor tissues confirmed the findings. We concluded that incorporating urine liquid biopsy is a promising strategy in the management of bladder cancer patients.
Collapse
|
28
|
Cifarelli DT, Weir JS, Slusser JD, Smith TM, DeWitt R, Cifarelli CP. Telemedicine for Cranial Radiosurgery Patients in a Rural U.S. Population: Patterns and Predictors of Patient Utilization. Telemed J E Health 2022; 28:1317-1323. [PMID: 35076292 DOI: 10.1089/tmj.2021.0519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Telemedicine retains potential for increasing access to specialty providers in underserved and rural communities. COVID-19 accelerated adoption of telehealth beyond rural populations, serving as a primary modality of patient-provider encounters for many nonemergent diagnoses. Methods: From 2020 to 2021, telemedicine was incorporated in management of stereotactic radiosurgery patients. Retrospective data on diagnoses, demographics, distance to primary clinic, and encounter type were captured and statistically analyzed using descriptive measures and Cox proportional regression modeling. Graphical representation of service areas was created using geo-mapping software. Results: Patients (n = 208) completed 331 telemedicine encounters over 12 months. Metastases and meningiomas comprised 60% of diagnoses. Median age was 62 years with median household income and residential population of $44,752 and 7,634 people. The one-way mean and median travel distances were 74.6 and 66.3 miles. The total potential road mileage for all patients was 44,596 miles. A total of 118 (57%) patients completed video visits during the first encounter, whereas 90 (43%) opted for telephone encounters. At 12 months, 138 patients (66%) utilized video visits and 70 (34%) used telephone visits. Predictors of video visit use were video-enabled visit during the first encounter (hazard ratio [HR] 2.806, p < 0.001), total potential distance traveled (HR 1.681, p < 0.05), and the need for more than one visit per year (HR 2.903, p < 0.001). Discussion: Telemedicine can be effective in radiosurgery practice with predictors of video-enabled use being pre-existing patient comfort levels with videoconferencing, total annual travel distance, and number of visits per year. Age, rural population status, and household income did not impact telemedicine use in our patient cohort.
Collapse
Affiliation(s)
- Daniel T Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Joshua S Weir
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Jenifer D Slusser
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA
| | - Tanya M Smith
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Rebecca DeWitt
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Christopher P Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
29
|
Mafi JN, Craff M, Vangala S, Pu T, Skinner D, Tabatabai-Yazdi C, Nelson A, Reid R, Agniel D, Tseng CH, Sarkisian C, Damberg CL, Kahn KL. Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021. JAMA 2022; 327:237-247. [PMID: 35040886 PMCID: PMC8767442 DOI: 10.1001/jama.2021.24294] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/19/2021] [Indexed: 01/24/2023]
Abstract
Importance Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.
Collapse
Affiliation(s)
- John N. Mafi
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- RAND Health, RAND Corporation, Santa Monica, California
| | | | - Sitaram Vangala
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Thomas Pu
- Milliman MedInsight, Seattle, Washington
| | | | | | | | - Rachel Reid
- RAND Health, RAND Corporation, Santa Monica, California
- Division of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Denis Agniel
- RAND Health, RAND Corporation, Santa Monica, California
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | - Catherine Sarkisian
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
| | | | - Katherine L. Kahn
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- RAND Health, RAND Corporation, Santa Monica, California
| |
Collapse
|
30
|
Bruce SF, Huysman B, Bharucha J, Massad LS, Mullen MM, Hagemann AR, Fuh KC, McCourt CK, Thaker PH, Khabele D, Powell MA, Mutch DG, Kuroki LM. Impact of the COVID-19 pandemic on referral to and delivery of gynecologic oncology care. Gynecol Oncol Rep 2022; 39:100928. [PMID: 35024405 PMCID: PMC8739812 DOI: 10.1016/j.gore.2022.100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/15/2021] [Accepted: 01/03/2022] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic has significantly impacted gynecologic cancer care. Referrals to gynecologic oncology decreased in the early months of the pandemic. Referral time to gynecologic oncology evaluation was not impacted by the pandemic. Time to cancer treatment initiation decreased significantly during the pandemic. Disparities in time to cancer treatment initiation improving during the pandemic.
