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Rasic G, Beaulieu-Jones BR, Chung SH, Romatoski KS, Kenzik K, Ng SC, Tseng JF, Sachs TE. The Impact of the COVID-19 Pandemic on Hepatocellular Carcinoma Time to Treatment Initiation: A National Cancer Database Study. Ann Surg Oncol 2023; 30:4249-4259. [PMID: 37099088 PMCID: PMC10132402 DOI: 10.1245/s10434-023-13468-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic strained oncologic care access and delivery, yet little is known about how it impacted hepatocellular carcinoma (HCC) management. Our study sought to evaluate the annual effect of the COVID-19 pandemic on time to treatment initiation (TTI) for HCC. METHODS The National Cancer Database was queried for patients diagnosed with clinical stages I-IV HCC (2017-2020). Patients were categorized based on their year of diagnosis as "Pre-COVID" (2017-2019) and "COVID" (2020). TTI based on stage and type of treatment first received was compared by the Mann-Whitney U test. A logistic regression model was used to evaluate factors of increased TTI and treatment delay (> 90 days). RESULTS In total, 18,673 patients were diagnosed during Pre-COVID, whereas 5249 were diagnosed during COVID. Median TTI for any first-line treatment modality was slightly shorter during the COVID year compared with Pre-COVID (49 vs. 51 days; p < 0.0001), notably in time to ablation (52 vs. 55 days; p = 0.0238), systemic therapy (42 vs. 47 days; p < 0.0001), and radiation (60 vs. 62 days; p = 0.0177), but not surgery (41 vs. 41 days; p = 0.6887). In a multivariate analysis, patients of Black race, Hispanic ethnicity, and uninsured/Medicaid/Other Government insurance status were associated with increased TTI by factors of 1.057 (95% CI: 1.022-1.093; p = 0.0013), 1.045 (95% CI: 1.010-1.081; p = 0.0104), and 1.088 (95% CI: 1.053-1.123; p < 0.0001), respectively. Similarly, these patient populations were associated with delayed treatment times. CONCLUSIONS For patients diagnosed during COVID, TTI for HCC, while statistically significant, had no clinically significant differences. However, vulnerable patients were more likely to have increased TTI.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Brendin R Beaulieu-Jones
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Sophie H Chung
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kelsey S Romatoski
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kelly Kenzik
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sing Chau Ng
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Teviah E Sachs
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
- Department of Surgery, Boston Medical Center, Boston, MA, USA.
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2
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Fortune EE, Zaleta AK, Morris VG. Perceived COVID-19 pandemic impact and protective factors predicting patient-reported depression and anxiety in individuals living with cancer. J Patient Rep Outcomes 2023; 7:29. [PMID: 36928789 PMCID: PMC10019398 DOI: 10.1186/s41687-023-00571-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic presents a unique, amplified threat to those living with a cancer diagnosis, but personal factors may play a role in how this affects well-being. This cross-sectional study (1) describes the impacts of COVID-19 on cancer patients' lives, and (2) explores the extent to which specific impacts of COVID-19 and noted protective factors, hope and resilience, predict two crucial patient-reported outcomes, depression and anxiety, after controlling for relevant sociodemographic and clinical factors. METHODS 520 cancer patients and survivors in the U.S. completed an online survey during the first year of the pandemic and answered questions about COVID-19 areas of impact, psychological well-being, hope, and resilience. Hierarchical regression analyses were used to analyze the unique impact of each group of variables on patient-reported levels of depression and anxiety during the pandemic. RESULTS Participants strongly endorsed COVID-19 impact across several areas of life, especially social activity, well-being, and ability to acquire basic essentials. Regression models explained a substantial amount of variance in patient-reported depression (R2 = .50, p < .001) and anxiety (R2 = .44, p < .001), revealing COVID-19 financial impact as a significant predictor of depression (β = 0.07), and COVID-19 family impact as a significant predictor of anxiety (β = 0.14), even after controlling for the effects of relevant sociodemographic and clinical variables. Additionally, resilience and hope were the largest predictors of both depression (β = - 0.19 and - 0.37, respectively) and anxiety (β = - 0.18 and - 0.29), suggesting that they account for unique variance in patient-reported mental health during the COVID-19 pandemic and might serve as important protective factors. CONCLUSIONS The current results add to existing literature documenting the significant effect of COVID-19 on those living with cancer. COVID-19 impact, including financial and family well-being, as well as positive psychological constructs, hope and resilience, play a crucial role in levels of patient-reported depression and anxiety during the pandemic. As COVID-19 continues to evolve, health care providers should routinely assess psychological well-being and needs related to COVID-19 financial and family impact in an effort to appropriately align individuals with resources and support, and consider how hope and resilience can be fostered to serve as psychological buffers during this time.
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Affiliation(s)
- Erica E Fortune
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA.
| | - Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
| | - Victoria G Morris
- Cancer Support Community, Research and Training Institute, 520 Walnut Street, Suite 1170, Philadelphia, PA, 19106, USA
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3
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Budisavljevic A, Kelemenic-Drazin R, Silovski T, Plestina S, Plavetic ND. Correlation between psychological resilience and burnout syndrome in oncologists amid the Covid-19 pandemic. Support Care Cancer 2023; 31:207. [PMID: 36897484 PMCID: PMC9999072 DOI: 10.1007/s00520-023-07660-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Oncologists are predisposed to developing burnout syndrome. Like other health care professionals worldwide, oncologists have endured additional, extreme challenges during the Covid-19 pandemic. Psychological resilience presents a potential protective mechanism against burnout. This cross-sectional study examines whether psychological resilience eased burnout syndrome among Croatian oncologists during the pandemic. METHODS An anonymized self-reporting questionnaire was electronically distributed by the Croatian Society for Medical Oncology to 130 specialist and resident oncologists working in hospitals. Available for completion from September 6-24, 2021, the survey comprised demographic questions; the Oldenburg Burnout Inventory (OLBI), covering exhaustion and disengagement; and the Brief Resilience Scale (BRS). The response rate was 57.7%. RESULTS Burnout was moderate or high for 86% of respondents, while 77% had moderate or high psychological resilience. Psychological resilience was significantly negatively correlated with the OLBI exhaustion subscale (r = - .54; p < 0.001) and the overall OLBI score (r = - .46; p < 0.001). Scheffe's post hoc test showed that oncologists with high resilience scored significantly lower on the overall OLBI (M = 2.89; SD = 0.487) compared to oncologists with low resilience (M = 2.52; SD = 0.493). CONCLUSION The findings thus indicate that oncologists with high psychological resilience are at significantly lower risk of developing burnout syndrome. Accordingly, convenient measures to encourage psychological resilience in oncologists should be identified and implemented.
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Affiliation(s)
- Anuska Budisavljevic
- Department of Medical Oncology and Hematology, General Hospital Pula, Pula, Croatia
| | - Renata Kelemenic-Drazin
- Department of Hematology, Oncology and Clinical Immunology, General Hospital Varazdin, Varazdin, Croatia.
| | - Tajana Silovski
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Stjepko Plestina
- Department of Oncology, University Hospital Centre Zagreb, Zagreb, Croatia
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4
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Ram A, Pagès A, Cubilier E, Daoudi N, Vandergheynst F, Scotte F, Antoun S, Merad M. COVID-19 impact on an oncologic emergency department visits: observational study. BMJ Support Palliat Care 2023:spcare-2023-004184. [PMID: 36813536 DOI: 10.1136/spcare-2023-004184] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE This study aimed at evaluating the impact of COVID-19 on emergency department (ED) visits in a tertiary cancer centre and providing information on the features of the unplanned events during the first wave of COVID-19 pandemic. METHODS This retrospective observational study based on data from ED reports was divided into three periods of 2 months each around the first lockdown announcement of 17 March 2020: pre-lockdown, lockdown and post-lockdown. RESULTS A total of 903 ED visits were included in the analyses. The mean (±SD) daily number of ED visits did not change during the lockdown period (14.6±5.5) when compared with the periods before (13.6±4.5) and after lockdown (13.7±4.4) (p=0.78). The proportion of ED visits for fever and respiratory disorders increased significantly to 29.5% and 28.5%, respectively (p<0.01) during lockdown. Pain, the third most frequent motive, remained stable with 18.2% (p=0.83) throughout the three periods. Symptom severity also showed no significant differences in the three periods (p=0.31). CONCLUSION Our study shows that ED visits during the first wave of the COVID-19 pandemic remained stable for our patients regardless of the symptom's severity. The fear of an in-hospital viral contamination appears weaker than the need for pain management or for the treatment of cancer-related complications. This study highlights the positive impact of cancer ED in the first-line treatment and supportive care of patients with cancer.
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Affiliation(s)
- Aurélie Ram
- Internal medicine, Hôpital Erasme, Brussels, Belgium
| | - Arnaud Pagès
- Biostatistics, Gustave Roussy Institute, Villejuif, Île de France, France
| | - Edouard Cubilier
- Internal medicine, Brugmann University Hospital, Brussels, Belgium
| | - Nesrine Daoudi
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | | | - Florian Scotte
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Sami Antoun
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Mansouriah Merad
- Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
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5
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Roberts NA, Dhillon HM, Paterson C, Schubach K, McJannett M. The impact of coronavirus disease 2019 on genitourinary and prostate cancer care and clinical trials: A qualitative exploration of the Australian and New Zealand experience. Asia Pac J Clin Oncol 2022; 19:337-346. [PMID: 36281656 PMCID: PMC9874658 DOI: 10.1111/ajco.13847] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE This qualitative study aimed to understand the impact of the coronavirus disease 2019 pandemic from March to November 2020 on healthcare delivery and clinical trials for genitourinary (GU) cancers in Australia. METHODS Annually a pre-conference workshop is hosted by the Australian New Zealand Urogenital and Prostate Cancer Trials Group for supportive care health professionals. In November 2020, those that selected to attend were invited to participate in a focus group. Workshop and focus group discussions were recorded and transcripts were analyzed thematically. RESULTS Seventy-two individuals involved in GU cancer care and clinical trials took part. Participants described negative changes to GU cancer care and clinical trials from the pandemic due to reduced clinical services and increased wait times. Trial recruitment was paused temporarily during lockdowns, and standard treatment protocols were used to limit hospital visits. Trial process changes included electronic capture of informed consent, home delivery of oral medications, and delegations of assessments. These changes increased administrative activity for clinical trial teams and Human Research Ethics Committees. A transition to telehealth enabled continuity of service delivery and trials but reduced the opportunity for face-to-face patient consultations with increasing concern about the failure to detect supportive care needs. CONCLUSION The pandemic has prompted a critical review of service delivery and clinical trials for people with GU cancers.
