The influence of the COVID-19 pandemic on the prevalence of severe injuries in The Netherlands

Our goal was to study the influence of COVID-19 measures and coinciding changes in activities on the prevalence of severe injuries treated at the Emergency Departments (EDs) in The Netherlands. We performed a retrospective observational study with data from the Dutch Injury Surveillance System (DISS) and compared prevalences of ED-visits during lockdown period (March 16 - May 10 2020) with prevalences in the same period in 2019. We also compared a period from May 11 to July 5 2020, in which the measures were relaxed, with the same period in 2019. To exclude a possible effect of avoiding hospitals and EDs duet o COVID-19, we included only treatments for severe injuries. The prevalence of ED-visits due to severe injuries was 27% lower during lockdown than during the same period in 2019 (6755 vs. 4902, p < 0,05). This decrease was seen among all types of injuries and all age categories, but was largest within sports injuries and among 10-19 year old persons (-55%). Opposite to those decreases we saw increases in specific types of injuries such as doing home maintenace work (+31%), and skeelering or skating. (+233%). Among 0-11 year olds, the prevalence of injuries due to trampoline use increased by 68%. During the relaxation period regarding COVID-19 measures, the prevalence of severe injuries increased by 19% compared to lockdown, but was still 11% lower than compared with the same period in 2019. We concluded that changes in activities due to COVID-19 measures during lockdown have led to changes in the number of severe injuries treated at the ED. Variations in prevalence primarily seem to relate to variations in sports and traffic participation, and stay in and around the home.

Abstract P2-06-04: Breast cancer after Hodgkin lymphoma: Influence of endogenous and exogenous gonadal hormones on the radiation dose-response relationship

Background

After chest radiotherapy (RT) for Hodgkin lymphoma (HL), women experience a dose-dependent increased breast cancer (BC) risk. It is unknown whether endogenous and exogenous gonadal hormones affect the radiation dose-response relationship.

Methods

We conducted a nested case-control study among female 5-year HL survivors treated before 41 years between 1965-2000. Data were collected through medical records and questionnaires for 174 BC cases and 466 matched controls. RT charts, simulation films and mammography reports were used to estimate the radiation dose to the location of the breast tumor.

Results

The median interval between HL and BC diagnosis was 21.9 years. 98% of BC cases had received chest RT, compared to 92% of controls. We observed a linear radiation dose-response curve with an adjusted excess odd ratio (EOR) of 5.4%/Gray (95%CI:1.8%-13.37%). Women with menopause <30 years (caused by high-dose procarbazine or pelvic RT) had a lower BC risk (OR:0.13, 95%CI:0.03-0.54) than women with menopause ≥50 years. BC risk increased with 7.4% for each additional year of intact ovarian function after RT (P<0.001). Among women with an early menopause (<45 years), the use of hormone replacement therapy (HRT) for ≥2 years did not increase BC risk (OR:0.81, 95%CI:0.30-2.21). Endogenous and exogenous hormones did not statistically significantly modify the slope of the radiation dose-response relationship.

Conclusion

HRT use did not appear to increase BC risk in female HL survivors with a therapy-induced early menopause. Moreover, there was no evidence for interaction between RT dose and years with intact ovarian function or HRT use.

Citation Format: Krul IM, Opstal - van Winden AWJ, Aleman BMP, Janus CPM, van Eggermond AM, de Bruin ML, Hauptmann M, Krol ADG, Schaapveld M, Broeks A, Kooijman KR, Fase S, Lybeert ML, Zijlstra JM, van der Maazen RWM, Kesminiene A, Diallo I, de Vathaire F, Russell NS, van Leeuwen FE. Breast cancer after Hodgkin lymphoma: Influence of endogenous and exogenous gonadal hormones on the radiation dose-response relationship [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-06-04.