Objective To evaluate the impact of the COVID-19 pandemic on referral to and delivery of gynecologic oncology care at a National Cancer Institute-designated Comprehensive Cancer Center. Methods We conducted a retrospective cohort study of patients referred for evaluation by a gynecologic oncologist at Washington University in St. Louis from October 2019 – February 2020 (pre-COVID-19), and April - August 2020 (COVID-19). The primary outcome, time from referral to evaluation by a gynecologic oncologist, was compared between the two time periods. Secondary outcomes included time from initial evaluation to treatment and delays/interruptions in care due to the pandemic. Sub-group analyses were performed on patients with a cancer diagnosis to evaluate the impact of COVID-19 on treatment decision making. Results 884 patients were referred during the study period. Total referrals fell by 32% (526 to 358 patients, p < 0.001) and referrals for cancer fell by 18% (228 to 188 patients, p = 0.049). The pandemic did not impact time from referral to initial gynecologic oncology appointment overall (pre-COVID-19: 19.1 vs. COVID-19: 17.4 days, p = 0.315) or among patients with cancer (14.4 vs. 13.9 days, p = 0.662). Time from initial appointment to cancer treatment decreased by 9 days (34 days to 25 days, p = 0.001). Conclusion Referrals to gynecologic oncology decreased significantly during the early months of COVID-19. Though time from referral to evaluation was not impacted by the pandemic, time to treatment initiation decreased despite institutional changes related to COVID-19.
Collapse
Affiliation(s)
- Shaina F Bruce
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Bridget Huysman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Jinai Bharucha
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - L Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Mary M Mullen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Dineo Khabele
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Barnes Jewish Hospital, Washington University, St. Louis, MO, United States
| |
Collapse
|
31
|
Street RL, Treiman K, Kranzler EC, Moultrie R, Arena L, Mack N, Garcia R. Oncology patients' communication experiences during COVID-19: comparing telehealth consultations to in-person visits. Support Care Cancer 2022; 30:4769-4780. [PMID: 35141772 PMCID: PMC9046548 DOI: 10.1007/s00520-022-06897-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/02/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The COVID-19 pandemic created significant disruptions in cancer care, much of which was transitioned to telehealth. Because telehealth alters the way clinicians and patients interact with one another, this investigation examined patients' perceptions of their communication with clinicians during the pandemic. METHOD Patients were recruited from the Cancer Support Community, Fight Colorectal Cancer, and a market research firm to participate in an online survey. In addition to demographic and health-related information, respondents completed measures of patient-centered communication and evaluated how their communication in telehealth sessions compared with in-person visits. RESULTS From October to December 2020, 227 respondents (65.6% female, 64.6% Non-Hispanic White, 33.5% had 6 or more telehealth sessions, 55% were 50 or older) reported having some of their cancer care provided via telehealth. Respondents who were of racial/ethnic minorities, male, had more telehealth sessions, or had poorer mental health reported less patient-centered communication with clinicians. Most patients thought communication in telehealth sessions was "about the same" as in-person visits with respect to good communication (59%). However, patients thinking communication in telehealth sessions was "better" than in-person visits were more likely to be Hispanic (49%), Non-Hispanic Black (41%), under 50 years of age (32%), male (40%), and had more telehealth sessions (34%). CONCLUSION Respondents reporting less patient-centered communication during the pandemic-e.g., persons of racial/ethnic minorities and males-were also more likely to evaluate communication in telehealth sessions as better than in-person visits. Further research is needed to understand reasons underlying this finding. Cancer care clinicians should take into account patient preferences regarding telehealth care, which may be particularly important for racial and ethnic minority patients.
Collapse
Affiliation(s)
| | | | - Elissa C Kranzler
- Cancer Support Community (formerly), currently Fors Marsh Group, Arlington, VA, USA
| | | | | | | | | |
Collapse
|
32
|
Acquati C, Chen TA, Martinez Leal I, Connors SK, Haq AA, Rogova A, Ramirez S, Reitzel LR, McNeill LH. The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol. Int J Environ Res Public Health 2021; 18:ijerph182413084. [PMID: 34948695 PMCID: PMC8702073 DOI: 10.3390/ijerph182413084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.