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Affiliation(s)
- Natasha A. Roberts
- Centre for Clinical ResearchUniversity of QueenslandBrisbaneAustralia,Cancer Care ServicesMetro North Health ServiceHerstonAustralia,Australian New Zealand Urogenital and Prostate Cancer Trials GroupSydneyAustralia
| | - Haryana M. Dhillon
- Centre for Medical Psychology and Evidence‐Based Decision‐MakingSchool of Psychology, Faculty of ScienceUniversity of SydneySydneyAustralia,Australian New Zealand Urogenital and Prostate Cancer Trials GroupSydneyAustralia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public HealthUniversity of CanberraCanberraAustralia,Prehabilitation, ActivityCancerExercise and Survivorship (PACES) Research GroupUniversity of CanberraCanberraAustralia,Canberra Health Services and ACT HealthSYNERGY Nursing and Midwifery Research CentreACT Health Directorate Level 3Canberra HospitalCanberraAustralia,Robert Gordon UniversityAberdeenUK,Australian New Zealand Urogenital and Prostate Cancer Trials GroupSydneyAustralia
| | - Kathryn Schubach
- Men's Health MelbourneMelbourneAustralia,Australian and New Zealand Urology Nurses Society (ANZUNS)MarrickvilleAustralia,Australian New Zealand Urogenital and Prostate Cancer Trials GroupSydneyAustralia
| | - Margaret McJannett
- Australian New Zealand Urogenital and Prostate Cancer Trials GroupSydneyAustralia
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6
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Evered J, Andersen L, Foxwell A, Iroegbu C, Whitney C. The impact and implications of virtual supportive cancer care during the COVID-19 pandemic: integrating patient and clinician perspectives. Support Care Cancer 2022; 30:9945-9952. [PMID: 36208318 PMCID: PMC9547569 DOI: 10.1007/s00520-022-07393-9] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
Purpose Many cancer centers made rapid shifts in supportive care delivery modalities at the onset of the COVID-19 pandemic. Improving virtual supportive cancer care requires deeply understanding both patient’s and clinician’s experiences. We aimed to integrate the perspectives of clinicians and patients to describe the transition to virtual supportive cancer care during COVID-19. Methods In clinical-academic partnership between a multi-site cancer care center in the Northeastern USA and a school of nursing, we conducted a study using dimensional analysis method. Theoretical sampling drove recruitment of patients and clinicians who engaged in virtual supportive cancer care from March 15, 2020 to December 15, 2020. In this sub-analysis, we coded the dimensional analysis data from semi-structured interviews using a descriptive approach with inductive conventional content analysis. Results We interviewed 17 clinicians, 18 patients, and 3 care partners about their experiences. We integrate patient and clinician perspectives in four in vivo categories: “When COVID hit,” “Not an IT expert,” “Those little moments,” and “The mothership.” Conclusion The findings uncover shared patient and clinician fears of missing or sub-optimal care at the onset of COVID-19, technological and relational challenges to engaging in care, and the mixed impacts of virtual care on access, convenience, and efficiency. This analysis suggests concrete action items to improve virtual supportive care for patients and clinicians. The findings corroborate the importance of convenience, access, and efficiency as care quality indicators and suggest potential to emphasize the clinician-patient relationship as an additional indicator of care quality.
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Affiliation(s)
- Jane Evered
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine CT, Madison, WI, 53711, USA. .,University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Lucy Andersen
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Anessa Foxwell
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christin Iroegbu
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Clare Whitney
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Stony Brook University School of Nursing, Stony Brook, NJ, USA
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7
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Airth A, Whittle JR, Dimou J. How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology? J Clin Neurosci 2022; 105:91-102. [PMID: 36122487 PMCID: PMC9452416 DOI: 10.1016/j.jocn.2022.09.004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 09/03/2022] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic has challenged the continued delivery of healthcare globally. Due to disease risk, clinicians were forced to re-evaluate the safety and priorities of pre-pandemic care. Neuro-oncology presents unique challenges, as patients can deteriorate rapidly without intervention. These challenges were also observed in countries with reduced COVID-19 burden with centres required to rapidly develop strategies to maintain efficient and equitable care. This review aims to summarise the impact of the pandemic on clinical care and research within the practice of Neuro-oncology. A narrative review of the literature was performed using MEDLINE and EMBASS and results screened using PRISMA guidelines with relevant inclusion and exclusion criteria. Search strategies included variations of ‘Neuro-oncology’ combined with COVID-19 and other clinical-related terms. Most adult and paediatric neurosurgical centres experienced reductions in new referrals and operations for brain malignancies, and those who did present for treatment frequently had operations cancelled or delayed. Many radiation therapy and medical oncology centres altered treatment plans to mitigate COVID-19 risk for patients and staff. New protocols were developed that aimed to reduce in-person visits and reduce the risk of developing severe complications from COVID-19. The COVID-19 pandemic has presented many challenges to the provision of safe and accessible healthcare. Despite these challenges, some benefits to healthcare provision such as the use of telemedicine are likely to remain in future practice. Neuro-oncology staff must remain vigilant to ensure patient and staff safety.
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Affiliation(s)
- Angus Airth
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - James R Whittle
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia; Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - James Dimou
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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8
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Galica J, Kilgour HM, Oliffe JL, Haase KR. Coping Strategies Used by Older Cancer Survivors During the COVID-19 Pandemic: A Longitudinal Qualitative Study. Res Aging 2022; 45:448-457. [PMID: 36047406 PMCID: PMC10130934 DOI: 10.1177/01640275221120102] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The objective of this study is to longitudinally examine the coping strategies used by older cancer survivors (≥60 years of age) during COVID-19. Methods: An interpretive descriptive approach was used to collect and analyse qualitative data collected via 1:1 telephone interviews at three timepoints: June/July 2020, January 2021, and March 2021. Main Findings: Coping strategies used by older adults reflected the resources available to them, and their agency in self-triaging and deciding on resources to support their coping. These decisions were impacted by pandemic-imposed restrictions and necessitated readjustment over time. Three themes were developed to describe coping strategies (including any changes): adapting means and methods to connect with others; being intentional about outlook; and taking actions toward a brighter future. Conclusion: Older adults used a variety of coping strategies, though their reliance on resources beyond themselves (e.g., family/friends) indicates a need to add tailored resources to existing professional services.
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Affiliation(s)
- Jacqueline Galica
- School of Nursing, Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, 4257Queen's University, Kingston, ON, Canada
| | - Heather M Kilgour
- School of Nursing, Faculty of Applied Science, 8166The University of British Columbia, Vancouver, BC, Canada
| | - John L Oliffe
- School of Nursing, Faculty of Applied Science, 8166The University of British Columbia, Vancouver, BC, Canada
| | - Kristen R Haase
- School of Nursing, Faculty of Applied Science, 8166The University of British Columbia, Vancouver, BC, Canada
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9
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Milch V, Nelson AE, Austen M, Hector D, Turnbull S, Sathiaraj R, Der Vartanian C, Wang R, Anderiesz C, Keefe D. Conceptual Framework for Cancer Care During a Pandemic Incorporating Evidence From the COVID-19 Pandemic. JCO Glob Oncol 2022; 8:e2200043. [PMID: 35917484 PMCID: PMC9470141 DOI: 10.1200/go.22.00043] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With successive infection waves and the spread of more infectious variants, the COVID-19 pandemic continues to have major impacts on health care. To achieve best outcomes for patients with cancer during a pandemic, efforts to minimize the increased risk of severe pandemic infection must be carefully balanced against unintended adverse impacts of the pandemic on cancer care, with consideration to available health system capacity. Cancer Australia's conceptual framework for cancer care during a pandemic provides a planning resource for health services and policy-makers that can be broadly applied globally and to similar pandemics. METHODS Evidence on the impact of the COVID-19 pandemic on cancer care and health system capacity to June 2021 was reviewed, and the conceptual framework was developed and updated. RESULTS Components of health system capacity vary during a pandemic, and capacity relative to pandemic numbers and severity affects resources available for cancer care delivery. The challenges of successive pandemic waves and high numbers of pandemic cases necessitate consideration of changing health system capacity in decision making about cancer care. Cancer Australia’s conceptual framework provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimizing infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption. CONCLUSION Evidence from the COVID-19 pandemic supports continuation of cancer care wherever possible during similar pandemics. Cancer Australia's conceptual framework, underpinned by principles for optimal cancer care, informs decision making across the cancer care continuum. It incorporates consideration of changes in health system capacity and capacity for cancer care, in relation to pandemic progression, enabling broad applicability to different global settings.
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Affiliation(s)
- Vivienne Milch
- Cancer Australia, Sydney, New South Wales, Australia
- The University of Notre Dame, Sydney, New South Wales, Australia
| | - Anne E. Nelson
- Evidence Review Contractor, Sydney, New South Wales, Australia
| | | | - Debra Hector
- Cancer Australia, Sydney, New South Wales, Australia
| | | | | | | | - Rhona Wang
- Cancer Australia, Sydney, New South Wales, Australia
| | - Cleola Anderiesz
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- National Breast Cancer Foundation, Sydney, New South Wales, Australia
| | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
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10
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Kotha NV, Kumar A, Nelson TJ, Qiao EM, Qian AS, Voora RS, McKay RR, Rose BS, Stewart TF. Outcomes by time to definitive chemoradiation treatment for patients with muscle-invasive bladder cancer. Urol Oncol 2022; 40:274.e1-274.e6. [PMID: 35216893 PMCID: PMC8863428 DOI: 10.1016/j.urolonc.2022.01.010] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has raised concerns about delaying treatment for localized cancer and its impact on long-term outcomes. OBJECTIVE We aimed to investigate the impact of time to chemoradiation (CRT) on recurrence and survival outcomes for patients with muscle-invasive bladder cancer (MIBC). METHODS In the national Veterans Affairs' database, we identified patients with urothelial histology, MIBC (T2-4a/N0-3/M0) diagnosed between 2000 to 2018 and treated with definitive CRT. Time to treatment was defined as the number of days between date of diagnosis and start date of CRT. The cohort was stratified into < 90 (early) or ≥ 90 days (delayed) groups. Endpoints of locoregional failure (LRF), distant failure (DF), overall survival (OS), and bladder cancer-specific survival (BCS) were evaluated in multivariable Cox and Fine-Gray models. RESULTS 305 patients with MIBC underwent CRT - 190 (62.3%) received early CRT, 115 (37.7%) received delayed CRT. Multivariable analysis (including success of transurethral resection of bladder tumor and type of chemotherapy) revealed no difference in recurrence between groups - LRF HR 1.12 (95%CI 0.76-1.67, P = 0.56) and DF HR 1.03 (95%CI 0.70-1.53, P = 0.88). Similarly, there were no differences in survival outcomes. The lack of association was maintained at both earlier and later time cutoffs (60-120 days). CONCLUSIONS Our findings suggest that a short-term delay in definitive therapy may not affect long-term outcomes for patients with MIBC undergoing CRT. This study does not endorse delays in therapy, but rather provides information to aid patients and clinicians navigate the unique challenges of MIBC care in both pandemic and non-pandemic times.
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Affiliation(s)
- Nikhil V. Kotha
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, CA,Department of Radiation Oncology, Duke University, Durham, NC
| | - Tyler J. Nelson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Edmund M. Qiao
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Alex S. Qian
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Rohith S. Voora
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Rana R. McKay
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Brent S. Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA,Veterans Affairs San Diego Healthcare System, San Diego, CA
| | - Tyler F. Stewart
- Veterans Affairs San Diego Healthcare System, San Diego, CA,Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA,Corresponding author: Ph: 858-822-6185, Fax: 858-249-0905
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11
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Teicher S, Whitney RL, Liu R. Breast Cancer Survivors' Satisfaction and Information Recall of Telehealth Survivorship Care Plan Appointments During the COVID-19 Pandemic. Oncol Nurs Forum 2022; 49:223-231. [PMID: 35446836 DOI: 10.1188/22.onf.223-231] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To examine patient satisfaction and information recall after telehealth breast cancer survivorship visits with a nurse practitioner. SAMPLE & SETTING Female survivors of breast cancer after their first visit with a nurse practitioner in the outpatient survivorship clinic post-treatment. METHODS & VARIABLES Participants included female survivors who were originally diagnosed with stage 0-III breast cancer and have since completed an initial telehealth appointment to review the survivorship care plan. Survivors were invited to complete a 20-question electronic survey about their satisfaction and recall of visit information. RESULTS 62 participants completed the survey and indicated an overall high level of satisfaction with telehealth survivorship appointments. Most recalled key survivorship information from the visit and felt the appropriate amount of information was discussed. Overall satisfaction was significantly correlated with the length and convenience of the appointment, and the personal manner and technical skills of the nurse practitioner. Survivors' age was not associated with significant differences in overall satisfaction. IMPLICATIONS FOR NURSING Telehealth for initial survivorship visits demonstrated high satisfaction with telehealth and the overall visit as a low-cost intervention to treat symptoms.
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12
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Kotha NV, Williamson CW, Mell LK, Murphy JD, Martinez E, Binder PS, Mayadev JS. Disparities in time to start of definitive radiation treatment for patients with locally advanced cervical cancer. Int J Gynecol Cancer 2022; 32:613-618. [DOI: 10.1136/ijgc-2021-003305] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundChemoradiation or radiation therapy alone are curative standards for patients with locally advanced cervical cancer.ObjectiveTo investigate factors that influence time to initiation of chemoradiation or radiation and the subsequent impact of time to treatment on recurrence and survival outcomes.MethodsPatients with locally advanced cervical cancer treated with definitive chemoradiation or radiation at our institution between November 2015 and August 2020 were retrospectively identified. Time to treatment initiation was defined as the number of days from date of diagnosis (via biopsy) to the start date of radiation. The cohort was stratified by the median time to treatment into early (<75 days) and delayed (≥75 days) cohorts. Multivariable logistic regression was conducted to examine factors associated with delayed time to treatment.ResultsWe identified 143 patients with locally advanced cervical cancer who underwent definitive chemoradiation or radiation. Median follow-up time was 18 months (range 2–62). A total of 71 (49.7%) patients had time to treatment <75 days and 72 (50.3%) patients had time to treatment ≥75 days. The delayed cohort had a higher proportion of Hispanic patients (51.4% vs 31.0%, p=0.04). In multivariable modeling, Hispanic women were 2.71 times more likely (p=0.04) to undergo delayed time to treatment than non-Hispanic white women. Additionally, patients with stage >IIB disease were less likely to undergo delayed time to treatment (OR 0.26, p=0.02) than patients with stage <IIB disease. There was no interaction between race/ethnicity and disease stage. Delayed time to treatment was not associated with inferior overall survival, loco-regional failure, or distant failure.ConclusionHispanic patients with locally advanced cervical cancer were more likely to receive delayed time to definitive treatment of ≥75 days. Further studies examining the presence of similar disparities in delay to definitive treatment for locally advanced cervical cancer at other institutions and settings are warranted.
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Haase KR, Verma R, Kilgour HM. Impact of COVID-19 on care of older adults with cancer: a narrative synthesis of reviews, guidelines and recommendations. Curr Opin Support Palliat Care 2022; 16:3-13. [DOI: 10.1097/spc.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Cheung MC, Franco BB, Meti N, Thawer A, Tahmasebi H, Shankar A, Loblaw A, Wright FC, Fox C, Peek N, Sim V, Singh S. Delivery of Virtual Care in Oncology: Province-Wide Interprofessional Consensus Statements Using a Modified Delphi Process. Curr Oncol 2021; 28:5332-45. [PMID: 34940084 DOI: 10.3390/curroncol28060445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/08/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022] Open
Abstract
Virtual cancer care (i.e., teleoncology) was rapidly adopted during the COVID-19 pandemic to meet the needs of patients with cancer. However, there is a paucity of guidance for clinicians regarding virtual cancer care. We sought to develop consensus-based statements to guide the optimal provision of virtual care for clinicians caring for patients with cancer, using a modified Delphi consensus process with a 29-member panel consisting of an interprofessional group of clinicians caring for patients with cancer and patient representatives. The consensus process consisted of two rounds and one synchronous final consensus meeting. At the end of the modified Delphi process, 62 of 62 statements achieved consensus. Fifty-seven statements reached consensus in the first round of the process. Concerns regarding the ability to convey difficult news virtually and maintaining similar standards as in-person care without disproportionate strain on clinicians and patients were addressed in the consensus process. We achieved interprofessional consensus on virtual cancer care practices. Further research examining the impact of virtual cancer care on person-centred and clinical outcomes are needed to inform practices during the COVID-19 pandemic and beyond.
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15
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Abedi SM, Lekkala M, Moftakhar B, Clarke T, Patel A. Protecting High-Risk Oncology Patients During the COVID-19 Pandemic by Creating an Isolated Outpatient Clinic. JCO Oncol Pract 2021; 18:e626-e631. [PMID: 34882499 PMCID: PMC9014457 DOI: 10.1200/op.21.00126] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Delivering care for immunocompromised, high-risk patients with cancer during a pandemic has proven challenging. Patients with cancer on chemotherapy have a high risk of mortality if contracted COVID-19. If a patient goes directly to the emergency room, multiple contact points with other individuals can lead to unnecessary exposures from any airborne virus, such as COVID-19. Our cancer center has implemented an isolated clinic with personal protective equipment and direct access to a COVID-19 rule-out floor to manage those with febrile neutropenia (FN). ![]()
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Affiliation(s)
- Seyed Mohammad Abedi
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Manidhar Lekkala
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Bahar Moftakhar
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Tammy Clarke
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Arpan Patel
- Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Milch V, Wang R, Der Vartanian C, Austen M, Hector D, Anderiesz C, Keefe D. Cancer Australia consensus statement on COVID-19 and cancer care: embedding high value changes in practice. Med J Aust 2021; 215:479-484. [PMID: 34689343 PMCID: PMC8662192 DOI: 10.5694/mja2.51304] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
Introduction Driven by the need to reduce risk of SARS‐CoV‐2 infection and optimise use of health system resources, while maximising patient outcomes, the COVID‐19 pandemic has prompted unprecedented changes in cancer care. Some new or modified health care practices adopted during the pandemic will be of long term value in improving the quality and resilience of cancer care in Australia and internationally. The Cancer Australia consensus statement is intended to guide and enhance the delivery of cancer care during the pandemic and in a post‐pandemic environment. This article summarises the full statement, which is available at https://www.canceraustralia.gov.au/covid‐19/covid‐19‐recovery‐implications‐cancer‐care. Main recommendations The statement is informed by a desktop literature review and input from cancer experts and consumers at a virtual roundtable, held in July 2020, on key elements of cancer care that changed during the pandemic. It describes targeted strategies (at system, service, practitioner and patient levels) to retain, enhance and embed high value changes in practice. Principal strategies include:
implementing innovative models of care that are digitally enabled and underpinned by clear governance, policies and procedures to guide best practice cancer care; enabling health professionals to deliver evidence‐based best practice and coordinated, person‐centred cancer care; and empowering patients to improve health literacy and enhancing their ability to engage in informed, shared decision making.
Changes in management as a result of this statement Widespread adoption of high value health care practices across all levels of the cancer control sector will be of considerable benefit to the delivery of optimal cancer care into the future.