Collapse
Affiliation(s)
- Chiara Acquati
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX 77204, USA
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-743-4343
| | - Tzuan A. Chen
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Isabel Martinez Leal
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Arooba A. Haq
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Anastasia Rogova
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Stephanie Ramirez
- College of Natural Sciences and Mathematics, University of Houston, 3507 Cullen Blvd, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Lorna H. McNeill
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| |
Collapse
|
33
|
Elkrief A, Wu JT, Jani C, Enriquez KT, Glover M, Shah MR, Shaikh HG, Beeghly-Fadiel A, French B, Jhawar SR, Johnson DB, McKay RR, Rivera DR, Reuben DY, Shah S, Tinianov SL, Vinh DC, Mishra S, Warner JL. Learning through a Pandemic: The Current State of Knowledge on COVID-19 and Cancer. Cancer Discov 2021; 12:303-330. [PMID: 34893494 DOI: 10.1158/2159-8290.cd-21-1368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
The ongoing COVID-19 pandemic has left patients with current or past history of cancer facing disparate consequences at every stage of the cancer trajectory. This comprehensive review offers a landscape analysis of the current state of the literature on COVID-19 and cancer including the immune response to COVID-19, risk factors for severe disease, and impact of anticancer therapies. We also review the latest data on treatment of COVID-19 and vaccination safety and efficacy in patients with cancer, as well as impact of the pandemic on cancer care, including the urgent need for rapid evidence generation and real-world study designs.
Collapse
Affiliation(s)
- Arielle Elkrief
- Hemato-Oncology, University of Montreal Research Center (CRCHUM)
| | | | | | - Kyle T Enriquez
- Medical Scientist Training Program, Vanderbilt University School of Medicine
| | | | - Mansi R Shah
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey
| | | | | | | | - Sachin R Jhawar
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center
| | | | | | | | - Daniel Y Reuben
- Hematology and Oncology, Medical University of South Carolina
| | | | | | | | - Sanjay Mishra
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center
| | - Jeremy L Warner
- Medicine and Biomedical Informatics, Vanderbilt University Medical Center
| |
Collapse
|
34
|
Ferro M, Del Giudice F, Carrieri G, Busetto GM, Cormio L, Hurle R, Contieri R, Arcaniolo D, Sciarra A, Maggi M, Porpiglia F, Manfredi M, Fiori C, Antonelli A, Tafuri A, Bove P, Terrone C, Borghesi M, Costantini E, Iliano E, Montanari E, Boeri L, Russo GI, Madonia M, Tedde A, Veccia A, Simeone C, Liguori G, Trombetta C, Brunocilla E, Schiavina R, Dal Moro F, Racioppi M, Vartolomei MD, Longo N, Spirito L, Crocetto F, Cantiello F, Damiano R, Di Stasi SM, Marchioni M, Schips L, Parma P, Carmignani L, Conti A, Soria F, Gontero P, Barone B, Deho F, Zaffuto E, Papalia R, Scarpa RM, Pagliarulo V, Lucarelli G, Ditonno P, Botticelli FMG, Musi G, Catellani M, de Cobelli O. The Impact of SARS-CoV-2 Pandemic on Time to Primary, Secondary Resection and Adjuvant Intravesical Therapy in Patients with High-Risk Non-Muscle Invasive Bladder Cancer: A Retrospective Multi-Institutional Cohort Analysis. Cancers (Basel) 2021; 13:cancers13215276. [PMID: 34771440 PMCID: PMC8582553 DOI: 10.3390/cancers13215276] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary The worldwide COVID-19 emergency has had an important impact on healthcare systems with the need to assist infected patients and also treat non-deferrable oncological conditions. In urology, the main concern has been for patients with bladder cancer, the tenth most common malignancy, where the quality and the alacrity of treatment has a clear well-demonstrated impact on the survivor. The aim of our Italian multi-institutional retrospective study was to assess the impact of the COVID-19 outbreak on diagnosis and treatment of non-muscle invasive bladder cancer. We observed a significant delay between diagnosis and surgical treatment, with a lower adherence to the standard therapeutic scheme such as BCG intravesical instillation and urological guidelines. We also recorded a different attitude in treatment depending on the patients’ location in Italy. Further investigation could show the impact of the pandemic on the survival of these patients. Abstract Background: To investigate the impact of COVID-19 outbreak on the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). Methods: A retrospective analysis was performed using an Italian multi-institutional database of TURBT patients with high-risk urothelial NMIBC between January 2019 and February 2021, followed by Re-TURBT and/or adjuvant intravesical BCG. Results: A total of 2591 patients from 27 institutions with primary TURBT were included. Of these, 1534 (59.2%) and 1056 (40.8%) underwent TURBT before and during the COVID-19 outbreak, respectively. Time between diagnosis and TURBT was significantly longer during the COVID-19 period (65 vs. 52 days, p = 0.002). One thousand and sixty-six patients (41.1%) received Re-TURBT, 604 (56.7%) during the pre-COVID-19. The median time to secondary resection was significantly longer during the COVID-19 period (55 vs. 48 days, p < 0.0001). A total of 977 patients underwent adjuvant intravesical therapy after primary or secondary resection, with a similar distribution across the two groups (n = 453, 86% vs. n = 388, 86.2%). However, the proportion of the patients who underwent maintenance significantly differed (79.5% vs. 60.4%, p < 0.0001). Conclusions: The COVID-19 pandemic represented an unprecedented challenge to our health system. Our study did not show significant differences in TURBT quality. However, a delay in treatment schedule and disease management was observed. Investigation of the oncological impacts of those differences should be advocated.
Collapse
Affiliation(s)
- Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
| | - Francesco Del Giudice
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (G.C.); (G.M.B.); (L.C.)
| | - Rodolfo Hurle
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Roberto Contieri
- Department of Urology, Humanitas Research Hospital, IRCCS, 20089 Milan, Italy; (R.H.); (R.C.)
| | - Davide Arcaniolo
- Unit of Urology, Luigi Vanvitelli University of Campania, 80138 Naples, Italy;
| | - Alessandro Sciarra
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Martina Maggi
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (F.D.G.); (A.S.); (M.M.)
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy; (F.P.); (M.M.); (C.F.)
| | - Alessandro Antonelli
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Ospedale Civile Maggiore, Polo Chirurgico Confortini, University of Verona, 37126 Verona, Italy; (A.A.); (A.T.)
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Via Aurelia 275, 00165 Rome, Italy;
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Marco Borghesi
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, 16132 Genova, Italy; (C.T.); (M.B.)
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Ester Iliano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy; (E.C.); (E.I.)
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.M.); (L.B.)
| | | | - Massimo Madonia
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Tedde
- Urologic Clinic, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (M.M.); (A.T.)
| | - Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA 23298, USA;
- Urology Unit, ASST Spedali Civili Hospital, 25133 Brescia, Italy
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25121 Brescia, Italy;
| | - Giovanni Liguori
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Carlo Trombetta
- Department of Urology, ASUITS, University of Trieste, 34149 Trieste, Italy; (G.L.); (C.T.)
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital, 40138 Bologna, Italy; (E.B.); (R.S.)
| | - Fabrizio Dal Moro
- Urology Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35128 Padua, Italy;
| | - Marco Racioppi
- Urology Clinic, A. Gemelli Hospital Foundation, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Mihai Dorin Vartolomei
- Urology Department, Medical University of Vienna, A-1090 Vienna, Austria;
- IOSUD, Universitatea de Medicina Farmacie Stiinte si Tehnologie “George Emil Palade” din Targu Mures, 540142 Mureș, Romania
| | - Nicola Longo
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Lorenzo Spirito
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Felice Crocetto
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Francesco Cantiello
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Savino M. Di Stasi
- Department of Surgery and Experimental Medicine, Tor Vergata University, 00133 Rome, Italy;
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, “SS. Annunziata” Hospital, G. d’Annunzio University of Chieti, 66100 Chieti, Italy; (M.M.); (L.S.)
- Department of Urology, ASL Abruzzo 2, 65017 Chieti, Italy
| | - Paolo Parma
- Urology Unit, Ospedale San Carlo Poma, 46100 Mantova, Italy;
| | - Luca Carmignani
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Andrea Conti
- Department of Urology, San Donato Policlinic Hospital, 20094 Milan, Italy; (L.C.); (A.C.)
| | - Francesco Soria
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Paolo Gontero
- Department of Surgical Sciences, Division of Urology, San Giovanni Battista Hospital, University of Studies of Torino, 10121 Turin, Italy; (F.S.); (P.G.)
| | - Biagio Barone
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (L.S.); (F.C.); (F.C.); (B.B.)
| | - Federico Deho
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Emanuele Zaffuto
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, 21100 Varese, Italy; (F.D.); (E.Z.)
| | - Rocco Papalia
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | - Roberto M. Scarpa
- Department of Urology, Campus Biomedico University Hospital, 00198 Rome, Italy; (R.P.); (R.M.S.)
| | | | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (G.L.); (P.D.)