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Affiliation(s)
| | | | | | | | | | - Cleola Anderiesz
- Cancer Australia, Sydney, NSW.,Centre for Health Policy, University of Melbourne, Melbourne, VIC
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17
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Marshall VK, Chavez M, Mason TM, Martinez‐Tyson D. Emergency preparedness during the COVID-19 pandemic: Perceptions of oncology professionals and implications for nursing management from a qualitative study. J Nurs Manag 2021; 29:1375-1384. [PMID: 34174005 PMCID: PMC8420290 DOI: 10.1111/jonm.13399] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/05/2021] [Accepted: 06/22/2021] [Indexed: 01/09/2023]
Abstract
AIM To explore oncology health care professionals' perceptions of the COVID-19 pandemic response. BACKGROUND The pandemic has created health care delivery challenges globally and many countries have exhibited low readiness and emergency preparedness. METHODS A descriptive design using a qualitative approach was employed. Semi-structured interviews, which were completed via telephone, were audio recorded and transcribed verbatim. A thematic analysis was conducted. RESULTS Participants (N = 30) were mostly registered nurses (70%). Three themes emerged: (1) ability to adapt and operationalize disaster planning, training and restructure nursing models (subtheme: reactive vs. proactive approach to emergency preparedness); (2) COVID-19 task forces and professional organisations were critical for valid information surrounding the pandemic; and (3) recommendations for emergency preparedness/planning for future pandemics. CONCLUSION Oncology organisations adapted during the pandemic, but policies and procedures were perceived as reactive and not proactive. Recommendations for planning for future pandemics included (1) adequate personal protective equipment, (2) developing cancer-specific guidelines/algorithms and (3) telehealth training related to billing/reimbursement. Professional organisations were reliable resources of information during the pandemic, but oncology professionals ultimately trusted employers and administration to distribute information needed for safe patient care. IMPLICATIONS FOR NURSING MANAGEMENT Frontline nurses should hold positions on task forces to develop future emergency preparedness.
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Affiliation(s)
| | - Melody Chavez
- College of Public HealthUniversity of South FloridaTampaFloridaUSA
| | - Tina M. Mason
- H. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
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18
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Kamada K, Konno S, Kaneko T, Fukunaga K, Hasegawa Y, Yokoyama A. The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society. Respir Investig 2021; 59:792-798. [PMID: 34446400 PMCID: PMC8324411 DOI: 10.1016/j.resinv.2021.07.001] [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: 04/23/2021] [Revised: 06/20/2021] [Accepted: 07/04/2021] [Indexed: 12/23/2022]
Abstract
Background The impact of the outbreak of COVID-19 on the work of respiratory physicians in Japan has not yet been evaluated. The study investigates the impact of the outbreak on respiratory physicians’ work over time and identifies problems to be addressed in the future. Methods We conducted a web-based survey of respiratory physicians in 848 institutions. The survey comprised 32 questions and four sections: Survey 1 (April 20, 2020), Survey 2 (May 27, 2020), Survey 3 (August 31, 2020), and Survey 4 (December 4, 2020). Results The mean survey response rate was 24.9%, and 502 facilities (59.2%) participated in at least one survey. The proportion of facilities that could perform PCR tests for diagnosis and more than 20 tests per day gradually increased. The percentage capable of managing extracorporeal membrane oxygenation (ECMO) or more than five ventilators did not increase over time. The proportion that reported work overload of 150% or more, stress associated with lack of personal protective equipment (PPE), and harassment or stigma in the surrounding community did not sufficiently improve. Conclusion While there was an improvement in expanding the examination system and medical cooperation in the community, there was no indication of enhancement of the critical care management system. The overwork of respiratory physicians, lack of PPE, and harassment and stigma related to COVID-19 did not sufficiently improve and need to be addressed urgently.
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Affiliation(s)
- Keisuke Kamada
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan; Department of Mycobacterium Reference and Research, The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan.
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Japan
| | | | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
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19
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Tang M, Daniels B, Aslam M, Schaffer A, Pearson SA. Changes in systemic cancer therapy in Australia during the COVID-19 pandemic: a population-based study. Lancet Reg Health West Pac 2021; 14:100226. [PMID: 34368796 PMCID: PMC8329989 DOI: 10.1016/j.lanwpc.2021.100226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022]
Abstract
Background Since the emergence of COVID-19 there have been increasing global concerns about delays and/or discontinuations in cancer care. However, it is unclear to what extent systemic cancer therapy was impacted by COVID-19 in countries with relatively low COVID-19 infection rates. We examined changes in systemic cancer therapy in Australia during the COVID-19 pandemic. Methods We conducted a national observational study using de-identified records of government-subsidised cancer medicines dispensed to a random 10% sample of Australians between January 2017 to December 2020. We reported monthly dispensing and initiation rates of antineoplastic (chemo-, immuno- and targeted therapy), endocrine and supportive medicines per 100,000 population. We reported monthly discontinuation rates (defined as ≥90 days gap between cancer medicine dispensings) per 1,000 people treated. We used interrupted time series analysis to examine changes during times of increased COVID-19 risk and related public health measures (March, April and July 2020). Findings Between January 2017 and December 2020, 1,011,255 cancer medicines were dispensed to 51,515 people. Overall, there were no reductions in antineoplastic dispensing or initiation during the COVID-19 pandemic. In March 2020, we observed a temporary increase of 39/100,000 (95% CI: 14 to 65/100,000) in antineoplastic dispensing, driven by immunotherapy and targeted therapy. In April 2020, we observed a temporary decrease in chemotherapy initiation (-2/100,000, 95% CI: -4 to -1/100,000) and temporary increase in discontinuation of all antineoplastic medicines (35/1,000, 95% CI: 20 to 51/1,000), but these changes were not sustained. Interpretation The effective control of COVID-19 in Australia appears to have mitigated the initial impact of COVID-19 on systemic cancer therapy. We observed only small and temporary changes in the use of some cancer medicines early in the pandemic. Funding National Health and Medical Research Council; National Breast Cancer Foundation; Translational Cancer Research Network, supported by the Cancer Institute NSW.
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Affiliation(s)
- Monica Tang
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney Australia
| | - Benjamin Daniels
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney Australia
| | - Maria Aslam
- School of Medicine and Public Health, Faculty of Heath, University of Newcastle, Newcastle Australia
| | - Andrea Schaffer
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney Australia
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20
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Yuen KCJ, Mortensen MJ, Azadi A, Fonkem E, Findling JW. Rethinking the management of immune checkpoint inhibitor-related adrenal insufficiency in cancer patients during the COVID-19 pandemic. Endocrinol Diabetes Metab 2021; 4:e00246. [PMID: 34268454 PMCID: PMC8250331 DOI: 10.1002/edm2.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/20/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) is currently a major pandemic challenge, and cancer patients are at a heightened risk of severity and mortality from this infection. In recent years, immune checkpoint inhibitor (ICI) use to treat multiple cancers has increased in oncology, but equally has raised the question of whether ICI therapy and its side-effects is harmful or beneficial during this pandemic. Methods A combination of published literature in PubMed between January 2010 and December 2020, recommended guidelines in non-cancer patients, and clinical experience was utilized to outline recommendations on glucocorticoid timing and dosing regimens in ICI-treated patients presenting with AI during this COVID-19 pandemic. Results The potential immune interaction between ICIs and COVID-19 require major consideration because these agents act at the intersection between effective cancer immunotherapy and increasing patient susceptibility, severity and complications from the SARS-CoV-2 sepsis. Furthermore, ICI use can induce autoimmune adrenal insufficiency (AI) that further increases infection susceptibility. Thus, ICI-treated cancer patients with AI may be at greater risk of COVID-19 infection. Glucocorticoids are the cornerstone for replacement therapy, and for treatment and mitigation of adrenal crisis and relief of mass effects in ICI-related hypophysitis. High-dose glucocorticoids have also been used with cytotoxic chemotherapy as part of cancer treatment, and iatrogenic AI may arise after glucocorticoid discontinuation that increases the risk of adrenal crisis. Furthermore, in patients who develop the "long COVID-19" syndrome, when to discontinue glucocorticoid therapy becomes crucial to avoid unnecessary prolongation of therapy and the development of iatrogenic hypercortisolemia. Conclusion During the COVID-19 pandemic, much of cancer care have been impacted and an important clinical question is how to optimally manage ICI-related AI during these unprecedented times. Herein, we suggest practical recommendations on the timing and dosing regimens of glucocorticoids in different clinical scenarios of ICI-treated cancer patients presenting with AI during this COVID-19 pandemic.
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Affiliation(s)
- Kevin C. J. Yuen
- Departments of Neuroendocrinology and NeurosurgeryBarrow Neurological InstituteUniversity of Arizona College of Medicine and Creighton School of MedicinePhoenixArizonaUSA
| | | | - Amir Azadi
- Departments of Neurology and Neuro‐OncologyBarrow Neurological Institute/Ivy Brain Center at PhoenixSt. Joseph’s Hospital and Medical CenterPhoenixArizonaUSA
| | - Ekokobe Fonkem
- Departments of Neurology and Neuro‐OncologyBarrow Neurological Institute/Ivy Brain Center at PhoenixSt. Joseph’s Hospital and Medical CenterPhoenixArizonaUSA
| | - James W. Findling
- Division of Endocrinology and Molecular MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
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21
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Hlubocky FJ, Back AL, Shanafelt TD, Gallagher CM, Burke JM, Kamal AH, Paice JA, Page RD, Spence R, McGinnis M, McFarland DC, Srivastava P. Occupational and Personal Consequences of the COVID-19 Pandemic on US Oncologist Burnout and Well-Being: A Study From the ASCO Clinician Well-Being Task Force. JCO Oncol Pract 2021; 17:e427-e438. [PMID: 34152789 DOI: 10.1200/op.21.00147] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is an unprecedented global crisis profoundly affecting oncology care delivery. PURPOSE This study will describe the occupational and personal consequences of the COVID-19 pandemic on oncologist well-being and patient care. MATERIALS AND METHODS Four virtual focus groups were conducted with US ASCO member oncologists (September-November 2020). Inquiry and subsequent discussions centered on self-reported accounts of professional and personal COVID-19 experiences affecting well-being, and oncologist recommendations for well-being interventions that the cancer organization and professional societies (ASCO) might implement were explored. Qualitative interviews were analyzed using Framework Analysis. RESULTS Twenty-five oncologists were interviewed: median age 44 years (range: 35-69 years), 52% female, 52% racial or ethnic minority, 76% medical oncologists, 64% married, and an average of 51.5 patients seen per week (range: 20-120). Five thematic consequences emerged: (1) impact of pre-COVID-19 burnout, (2) occupational or professional limitations and adaptations, (3) personal implications, (4) concern for the future of cancer care and the workforce, and (5) recommendations for physician well-being interventions. Underlying oncologist burnout exacerbated stressors associated with disruptions in care, education, research, financial practice health, and telemedicine. Many feared delays in cancer screening, diagnosis, and treatment. Oncologists noted personal and familial stressors related to COVID-19 exposure fears and loss of social support. Many participants strongly considered working part-time or taking early retirement. Yet, opportunities arose to facilitate personal growth and rise above pandemic adversity, fostering greater resilience. Recommendations for organizational well-being interventions included psychologic or peer support resources, flexible time-off, and ASCO and state oncology societies involvement to develop care guidelines, well-being resources, and mental health advocacy. CONCLUSION Our study suggests that the COVID-19 pandemic has adversely affected oncologist burnout, fulfillment, practice health, cancer care, and workforce. It illuminates where professional organizations could play a significant role in oncologist well-being.