| | - Francesco Maria Gerardo Botticelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Michele Catellani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.G.B.); (G.M.); (M.C.); (O.d.C.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| |
Collapse
|
35
|
Waldhorn I, Holland R, Goshen-Lago T, Shirman Y, Szwarcwort-Cohen M, Reiner-Benaim A, Shachor-Meyouhas Y, Hussein K, Fahoum L, Peer A, Almog R, Shaked Y, Halberthal M, Ben-Aharon I. Six-Month Efficacy and Toxicity Profile of BNT162b2 Vaccine in Cancer Patients with Solid Tumors. Cancer Discov 2021; 11:2430-2435. [PMID: 34475136 DOI: 10.1158/2159-8290.cd-21-1072] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
We had previously reported short-term efficacy, immunogenicity, and safety of the BNT162b2 vaccine among cancer patients with solid tumors. We aimed to evaluate these outcomes at six months postvaccination. The study cohort comprised patients who were on treatment during vaccination and throughout six months postvaccination. Serologic tests were performed after second vaccination and six months afterward. An age-matched cohort of health care workers served as controls. Documentation of COVID-19 infection, blood tests, and imaging studies during the study period was reviewed. Participants included 154 patients and 135 controls. Six months postvaccination, 122 (79%) patients were seropositive compared with 114 (84%) controls (P = 0.32). Serology titer dramatically decreased in a similar manner in both cohorts. No COVID-19 cases were documented in controls, and one case occurred in patient cohort. All previously reported adverse effects resolved. Taken together, the pattern of immunogenicity, efficacy, and safety of BNT162b2 in patients with cancer with solid tumors at six months postvaccination resembles that of the general population. SIGNIFICANCE: Evidence regarding efficacy and safety of COVID-19 vaccines in patients with cancer indicate a favorable short-term profile. Immunomodulation due to anticancer treatments may affect immunity and immunogenicity of patients with cancer to the BNT162b2 vaccine over time. Our study sheds light on these long-term outcomes and portrays a trend that resembles the general population.This article is highlighted in the In This Issue feature, p. 2355.
Collapse
Affiliation(s)
- Ithai Waldhorn
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Roy Holland
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Tal Goshen-Lago
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Yelena Shirman
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Yael Shachor-Meyouhas
- General Management, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Khetam Hussein
- General Management, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Liana Fahoum
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Avivit Peer
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Ronit Almog
- Clinical Epidemiology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Shaked
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Technion-Integrated Cancer Center, Technion, Haifa, Israel
| | - Michael Halberthal
- General Management, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel. .,Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Technion-Integrated Cancer Center, Technion, Haifa, Israel
| |
Collapse
|
36
|
Bhalla S, Bakouny Z, Schmidt AL, Labaki C, Steinharter JA, Tremblay DA, Awad MM, Kessler AJ, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang HH, Anderson-Keightly HM, El Zarif T, Abou Alaiwi S, Rosenbloom TD, Stewart PS, Galsky MD, Choueiri TK, Doroshow DB. Care disruptions among patients with lung cancer: A COVID-19 and cancer outcomes study. Lung Cancer 2021; 160:78-83. [PMID: 34461400 PMCID: PMC8284065 DOI: 10.1016/j.lungcan.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 12/29/2022]
Abstract
Introduction Patients with lung cancer (LC) are susceptible to severe outcomes from COVID-19. This study evaluated disruption to care of patients with LC during the COVID-19 pandemic. Methods The COVID-19 and Cancer Outcomes Study (CCOS) is a prospective cohort study comprised of patients with a current or past history of hematological or solid malignancies with outpatient visits between March 2 and March 6, 2020, at two academic cancer centers in the Northeastern United States (US). Data was collected for the three months prior to the index week (baseline period) and the following three months (pandemic period). Results 313 of 2365 patients had LC, 1578 had other solid tumors, and 474 had hematological malignancies. Patients with LC were not at increased risk of COVID-19 diagnosis compared to patients with other solid or hematological malignancies. When comparing data from the pandemic period to the baseline period, patients with LC were more likely to have a decrease in in-person visits compared to patients with other solid tumors (aOR 1.94; 95% CI, 1.46–2.58), but without an increase in telehealth visits (aOR 1.13; 95% CI 0.85–1.50). Patients with LC were more likely to experience pandemic-related treatment delays than patients with other solid tumors (aOR 1.80; 95% CI 1.13–2.80) and were more likely to experience imaging/diagnostic procedure delays than patients with other solid tumors (aOR 2.59; 95% CI, 1.46–4.47) and hematological malignancies (aOR 2.01; 95% CI, 1.02–3.93). Among patients on systemic therapy, patients with LC were also at increased risk for decreased in-person visits and increased treatment delays compared to those with other solid tumors. Discussion Patients with LC experienced increased cancer care disruption compared to patients with other malignancies during the early phase of the COVID-19 pandemic. Focused efforts to ensure continuity of care for this patient population are warranted.
Collapse
Affiliation(s)
- Sheena Bhalla
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Andrew L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Chris Labaki
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - John A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Douglas A Tremblay
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Mark M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alaina J Kessler
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Michelle Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fiona Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Michael Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Catherine R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Brittney S Zimmerman
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Gabrielle Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tomi Jun
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Pier V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Qian Qin
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Laure Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jonathan Feld
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Kaitlin M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Danielle Seidman
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hsin-Hui Huang
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Heather M Anderson-Keightly
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Talal El Zarif
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Sarah Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Talia D Rosenbloom
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Penina S Stewart
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Matthew D Galsky
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Deborah B Doroshow
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
| |
Collapse
|
37
|
Bayle A, Baldini C, Martin-Romano P, Michot JM, Champiat S, Bahleda R, Gazzah A, Marabelle A, Verlingue L, Geraud A, Morel D, Michiels S, Hollebecque A, Albiges L, Besse B, Soria JC, Massard C, Barlesi F, Postel-Vinay S. Sustained cancer clinical trial activity in a French hospital during the first wave of the COVID-19 pandemic. Cancer Cell 2021; 39:1039-1041. [PMID: 34197735 PMCID: PMC8243022 DOI: 10.1016/j.ccell.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Arnaud Bayle
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France; Université Paris Saclay, Université Paris-Sud, Faculté de Médicine, Le Kremlin Bicêtre, Paris, France; Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France.
| | - Capucine Baldini
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | | | - Jean-Marie Michot
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Stéphane Champiat
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Rastilav Bahleda
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Anas Gazzah
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Aurélien Marabelle
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Loic Verlingue
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Arthur Geraud
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Daphné Morel
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Stefan Michiels
- Oncostat U1018, Inserm, Paris-Saclay University, Labeled Ligue Contre le Cancer, Villejuif, France; Biostatistics and Epidemiology Office, Gustave Roussy, Villejuif Cedex, France
| | - Antoine Hollebecque
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Benjamin Besse
- Université Paris Saclay, Université Paris-Sud, Faculté de Médicine, Le Kremlin Bicêtre, Paris, France; Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Jean-Charles Soria
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France; Université Paris Saclay, Université Paris-Sud, Faculté de Médicine, Le Kremlin Bicêtre, Paris, France
| | - Christophe Massard
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France; Université Paris Saclay, Université Paris-Sud, Faculté de Médicine, Le Kremlin Bicêtre, Paris, France
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Sophie Postel-Vinay
- Drug Development Department (DITEP) Gustave Roussy-Cancer Campus, Villejuif, France; ATIP-Avenir, U981 INSERM, Villejuif, France.
| |
Collapse
|
38
|
Labaki C, Bakouny Z, Schmidt A, Lipsitz SR, Rebbeck TR, Trinh QD, Choueiri TK. Recovery of cancer screening tests and possible associated disparities after the first peak of the COVID-19 pandemic. Cancer Cell 2021; 39:1042-1044. [PMID: 34265251 PMCID: PMC8245382 DOI: 10.1016/j.ccell.2021.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Chris Labaki
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ziad Bakouny
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew Schmidt
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Timothy R Rebbeck
- Division of Population Science, Dana-Farber Cancer Institute and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Urological Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| |
Collapse
|
39
|
Addeo A, Shah PK, Bordry N, Hudson RD, Albracht B, Di Marco M, Kaklamani V, Dietrich PY, Taylor BS, Simand PF, Patel D, Wang J, Labidi-Galy I, Fertani S, Leach RJ, Sandoval J, Mesa R, Lathrop K, Mach N, Shah DP. Immunogenicity of SARS-CoV-2 messenger RNA vaccines in patients with cancer. Cancer Cell 2021; 39:1091-1098.e2. [PMID: 34214473 PMCID: PMC8218532 DOI: 10.1016/j.ccell.2021.06.009] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022]
Abstract
Patients with cancer experience a higher burden of SARS-CoV-2 infection, disease severity, complications, and mortality, than the general population. SARS-CoV-2 mRNA vaccines are highly effective in the general population; however, few data are available on their efficacy in patients with cancer. Using a prospective cohort, we assessed the seroconversion rates and anti-SARS-CoV-2 spike protein antibody titers following the first and second dose of BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines in patients with cancer in US and Europe from January to April 2021. Among 131 patients, most (94%) achieved seroconversion after receipt of two vaccine doses. Seroconversion rates and antibody titers in patients with hematological malignancy were significantly lower than those with solid tumors. None of the patients with history of anti-CD-20 antibody in the 6 months before vaccination developed antibody response. Antibody titers were highest for clinical surveillance or endocrine therapy groups and lowest for cytotoxic chemotherapy or monoclonal antibody groups.