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Affiliation(s)
- Fay J Hlubocky
- Section Hematology/Oncology, Department of Medicine, Maclean Center for Clinical Medical Ethics, University of Chicago Medicine, Chicago, IL
| | - Anthony L Back
- Department of Medicine/Oncology, University of Washington, Seattle, WA
| | - Tait D Shanafelt
- VA Palo Alto Health Care System, Stanford University, Palo Alto, CA
| | - Colleen M Gallagher
- Section of Integrated Ethics in Cancer Care, The University of Texas MD Anderson Cancer Center, Houston, TX.,Research Scholar, UNESCO Chair for Bioethics and Human Rights
| | | | - Arif H Kamal
- Population Health Sciences, Duke Cancer Institute, Duke University, Durham, NC
| | - Judith A Paice
- Division Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
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22
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Travers A, Adler K, Blanchard G, Bonaventura T, Charlton J, Day F, Healey L, Kim S, Lombard J, Mallesara G, Mandaliya H, Navani V, Nordman I, Paterson R, Plowman L, Quah GT, Scalley M, Shrestha P, Tailor B, van der Westhuizen A, Zhang B, Gedye C, Lynam J. Business as unusual: medical oncology services adapt and deliver during COVID-19. Intern Med J 2021; 51:673-681. [PMID: 34047023 PMCID: PMC8206831 DOI: 10.1111/imj.15217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/26/2020] [Revised: 01/09/2021] [Accepted: 01/24/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has challenged cancer care globally, introducing resource limitations and competing risks into clinical practice. AIMS To describe the COVID-19 impact on medical oncology care provision in an Australian setting. METHODS Calvary Mater Newcastle and Newcastle Private Hospital medical oncology data from 1 February to 31 April 2019 versus 2020 were retrospectively analysed. RESULTS Three hundred and sixty-four inpatient admissions occurred in 2020, 21% less than in 2019. Total inpatient days decreased by 22% (2842 vs 2203). April was most impacted (36% and 44% fewer admissions and inpatient days respectively). Mean length of stay remained unchanged (6.4 vs 6.2 days, P = 0.7). In all, 5072 outpatient consultations were conducted, including 417 new-patient consultations (4% and 6% increase on 2019 respectively). Telephone consultations (0 vs 1380) replaced one-quarter of face-to-face consultations (4859 vs 3623, -25%), with minimal telehealth use (6 vs 69). Day Treatment Centre encounters remained stable (3751 vs 3444, -8%). The proportion of new patients planned for palliative treatment decreased (35% vs 28%, P = 0.04), observation increased (16% vs 23%, P = 0.04) and curative intent treatment was unchanged (both 41%). Recruiting clinical trials decreased by one-third (45 vs 30), two trials were activated (vs 5 in 2019) and 45% fewer patients consented to trial participation (62 vs 34). CONCLUSION Our medical oncology teams adapted rapidly to COVID-19 with significant changes to care provision, including fewer hospital admissions, a notable transition to telephone-based outpatient clinics and reduced clinical trial activity. The continuum of care was largely defended despite pandemic considerations and growing service volumes.
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Affiliation(s)
- Avraham Travers
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Kim Adler
- Medical Oncology Trial Unit, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Gillian Blanchard
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Tony Bonaventura
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Newcastle Private Hospital, Newcastle, New South Wales, Australia
| | - Julie Charlton
- Epic Pharmacy Newcastle, Newcastle, New South Wales, Australia
| | - Fiona Day
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Laura Healey
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Sang Kim
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Janine Lombard
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Newcastle Private Hospital, Newcastle, New South Wales, Australia
| | - Girish Mallesara
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Newcastle Private Hospital, Newcastle, New South Wales, Australia
| | - Hiren Mandaliya
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Newcastle Private Hospital, Newcastle, New South Wales, Australia
| | - Vishal Navani
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Ina Nordman
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Robin Paterson
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Newcastle Private Hospital, Newcastle, New South Wales, Australia
| | - Louise Plowman
- Medical Oncology Trial Unit, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Gaik Tin Quah
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Michael Scalley
- Newcastle Private Hospital, Newcastle, New South Wales, Australia.,Epic Pharmacy Newcastle, Newcastle, New South Wales, Australia
| | - Prajwol Shrestha
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Bharti Tailor
- Clinical Systems Team, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | | | - Betty Zhang
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - James Lynam
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Newcastle Private Hospital, Newcastle, New South Wales, Australia
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Palluzzi E, Corrado G, Marchetti C, Bolomini G, Vertechy L, Bottoni C, Distefano M, Scambia G, Ferrandina G. Medical treatment of patients with gynecologic cancer during the COVID-19 pandemic. Int J Gynecol Cancer 2021; 31:1154-1158. [PMID: 33883231 DOI: 10.1136/ijgc-2020-002288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, cancer care had to be reorganized; national and international recommendations were published to manage anticancer treatments safely and to reduce the risk of SARS-CoV-2 infection for patients and health workers. OBJECTIVE To evaluate whether the adoption of recommendations for the management of patients with gynaecologic cancer receiving treatment during the pandemic resulted in containment of infections and continuing oncologic care. METHODS Based on the published recommendations, and according to the local Health Direction guidelines, we developed and drafted a security protocol to modify access of patients with gynaecologic cancer to the "Fondazione Policlinico Agostino Gemelli-IRCCS, Rome" between February 1 and April 30, 2020 and compared results with the corresponding 3 months of 2019. RESULTS Between February and April 2019, we registered 3254 admissions, including 2253 patients receiving intravenous chemotherapies, 298 receiving oral therapies, and 703 having hospital visits. Between February and April 2020, we registered 3213 admissions, including 2221 patients receiving intravenous chemotherapies, 401 receiving oral therapies, and 591 having hospital visits. Oral treatments and general visits were different in the two time periods (p<0.001). Despite the elevated patient flow, only one patient (0.1%) tested positive for COVID-19 and there were no cases among healthcare staff. CONCLUSIONS Based on the adopted security protocol we provided continuity of care for all patients and limited the spread of the COVID-19 infection.
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Affiliation(s)
- Eleonora Palluzzi
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giacomo Corrado
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Claudia Marchetti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giulia Bolomini
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Laura Vertechy
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Carolina Bottoni
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Mariagrazia Distefano
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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24
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Ives A, Pusztai T, Keller J, Ahern E, Chan B, Gasper H, Wyld D, Kennedy G, Dickie G, Lwin Z, Roberts NA. Resilience and ongoing quality care for cancer clinical trials during COVID-19: Experience from a tertiary hospital in Australia. Asia Pac J Clin Oncol 2021; 18:e141-e147. [PMID: 33819387 PMCID: PMC8251164 DOI: 10.1111/ajco.13570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic has forced rapid system-wide changes to be implemented within cancer care at an alarming pace. Clinical trials are a key element of comprehensive cancer care. Ensuring the continuing safe conduct of cancer clinical trials in the context of a pandemic is challenging. METHODS We aimed to describe the COVID-19 pandemic response of a Cancer Care Clinical Research Unit (CRU) of a tertiary hospital in Queensland, Australia. We used a mixed methods approach for this case study. Emailed directives from CRU managers to all CRU staff sharing were qualitatively analysed and mapped against our unit activities over longitudinal time points. Data from patient recruitment and protocol deviations were analysed using descriptive statistics. RESULTS Mapping activity from 11 March to 30 September 2020 revealed rapid change during the first 2 weeks. Four key strategies to accommodate change were identified: supporting patients and families, introduction of telehealth, accessing investigational product, and social distancing. Early in the pandemic we recognised that our core key stakeholders were integral to our response. When compared to the previous 12 months, our recruitment numbers dropped markedly in early phases of the response but recovered over time, as we accommodated internal and external impacts. CONCLUSION Our experience of agility as a necessity, adapting to support patients, and managing both clinical research activity and sponsors during the height of the pandemic response is presented here in order to inform future disaster response planning by clinical trial organisations.
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Affiliation(s)
- Amy Ives
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tricia Pusztai
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Ahern
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Bryan Chan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Harry Gasper
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland Centre for Clinical Research (UQCCR), Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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25
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Fasola G, Pelizzari G, Zara D, Targato G, Petruzzellis G, Minisini AM, Bin A, Donato R, Mansutti M, Comuzzi C, Candoni A, Sperotto A, Fanin R. Feasibility and Predictive Performance of a Triage System for Patients with Cancer During the COVID-19 Pandemic. Oncologist 2021; 26:e694-e703. [PMID: 33539583 PMCID: PMC8014855 DOI: 10.1002/onco.13706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/07/2020] [Accepted: 01/22/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Triage procedures have been implemented to limit hospital access and minimize infection risk among patients with cancer during the coronavirus disease (COVID-19) outbreak. In the absence of prospective evidence, we aimed to evaluate the predictive performance of a triage system in the oncological setting. MATERIALS AND METHODS This retrospective cohort study analyzes hospital admissions to the oncology and hematology department of Udine, Italy, during the COVID-19 pandemic (March 30 to April 30, 2020). A total of 3,923 triage procedures were performed, and data of 1,363 individual patients were reviewed. RESULTS A self-report triage questionnaire identified 6% of triage-positive procedures, with a sensitivity of 66.7% (95% confidence interval [CI], 43.0%-85.4%), a specificity of 94.3% (95% CI, 93.5%-95.0%), and a positive predictive value of 5.9% (95% CI, 4.3%-8.0%) for the identification of patients who were not admitted to the hospital after medical review. Patients with thoracic cancer (odds ratio [OR], 1.69; 95% CI, 1.13-2.53, p = .01), younger age (OR, 1.52; 95% CI, 1.15-2.01, p < .01), and body temperature at admission ≥37°C (OR, 9.52; 95% CI, 5.44-16.6, p < .0001) had increased risk of positive triage. Direct hospital access was warranted to 93.5% of cases, a further 6% was accepted after medical evaluation, whereas 0.5% was refused at admission. CONCLUSION A self-report questionnaire has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. Differential diagnosis with tumor- or treatment-related symptoms is always required to avoid unnecessary treatment delays. Body temperature measurement improves the triage process's overall sensitivity, and widespread SARS-CoV-2 testing should be implemented to identify asymptomatic carriers. IMPLICATIONS FOR PRACTICE This is the first study to provide data on the predictive performance of a triage system in the oncological setting during the coronavirus disease outbreak. A questionnaire-based triage has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms, and a differential diagnosis with tumor- or treatment-related symptoms is mandatory to avoid unnecessary treatment delays. Consequently, adequate recourses should be reallocated for a triage implementation in the oncological setting. Of note, body temperature measurement improves the overall sensitivity of the triage process, and widespread testing for SARS-CoV-2 infection should be implemented to identify asymptomatic carriers.
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Affiliation(s)
- Gianpiero Fasola
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Giacomo Pelizzari
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Diego Zara
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Giada Targato
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | | | | | - Alessandra Bin
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Raffaela Donato
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Mauro Mansutti
- Department of Oncology, Santa Maria della Misericordia HospitalUdineItaly
| | - Chiara Comuzzi
- Department of Hematology, Santa Maria della Misericordia HospitalUdineItaly
| | - Anna Candoni
- Department of Hematology, Santa Maria della Misericordia HospitalUdineItaly
| | | | - Renato Fanin
- Department of Hematology, Santa Maria della Misericordia HospitalUdineItaly,Department of Medicine, University of UdineUdineItaly
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26
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Hlubocky FJ, Symington BE, McFarland DC, Gallagher CM, Dragnev KH, Burke JM, Lee RT, El-Jawahri A, Popp B, Rosenberg AR, Thompson MA, Dizon DS, Srivastava P, Patel MI, Kamal AH, Daugherty CK, Back AL, Dokucu ME, Shanafelt TD. Impact of the COVID-19 Pandemic on Oncologist Burnout, Emotional Well-Being, and Moral Distress: Considerations for the Cancer Organization's Response for Readiness, Mitigation, and Resilience. JCO Oncol Pract 2021; 17:365-374. [PMID: 33555934 DOI: 10.1200/op.20.00937] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fay J Hlubocky
- University of Chicago Medicine, Maclean Center for Clinical Medical Ethics, Chicago, IL
| | | | - Daniel C McFarland
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry, New York, NY
| | - Colleen M Gallagher
- MD Anderson Cancer Center, Section of Integrated Ethics in Cancer Care, Houston, TX
| | | | | | - Richard T Lee
- Case Comprehensive Cancer Center, Department of Medicine, Division of Hematology/Oncology, School of Medicine, Cleveland OH
| | - Areej El-Jawahri
- Massachusetts General Hospital, Cancer Center, Harvard Medical School, Boston MA
| | - Beth Popp
- Ichan School of Medicine, Geriatrics and Palliative Medicine, Mount Sinai, New York, NY
| | - Abby R Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine; Seattle WA; Seattle Children's Research Institute, Seattle, WA
| | | | - Don S Dizon
- Lifespan Cancer Institute, Rhode Island Hospital, Brown University Providence, RI
| | | | - Manali I Patel
- Stanford University, VA Palo Alto Health Care System, Palo Alto, CA
| | - Arif H Kamal
- Duke University, Duke Cancer Institute, Population Health Sciences, Durham, NC
| | - Christopher K Daugherty
- University of Chicago Medicine, Department of Medicine, Section Hematology/Oncology, Maclean Center for Clinical Medical Ethics, Chicago, IL Chicago, IL
| | - Anthony L Back
- University of Washington, Department of Medicine/Oncology, Seattle, WA
| | - Mehmet E Dokucu
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL
| | - Tait D Shanafelt
- Stanford University, Department of Medicine, Med/Hematology, Chief Wellness Officer, Palo Alto, CA
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27
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Abstract
BACKGROUND Understanding basic epidemiology and public health concepts is essential to the provision of safe care during a pandemic. These basic concepts and terms include containment, mitigation, predictive modeling, latent period, incubation period, reproduction number, case fatality rate, and test sensitivity and specificity. OBJECTIVES Public health concepts and terms are defined, described in the context of the COVID-19 pandemic, and specific implications for oncology nursing practice are discussed. METHODS A review of public health literature and reputable websites with a focus on COVID-19 data. This article defines epidemiologic and public health concepts and uses examples from the pandemic to illustrate oncology nursing implications. FINDINGS The COVID-19 pandemic is changing oncology nursing care delivery. Oncology nurses need to understand these concepts to anticipate and advocate for optimal oncology care.
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28
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Abstract
BACKGROUND The COVID-19 pandemic generated challenges to the delivery of safe, efficient, and high-quality cancer care. In ambulatory oncology, where most cancer care is delivered, these challenges required the rapid development of infrastructure. OBJECTIVES This article describes challenges to the design and implementation of ambulatory oncology infrastructures that support clinical oncology care during a pandemic. METHODS This article reviews clinical experiences in interprofessional, multicenter, academic, and community settings during the COVID-19 pandemic. Cohesive and efficient services, collaborative processes, and workflows; patient triage and symptom management; technology and equipment; and communication strategies are discussed. National ambulatory care guidelines and practice recommendations are included as applicable and available. FINDINGS Continued treatment delivery and support for patients with cancer, as well as infrastructure to minimize viral exposure to patients and oncology healthcare workers, are essential when caring for this high-risk population.
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Affiliation(s)
| | - Megha Shah
- Northwestern Medicine Delnor Cancer Center
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29
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Su Z, McDonnell D, Liang B, Kue J, Li X, Šegalo S, Advani S, Flores BE, Wang J. Technology-based health solutions for cancer caregivers to better shoulder the impact of COVID-19: a systematic review protocol. Syst Rev 2021; 10:43. [PMID: 33526095 PMCID: PMC7849615 DOI: 10.1186/s13643-021-01592-x] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning cancer caregivers' distinctive challenges amid COVID-19. METHODS A systematic search of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus from the database inception to the end of March 2021. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy will be developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process. CONCLUSIONS COVID-19 has upended cancer care as we know it. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020196301.
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Affiliation(s)
- Zhaohui Su
- School of Nursing, Center on Smart and Connected Health Technologies, Mays Cancer Center, UT Health San Antonio, San Antonio, TX 78229 USA
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, R93 V960, Ireland
| | - Bin Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10010 China
| | - Jennifer Kue
- School of Nursing, Ohio State University, Columbus, USA
| | - Xiaoshan Li
- Program of Public Relations and Advertising, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Sabina Šegalo
- Department of Microbiology, Faculty of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Shailesh Advani
- Terasaki Institute of Biomedical Innovation, Los Angeles, CA 21100 USA
| | - Bertha E. Flores
- School of Nursing, UT Health San Antonio, San Antonio, TX 78229 USA
| | - Jing Wang
- School of Nursing, Center on Smart and Connected Health Technologies, Mays Cancer Center, UT Health San Antonio, San Antonio, TX 78229 USA
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30
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Natalucci V, Virgili E, Calcagnoli F, Valli G, Agostini D, Zeppa SD, Barbieri E, Emili R. Cancer Related Anemia: An Integrated Multitarget Approach and Lifestyle Interventions. Nutrients 2021; 13:482. [PMID: 33535496 DOI: 10.3390/nu13020482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/24/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
Cancer is often accompanied by worsening of the patient's iron profile, and the resulting anemia could be a factor that negatively impacts antineoplastic treatment efficacy and patient survival. The first line of therapy is usually based on oral or intravenous iron supplementation; however, many patients remain anemic and do not respond. The key might lie in the pathogenesis of the anemia itself. Cancer-related anemia (CRA) is characterized by a decreased circulating serum iron concentration and transferrin saturation despite ample iron stores, pointing to a more complex problem related to iron homeostatic regulation and additional factors such as chronic inflammatory status. This review explores our current understanding of iron homeostasis in cancer, shedding light on the modulatory role of hepcidin in intestinal iron absorption, iron recycling, mobilization from liver deposits, and inducible regulators by infections and inflammation. The underlying relationship between CRA and systemic low-grade inflammation will be discussed, and an integrated multitarget approach based on nutrition and exercise to improve iron utilization by reducing low-grade inflammation, modulating the immune response, and supporting antioxidant mechanisms will also be proposed. Indeed, a Mediterranean-based diet, nutritional supplements and exercise are suggested as potential individualized strategies and as a complementary approach to conventional CRA therapy.
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31
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Su Z, McDonnell D, Liang B, Kue J, Li X, Šegalo S, Advani S, Flores BE, Wang J. Technology-based Health Solutions for Cancer Caregivers to Better Shoulder the Impact of COVID-19: A Systematic Review Protocol. Res Sq 2021:rs.3.rs-66218. [PMID: 32908975 PMCID: PMC7480034 DOI: 10.21203/rs.3.rs-66218/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning cancer caregivers' distinctive challenges amid COVID-19. METHODS A systematic search of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus from the database inception to the end of March, 2021. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy will be developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process. CONCLUSIONS COVID-19 has upended cancer care as we know it. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond. STUDY PROTOCOL REGISTRATION PROSPERO CRD42020196301.
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Affiliation(s)
- Zhaohui Su
- University of Texas Health Science Center at San Antonio
| | | | - Bin Liang
- Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | - Xiaoshan Li
- Beijing Normal University-Hong Kong Baptist University United International College
| | | | | | | | - Jing Wang
- University of Texas Health Science Center at San Antonio
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32
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Abstract
PURPOSE OF REVIEW The spread of the novel coronavirus SARS-CoV-2 and its associated disease, coronavirus disease of 2019 (COVID-19), has significantly derailed cancer care. Patients with leukemia are more likely to have severe infection and increased rates of mortality. There is paucity of information on how to modify care of leukemia patients in view of the COVID-19 risks and imposed restrictions. We review the available literature on the impact of COVID-19 on different types of leukemia patients and suggest general as well as disease-specific recommendations on care based on available evidence. RECENT FINDINGS The COVID-19 infection impacts leukemia subtypes in variable ways and the standard treatments for leukemia have similarly, varying effects on the course of COVID-19 infection. Useful treatment strategies include deferring treatment when possible, use of less intensive regimens, outpatient targeted oral agents requiring minimal monitoring, and prioritization of curative or life-prolonging strategies. Reducing health care encounters, rational transfusion standards, just resource allocation, and pre-emptive advance care planning will serve the interests of leukemia patients. Ad hoc modifications based on expert opinions and extrapolations of previous well-designed studies are the way forward to navigate the crisis. This should be supplanted with more rigorous prospective evidence.