Collapse
Affiliation(s)
- Alfredo Addeo
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland.
| | - Pankil K Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Natacha Bordry
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland
| | - Robert D Hudson
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Brenna Albracht
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Mariagrazia Di Marco
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland
| | - Virginia Kaklamani
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Pierre-Yves Dietrich
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland
| | - Barbara S Taylor
- Division of Infectious Diseases, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Pierre-Francois Simand
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland
| | - Darpan Patel
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Jing Wang
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Intidhar Labidi-Galy
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland; Center of Translational Research in Onco-Hematology, Faculty of Medicine, University of Geneva, Swiss Cancer Center Leman, Geneva, Switzerland
| | - Sara Fertani
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland
| | - Robin J Leach
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Jose Sandoval
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland
| | - Ruben Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Kate Lathrop
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA
| | - Nicolas Mach
- Department of Oncology, Geneva University Hospitals, University of Geneva, Swiss Cancer Center Leman, Switzerland
| | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, TX, USA.
| |
Collapse
|
40
|
Marron JM, Charlot M, Gaddy J, Rosenberg AR. The Ethical Imperative of Equity in Oncology: Lessons Learned From 2020 and a Path Forward. Am Soc Clin Oncol Educ Book 2021; 41:e13-e19. [PMID: 34061560 DOI: 10.1200/edbk_100029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic and the simultaneous increased focus on structural racism and racial/ethnic disparities across the United States have shed light on glaring inequities in U.S. health care, both in oncology and more generally. In this article, we describe how, through the lens of fundamental ethical principles, an ethical imperative exists for the oncology community to overcome these inequities in cancer care, research, and the oncology workforce. We first explain why this is an ethical imperative, centering the discussion on lessons learned during 2020. We continue by describing ongoing equity-focused efforts by ASCO and other related professional medical organizations. We end with a call to action-all members of the oncology community have an ethical responsibility to take steps to address inequities in their clinical and academic work-and with guidance to practicing oncologists looking to optimize equity in their research and clinical practice.
Collapse
Affiliation(s)
- Jonathan M Marron
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Center for Bioethics, Harvard Medical School, Boston, MA
| | - Marjory Charlot
- Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jacquelyne Gaddy
- Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| |
Collapse
|
41
|
Abstract
In its most direct interpretation, telemedicine is medical care provided at a distance. Although telemedicine's use had been steadily increasing, the COVID-19 pandemic prompted an unprecedented interest and urgency among patients, health care professionals, and policymakers to facilitate health care devoid of the need for in-person contact. The growth in personal access to telecommunications technology meant an unprecedented number of people in the United States and around the world had access to the equipment and technology that would make virtual care possible from the home. As the mass implementation of telemedicine unfolded, it became quickly apparent that scaling up the use of telemedicine presented considerable new challenges, some of which worsened disparities. This article describes those challenges by examining the history of telemedicine, its role in both supporting access and creating new barriers to access in trying to get everyone connected, frameworks for thinking about those barriers, and facilitators that may help overcome them, with a particular focus on older adults and patients with cancer in rural communities.
Collapse
Affiliation(s)
- Ana Maria Lopez
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Kenneth Lam
- University of California, San Francisco, San Francisco, CA
| | | |
Collapse
|
42
|
Oyer RA, Smeltzer MP, Kramar A, Boehmer LM, Lathan CS. Equity-Driven Approaches to Optimizing Cancer Care Coordination and Reducing Care Delivery Disparities in Underserved Patient Populations in the United States. JCO Oncol Pract 2021; 17:215-218. [PMID: 33974823 DOI: 10.1200/op.20.00895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Randall A Oyer
- Ann B. Barshinger Cancer Institute, Penn Medicine Lancaster General Health, Lancaster, PA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN
| | - Amanda Kramar
- Association of Community Cancer Centers, Rockville, MD
| | | | - Christopher S Lathan
- Dana-Farber Cancer Institute at St Elizabeth's Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| |
Collapse
|
43
|
Abstract
Patients with cancer have been disproportionally affected by the COVID-19 pandemic, with high rates of severe outcomes and death. Similarly, treatment decisions in this vulnerable population have been altered to a major degree during the past year, with significant disruption of care reported. Although complex, therapeutic choices in patients with cancer in times of COVID-19 are critical, as they may save thousands of lives. A mounting body of evidence, in addition to clear recommendations by multiple international societies, can help oncologists decide appropriately the necessity to administer antineoplastic regimens, helping to avoid a surge in cancer-related deaths in the upcoming months.