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33
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Shi J, Giess CS, Martin T, Lemaire KA, Curley PJ, Bay C, Mayo-Smith WW, Boland GW, Khorasani R. Radiology Workload Changes During the COVID-19 Pandemic: Implications for Staff Redeployment. Acad Radiol 2021; 28:1-7. [PMID: 33036897 PMCID: PMC7531432 DOI: 10.1016/j.acra.2020.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 07/02/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES Quantify changes in total and by-subspecialty radiology workload due to deferring nonurgent services during the initial COVID-19 pandemic, and describe operational strategies implemented due to shifts in priority. MATERIALS AND METHODS This retrospective, Institutional Review Board-exempt, study was performed between February 3, 2020 and April 19, 2020 at a large academic medical center. During March 9-15 (intervention period), nonurgent outpatient service deferments began. Five-week periods pre- (baseline) and postintervention (COVID) were defined. Primary outcomes were radiology volume (reports per day) overall and in 11 subspecialty divisions. Linear regression assessed relationship between baseline vs. COVID volumes stratified by division. Secondary outcomes included changes in relative value units (RVUs), inpatient and outpatient volumes. RESULTS There were 62,791 baseline reports vs. 23,369 during COVID; a 60% overall precipitous volume decrease (p < 0.001). Mean volume decrease pre- and during-COVID was significant (p < 0.001) amongst all individual divisions. Mean volume decrease differed amongst divisions: Interventional Radiology experienced least disruption (29% volume decrease), 7 divisions experienced 40%-60% decreases, and Musculoskeletal, Breast, and Cardiovascular imaging experienced >75% volume decrease. Total RVUs decreased 60% (71,186 baseline; 28,476 COVID). Both outpatient and inpatient report volumes decreased; 72% (41,115 baseline; 11,326 COVID) and 43% (12,626 baseline vs. 6,845 COVID), respectively. In labor pool tracking data, 21.8% (162/744) total radiology employees were reassigned to other hospital duties during the intervention period. CONCLUSION Precipitous radiology workload reductions impacted subspecialty divisions with marked variation. Data-driven operational decisions during COVID-19 assisted workflow and staffing assignment changes. Ongoing adjustments will be needed as healthcare systems transition operations to a "new normal."
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Affiliation(s)
- Junzi Shi
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115; Harvard Medical School, Boston, Massachusetts.
| | - Catherine S Giess
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115; Harvard Medical School, Boston, Massachusetts
| | - Tyler Martin
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115
| | - Karen A Lemaire
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115
| | - Patrick J Curley
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115
| | - Camden Bay
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115
| | - William W Mayo-Smith
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115; Harvard Medical School, Boston, Massachusetts
| | - Giles W Boland
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115; Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St, Boston, MA 02115; Harvard Medical School, Boston, Massachusetts
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34
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Rasschaert M, Vanclooster P, Depauw L, Mertens T, Roelant E, Coenen E, Anguille S, Janssens A, Van Dam P, Peeters M. Meeting the Challenges in Cancer Care Management During the SARS-Cov-2 Pandemic: A Retrospective Analysis. Cancer Control 2021; 28:10732748211045275. [PMID: 34623943 PMCID: PMC8504214 DOI: 10.1177/10732748211045275] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has overwhelmed the capacity of healthcare systems worldwide. Cancer patients, in particular, are vulnerable and oncology departments drastically needed to modify their care systems and established new priorities. We evaluated the impact of SARS-CoV-2 on the activity of a single cancer center. METHODS We performed a retrospective analysis of (i) volumes of oncological activities (2020 vs 2019), (ii) patients' perception rate of the preventive measures, (iii) patients' SARS-CoV-2 infections, clinical signs thereof, and (iv) new diagnoses made during the SARS-CoV-2 pandemic. RESULTS As compared with a similar time frame in 2019, the overall activity in total numbers of outpatient chemotherapy administrations and specialist visits was not statistically different (P = .961 and P = .252), while inpatient admissions decreased for both medical oncology and thoracic oncology (18% (P = .0018) and 44% (P < .0001), respectively). Cancer diagnosis plummeted (-34%), but no stage shift could be demonstrated.Acceptance and adoption of hygienic measures was high, as measured by a targeted questionnaire (>85%). However, only 46.2% of responding patients regarded telemedicine, although widely deployed, as an efficient surrogate to a consultation.Thirty-three patients developed SARS-CoV-2, 27 were hospitalized, and 11 died within this time frame. These infected patients were younger, current smokers, and suffered more comorbidities. CONCLUSIONS This retrospective cohort analysis adds to the evidence that continuation of active cancer therapy and specialist visits is feasible and safe with the implementation of telemedicine. These data further confirm the impact of SARS-CoV-2 on cancer care management, cancer diagnosis, and impact of infection on cancer patients.
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Affiliation(s)
- Marika Rasschaert
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
| | | | - Laura Depauw
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
| | - Tim Mertens
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trials Center (CTC), CRC Antwerp, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Elke Coenen
- Department of Occupational Medicine, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Sebastien Anguille
- Department of Hematology, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Annelies Janssens
- Department of Thoracic Oncology, 60202Antwerp University Hospital, Antwerp, Belgium
| | - Peter Van Dam
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, 60202Antwerp University Hospital, Antwerp, Belgium
- Center for Oncology Research (CORE), 60202University of Antwerp (UA), Antwerp, Belgium
| | - Marc Peeters
- Department of Oncology, 60202Antwerp University Hospital Antwerp, Antwerp, Belgium
- Center for Oncology Research (CORE), 60202University of Antwerp (UA), Antwerp, Belgium
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35
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Affiliation(s)
- Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
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36
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Chazan G, Franchini F, Alexander M, Banerjee S, Mileshkin L, Blinman P, Zielinski R, Karikios D, Pavlakis N, Peters S, Lordick F, Ball D, Wright G, I Jzerman M, Solomon B. Impact of COVID-19 on cancer service delivery: results from an international survey of oncology clinicians. ESMO Open 2020; 5:e001090. [PMID: 33262203 PMCID: PMC7709494 DOI: 10.1136/esmoopen-2020-001090] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/30/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives To report clinician-perceived changes to cancer service delivery in response to COVID-19. Design Multidisciplinary Australasian cancer clinician survey in collaboration with the European Society of Medical Oncology. Setting Between May and June 2020 clinicians from 70 countries were surveyed; majority from Europe (n=196; 39%) with 1846 COVID-19 cases per million people, Australia (AUS)/New Zealand (NZ) (n=188; 38%) with 267/236 per million and Asia (n=75; 15%) with 121 per million at time of survey distribution. Participants Medical oncologists (n=372; 74%), radiation oncologists (n=91; 18%) and surgical oncologists (n=38; 8%). Results Eighty-nine per cent of clinicians reported altering clinical practices; more commonly among those with versus without patients diagnosed with COVID-19 (n=142; 93% vs n=225; 86%, p=0.03) but regardless of community transmission levels (p=0.26). More European clinicians (n=111; 66.1%) had treated patients diagnosed with COVID-19 compared with Asia (n=20; 27.8%) and AUS/NZ (n=8; 4.8%), p<0.001. Many clinicians (n=307; 71.4%) reported concerns that reduced access to standard treatments during the pandemic would negatively impact patient survival. The reported proportion of consultations using telehealth increased by 7.7-fold, with 25.1% (n=108) of clinicians concerned that patient survival would be worse due to this increase. Clinicians reviewed a median of 10 fewer outpatients/week (including non-face to face) compared with prior to the pandemic, translating to 5010 fewer specialist oncology visits per week among the surveyed group. Mental health was negatively impacted for 52.6% (n=190) of clinicians. Conclusion Clinicians reported widespread changes to oncology services, in regions of both high and low COVID-19 case numbers. Clinician concerns of potential negative impacts on patient outcomes warrant objective assessment, with system and policy implications for healthcare delivery at large.
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Affiliation(s)
- Grace Chazan
- Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Fanny Franchini
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia; Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
| | - Marliese Alexander
- Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Linda Mileshkin
- Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Prunella Blinman
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Rob Zielinski
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia; Department of Medical Oncology, Orange Base Hospital, Orange, New South Wales, Australia
| | - Deme Karikios
- Department of Medical Oncology, Nepean Hospital, Penrith, New South Wales, Australia; Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Solange Peters
- Department of Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Florian Lordick
- Department of Institut Roi Albert II, University Cancer Centre Leipzig, Leipzig, Germany; Department of Oncology, Leipzig University Medical Center, Leipzig, Germany
| | - David Ball
- Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gavin Wright
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Maarten I Jzerman
- Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia; Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin Solomon
- Sir Peter MacCallum Department of Oncology, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Levine OH, McGillion M, Levine M. Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation. JMIR Cancer 2020; 6:e24222. [PMID: 33180741 PMCID: PMC7717920 DOI: 10.2196/24222] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19-free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon.
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Affiliation(s)
- Oren Hannun Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences - Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Mark Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences - Juravinski Cancer Centre, Hamilton, ON, Canada
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38
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Abstract
In the wake of the COVID-19 pandemic, due to reasons beyond control, health care workers have struggled to deliver treatment for the patients with cancer. The concern for otherwise healthy patients with curable cancers that require timely intervention or therapy is the risk of contracting COVID-19 may outweigh the benefits of cancer treatment. Lack of international guidelines leaves health care providers with a case-to-case approach for delivering optimal cancer care in the wake of the pandemic. Transition to telemedicine has somewhat bridged the gap for in-office visits, but there is a continuing challenge of delays in cancer screening or significant decline of new diagnoses of cancers due to the pandemic. We aim to propose a balance in risk from treatment delay versus risks from COVID-19 with emphasis on treatment modality (surgery, radiation, and systemic therapy) as well as supportive care for cancer patients, and therefore have reviewed the publications and recommendations from international societies and study groups available as of October 2020.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Andheri West, Mumbai, Maharashtra 400053 India
| | - Kaival K Gundavda
- Department of Surgical Oncology, Tata Memorial hospital, 93, Ground floor, Main Building, Mumbai, Maharashrta 400012 India
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39
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Cancino RS, Su Z, Mesa R, Tomlinson GE, Wang J. The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities. JMIR Cancer 2020; 6:e21697. [PMID: 33027039 PMCID: PMC7599065 DOI: 10.2196/21697] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
Cancer is a leading cause of death in the United States and across the globe. Cancer screening is an effective preventive measure that can reduce cancer incidence and mortality. While cancer screening is integral to cancer control and prevention, due to the COVID-19 outbreak many screenings have either been canceled or postponed, leaving a vast number of patients without access to recommended health care services. This disruption to cancer screening services may have a significant impact on patients, health care practitioners, and health systems. In this paper, we aim to offer a comprehensive view of the impact of COVID-19 on cancer screening. We present the challenges COVID-19 has exerted on patients, health care practitioners, and health systems as well as potential opportunities that could help address these challenges.
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Affiliation(s)
- Ramon S Cancino
- Department of Family & Community Medicine, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, United States
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
| | - Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
| | - Ruben Mesa
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
- Department of Medicine, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Gail E Tomlinson
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
- Department of Pediatrics, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Jing Wang
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
- School of Nursing, UT Health San Antonio, San Antonio, TX, United States
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40
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Norman ML, Malcolmson J, Randall Armel S, Gillies B, Ou B, Thain E, McCuaig JM, Kim RH. Stay at home: implementation and impact of virtualising cancer genetic services during COVID-19. J Med Genet 2020; 59:23-27. [DOI: 10.1136/jmedgenet-2020-107418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/30/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic has led to the rapid adoption of virtual clinic processes and healthcare delivery. Herein, we examine the impact of virtualising genetics services at Canada’s largest cancer centre. A retrospective review was conducted to evaluate relevant metrics during the 12 weeks prior to and during virtual care, including referral and clinic volumes, patient wait times and genetic testing uptake. The number of appointments and new patients seen were maintained during virtual care. Likewise, there was a significant increase in the number of patients offered testing during virtual care who did not provide a blood sample (176/180 (97.7%) vs 180/243 (74.1%); p<0.001), and a longer median time from the date of pretest genetic counselling to the date a sample was given (0 vs 11 days; p<0.001). Referral volumes significantly decreased during virtual care (35 vs 22; p<0.001), which was accompanied by a decreased median wait time for first appointment (55 days vs 30 days; p<0.001). The rapid virtualisation of cancer genetic services allowed the genetics clinic to navigate the COVID-19 pandemic without compromising clinical volumes or access to genetic testing. There was a decrease in referral volumes and uptake of genetic testing, which may be attributable to pandemic-related clinical restrictions.
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41
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Affiliation(s)
- Yada Kanjanapan
- Canberra Hospital, Canberra, ACT.,Australian National University, Canberra, ACT
| | - Desmond Yip
- Canberra Hospital, Canberra, ACT.,Australian National University, Canberra, ACT
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42
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Cherri S, Lemmers DHL, Noventa S, Abu Hilal M, Zaniboni A. Outcome of oncological patients admitted with COVID-19: experience of a hospital center in northern Italy. Ther Adv Med Oncol 2020; 12:1758835920962370. [PMID: 33062065 PMCID: PMC7533930 DOI: 10.1177/1758835920962370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/16/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent literature regarding the outcome of cancer patients infected with COVID-19 are not encouraging. Nevertheless, current evidence on the risk and benefits of continuing oncological treatment of cancer patients during the pandemic remains insufficient. We provide our experience in a center with high access for patients with COVID-19-associated pneumonia in Lombardy, Italy. We conducted a retrospective study using a prospectively maintained database of patients admitted to our hospital between 25 February 2020 and 9 April 2020 with a confirmed diagnosis of COVID-19 pneumonia. RESULTS A total of 53 patients with a history or current oncological disease were included in this study. Sixteen oncological patients (30.2%) died during hospitalization. Multivariable logistic regression analysis found that age (Odds ratio [OR]: 1.17, p = 0.009), diabetes (OR: 15.05, p = 0.028) and active oncological disease (OR 13.60, p = 0.015) were independently associated with in-hospital mortality. The mortality rate of the total number of cancer patients is about twice as high as that of non-oncological patients admitted to our hospital with a diagnosis of COVID-19. CONCLUSION The presence of active oncological disease is independently related to mortality as well as age and diabetes. The majority of patients who died were frail. Careful evaluation of the risks and benefits of treatment in frail patients is needed, considering that difficult access to intensive care may have affected the mortality rate.
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Affiliation(s)
- Sara Cherri
- Department of Clinical Oncology, Fondazione Poliambulanza, Brescia, Italy
| | - Daniel H. L. Lemmers
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Silvia Noventa
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
| | | | - Alberto Zaniboni
- Department of Oncology, Fondazione Poliambulanza, Brescia, Italy
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Underhill C, Parente P, McArthur G, Haydon A, McLachlan SA, Wong ZW, Segelov E. Towards new models of cancer care in Australia: lessons from Victoria's response to the COVID-19 pandemic. Intern Med J 2020; 50:1282-1285. [PMID: 32951279 PMCID: PMC7537092 DOI: 10.1111/imj.15012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/02/2020] [Indexed: 12/12/2022]
Abstract
In response to the COVID-19 pandemic, the Department of Health and Human Services Victoria (DHHS), the Monash Partners Comprehensive Cancer Consortium (MPCCC) and Victorian Comprehensive Cancer Centre (VCCC) pooled their combined infrastructure to establish the Victorian COVID-19 Cancer Network (VCCN) backed by a Taskforce of expert members. In a few short months, this state-wide clinical network implemented a number of new models of care including clinics to manage acutely presenting cancer patients away from emergency departments, chemotherapy in the home, telehealth models and addressing sustainability of clinical trials.
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Affiliation(s)
- Craig Underhill
- Border Medical Oncology, Albury-Wodonga Regional Cancer Centre, Albury, New South Wales, Australia.,University of NSW Rural Clinical School, Albury, New South Wales, Australia
| | - Phillip Parente
- Department of Oncology, Monash University and Eastern Health, Melbourne, Victoria, Australia
| | - Grant McArthur
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital Melbourne and Central and Eastern Medical School Monash University, Melbourne, Victoria, Australia
| | - Sue-Anne McLachlan
- Department of Oncology, St Vincent's Hospital Melbourne and Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Zee Wan Wong
- Oncology Unit, Peninsula Health, Monash University, Melbourne, Victoria, Australia
| | - Eva Segelov
- Department of Oncology, Monash University and Monash Health, Melbourne, Victoria, Australia
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Abstract
The novel 2019 coronavirus disease (COVID-19) pandemic is a global public health emergency. To date, physical distancing and good personal hygiene have been the only effective measures to limit spread. The pandemic has altered routine cancer care, including allied health and supportive care interventions. Clinicians must adapt and find ways to continue to deliver optimal patient care at this time. The prescription of exercise to people with cancer has been demonstrated to have meaningful benefits for both physical and mental health and quality of life, and may even enhance survival. Such exercise interventions provide the largest benefit to patients when delivered in a supervised, group, clinic-based setting. In the age of COVID-19, group-based exercise in communal facilities presents risks for both aerosol and surface transmission of the virus among people exercising, necessitating a pivot from the usual methods of exercise delivery to home-based exercise programs. In this article, we discuss the challenges that need to be overcome in moving to a home-based program for patients with cancer while maintaining the benefits of targeted and high-fidelity exercise medicine. We provide practical recommendations for how home-based exercise can be supported and nurtured by qualified exercise professionals who treat people living with cancer, as well as pointing to resources that are available online to assist practitioners. Despite the challenges faced during this pandemic, we believe that it is important for people to continue to benefit from exercise in a safe environment with the support of exercise specialists.
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Affiliation(s)
- Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University; and School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University; and School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,Institute for Health Research, University of Notre Dame Australia, Western Australia, Australia
| | - Tim Clay
- Exercise Medicine Research Institute, Edith Cowan University; and School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,Medical Oncology, St John of God Hospital; Medical Oncology, GenesisCare; and Medical Oncology, Icon Cancer Centre, Western Australia, Australia
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45
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Uwins C, Bhandoria GP, Shylasree TS, Butler-Manuel S, Ellis P, Chatterjee J, Tailor A, Stewart A, Michael A. COVID-19 and gynecological cancer: a review of the published guidelines. Int J Gynecol Cancer 2020; 30:1424-1433. [PMID: 32576608 DOI: 10.1136/ijgc-2020-001634] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/29/2023] Open
Abstract
On March 11, 2020 the COVID-19 outbreak was declared a 'pandemic' by the World Health Organization. COVID-19 is associated with higher surgical morbidity and mortality. An array of guidelines on the management of cancer during this pandemic have been published since the first reports of the outbreak. This narrative review brings all the relevant information from the guidelines together into one document, to support patient care. We present a detailed review of published guidelines, statements, comments from peer-reviewed journals, and nationally/internationally recognized professional bodies and societies' web pages (in English or with English translation available) between December 1, 2019 and May 27, 2020. Search terms included combinations of COVID, SARS-COV-2, guideline, gynecology, oncology, gynecological, cancer. Recommendations for surgical and oncological prioritization of gynecological cancers are discussed and summarized. The role of minimally invasive surgery, patient perspectives, medico-legal aspects, and clinical trials during the pandemic are also discussed. The consensus is that elective benign surgery should cease and cancer surgery, chemotherapy, and radiotherapy should continue based on prioritization. Patient and staff face-to-face interactions should be limited, and health resources used efficiently using prioritization strategies. This review and the guidelines on which it is based support the difficult decisions currently facing us in gynecological cancer. It is a balancing act: limited resources and a hostile environment pitted against the time-sensitive nature of cancer treatment. We can only hope to do our best for our patients with the resources available to us.
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Affiliation(s)
- Christina Uwins
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | | | - T S Shylasree
- Department of Gynaecologic Oncology, Tata Memorial Hospital, Homi Baba National Institute, Mumbai, India
| | - Simon Butler-Manuel
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Patricia Ellis
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Jayanta Chatterjee
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Anil Tailor
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Alexandra Stewart
- St Luke's Cancer Centre, Department of Oncology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Agnieszka Michael
- Department of Oncology, University of Surrey, Guildford, United Kingdom
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