Collapse
Affiliation(s)
- Chris Labaki
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute, Boston, Massachusetts. .,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
44
|
Xu W, Piper-Vallillo AJ, Bindal P, Wischhusen J, Patel JM, Costa DB, Peters MLB. Time to SARS-CoV-2 clearance among patients with cancer and COVID-19. Cancer Med 2021; 10:1545-1549. [PMID: 33560590 PMCID: PMC7940218 DOI: 10.1002/cam4.3708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/19/2023] Open
Abstract
Background For cancer patients, coronavirus disease 19 (COVID‐19) infection can lead to delays in cancer therapy both due to the infection itself and due to the need to minimize exposure to other patients and to staff. Clearance guidelines have been proposed, but expected time to clearance has not been established. Methods We identified all patients at a tertiary care hospital cancer center between 25 March 2020 and 6 June 2020 with a positive nasopharyngeal reverse transcriptase polymerase chain reaction (RT‐PCR) test for the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), a cancer‐related visit within 3 years, and at least one follow‐up assay. We determined the time to clearance using American Society of Clinical Oncology (ASCO), the UK National Institute for Health and Care Excellence (UK‐NICE), and Centers for Disease Control and Prevention (CDC) criteria. A matched non‐cancer comparison cohort was also identified. Results Thirty‐two cancer patients were identified. Nineteen were cleared by ASCO criteria, with estimated median time to clearance of 50 days. Fourteen patients resumed chemotherapy prior to clearance. Using UK‐NICE criteria, median time to clearance would have been 31 days, and using CDC criteria, it would have been 13 days. The matched non‐cancer cohort had similar clearance time, but with less frequent testing. Conclusion SARS‐CoV‐2 clearance times differ substantially depending on the criteria used and may be prolonged in cancer patients. This could lead to a delay in cancer care, increased use of clearance testing, and extension of infection control precautions.
Collapse
Affiliation(s)
- Wenxin Xu
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew J Piper-Vallillo
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Poorva Bindal
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan Wischhusen
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jaymin M Patel
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel B Costa
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mary Linton B Peters
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
45
|
Affiliation(s)
- Yasuyoshi Sato
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
| | - Yu Fujiwara
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan; Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 281 First Avenue, New York, NY 10003, USA
| | - Naoki Fukuda
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Brian Hayama
- Department of Infectious Diseases, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Yoshinori Ito
- Department of Chemotherapy, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 1358550, Japan
| | - Shinji Ohno
- Department of Breast Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | | |
Collapse
|
46
|
Bakouny Z, Hawley JE, Choueiri TK, Peters S, Rini BI, Warner JL, Painter CA. COVID-19 and Cancer: Current Challenges and Perspectives. Cancer Cell 2020; 38:629-646. [PMID: 33049215 PMCID: PMC7528740 DOI: 10.1016/j.ccell.2020.09.018] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
Patients with cancer have been disproportionately affected by the COVID-19 pandemic. This effect has included the adverse outcomes in patients with cancer who develop COVID-19, the impact of the COVID-19 pandemic on the delivery of cancer care, and the severe disruption to cancer research. However, patients with cancer are a heterogeneous population, and recent studies have now documented factors that allow risk stratification of patients with cancer in order to optimize care. In this review, we highlight data at the intersection of COVID-19 and cancer, including the biological interplay between the two diseases and practical recommendations for the treatment of patients with cancer during the pandemic. We additionally discuss the potential long-lasting impact of the pandemic on cancer care due to its deleterious effect on cancer research, as well as biological insights from the cancer research community that could help develop novel therapies for all patients with COVID-19.
Collapse
Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jessica E Hawley
- Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Brian I Rini
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy L Warner
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Corrie A Painter
- Cancer Program, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA.
| |
Collapse
|