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Nguyen DL, Ambinder EB, Myers KS, Oluyemi E. Addressing Disparities Related to Access of Multimodality Breast Imaging Services Before and During the COVID-19 Pandemic. Acad Radiol 2022; 29:1852-1860. [PMID: 35562265 PMCID: PMC8947962 DOI: 10.1016/j.acra.2022.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 01/26/2023]
Abstract
Despite technological advancements focused on reducing breast cancer mortality through early detection, there have been reported disparities in the access to these imaging services with underserved patient populations (including racial minority groups and patients of low socioeconomic status) showing underutilization compared to other patient groups. These underserved populations tend to have more advanced breast cancer presentations, in part due to delays in diagnosis resulting in later stage of disease presentation. To make matters worse, the COVID-19 pandemic declared in March 2020 has resulted in significant healthcare disruptions leading to extensive delays in breast imaging services which are expected to negatively impact breast cancer mortality long-term. Given the worsening disparity in breast cancer mortality among racial/ethnic minorities and financially disadvantaged groups, it is vital to address these disparity gaps with the goal of reducing the barriers to timely breast cancer diagnosis and addressing breast cancer mortality differences among breast cancer patients. Therefore, this review aims to provide a discussion highlighting the disparities related to breast imaging access, the effects of the COVID-19 pandemic on these disparities, current targeted interventions implemented in breast imaging practices to reduce these disparities, and future directions on the journey to reducing disparity gaps for breast imaging patients. Tackling the root cause factors of the persistent breast cancer-related disparities is critical to meeting the needs of patients who are disadvantaged and can lead to continued improvement in the quality of individualized care for patients who have higher breast cancer morbidity and mortality risks.
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52
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Luo Y, Li Q, Jeong H, Cheatham L. The association between social determinants of health and psychological distress during the COVID-19 pandemic: a secondary analysis among four racial/ethnic groups. BMC Public Health 2022; 22:2193. [PMID: 36443734 PMCID: PMC9702892 DOI: 10.1186/s12889-022-14486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/29/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Racial disparities in psychological distress associated with COVID-19 remain unclear in the U.S. This study aims to investigate the associations between social determinants of health and COVID-19-related psychological distress across different racial/ethnic groups in the US (i.e., non-Hispanic Whites, Hispanic, non-Hispanic Asians, and non-Hispanic African Americans). METHODS This study used cross-sectional data from the 2020 California Health Interview Survey Adult Data Files (N = 21,280). Adjusting for covariates-including age, gender, COVID-19 pandemic challenges, and risk of severe illness from COVID-19-four sets of weighted binary logistic regressions were conducted. RESULTS The rates of moderate/severe psychological distress significantly varied across four racial/ethnic groups (p < 0.001), with the highest rate found in the Hispanic group. Across the five domains of social determinants of health, we found that unemployment, food insecurity, housing instability, high educational attainment, usual source of health care, delayed medical care, and low neighborhood social cohesion and safety were associated with high levels of psychological distress in at least one racial/ethnic group (p < 0.05). CONCLUSION Our study suggests that Hispanic adults face more adverse social determinants of health and are disproportionately impacted by the pandemic. Public health practice and policy should highlight social determinants of heath that are associated with different racial/ethnic groups and develop tailored programs to reduce psychological distress.
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Affiliation(s)
- Yan Luo
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA ,grid.410445.00000 0001 2188 0957The University of Hawaiʻi at Mānoa, HI Honolulu, USA
| | - Qingyi Li
- grid.5386.8000000041936877XDepartment of Psychology, Cornell University, Ithaca, NY 14850 USA
| | - Haelim Jeong
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
| | - Leah Cheatham
- grid.411015.00000 0001 0727 7545School of Social Work, The University of Alabama, Tuscaloosa, AL 35401 USA
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Paladino AJ, Pebley K, Kocak M, Krukowski RA, Waters TM, Vidal G, Schwartzberg LS, Curry AN, Graetz I. An examination of health care utilization during the COVID-19 pandemic among women with early-stage hormone receptor-positive breast cancer. BMC Health Serv Res 2022; 22:1403. [PMID: 36419005 PMCID: PMC9684812 DOI: 10.1186/s12913-022-08705-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Women undergoing treatment for breast cancer require frequent clinic visits for maintenance of therapy. With COVID-19 causing health care disruptions, it is important to learn about how this population's access to health care has changed. This study compares self-reported health care utilization and changes in factors related to health care access among women treated at a cancer center in the mid-South US before and during the pandemic. METHODS Participants (N = 306) part of a longitudinal study to improve adjuvant endocrine therapy (AET) adherence completed pre-intervention baseline surveys about their health care utilization prior to AET initiation. Questions about the impact of COVID-19 were added after the pandemic started assessing financial loss and factors related to care. Participants were categorized into three time periods based on the survey completion date: (1) pre-COVID (December 2018 to March 2020), (2) early COVID (April 2020 - December 2020), and later COVID (January 2021 to June 2021). Negative binomial regression analyses used to compare health care utilization at different phases of the pandemic controlling for patient characteristics. RESULTS Adjusted analyses indicated office visits declined from pre-COVID, with an adjusted average of 17.7 visits, to 12.1 visits during the early COVID period (p = 0.01) and 9.9 visits during the later COVID period (p < 0.01). Hospitalizations declined from an adjusted average 0.45 admissions during early COVID to 0.21 during later COVID, after vaccines became available (p = 0.05). Among COVID period participants, the proportion reporting changes/gaps in health insurance coverage increased from 9.5% participants during early-COVID to 14.8% in the later-COVID period (p = 0.05). The proportion reporting financial loss due to the pandemic was similar during both COVID periods (34.3% early- and 37.7% later-COVID, p = 0.72). The proportion of participants reporting delaying care or refilling prescriptions decreased from 15.2% in early-COVID to 4.9% in the later-COVID period (p = 0.04). CONCLUSION COVID-19 caused disruptions to routine health care for women with breast cancer. Patients reported having fewer office visits at the start of the pandemic that continued to decrease even after vaccines were available. Fewer patients reported delaying in-person care as the pandemic progressed.
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Affiliation(s)
- Andrew J. Paladino
- grid.267301.10000 0004 0386 9246College of Medicine, The University of Tennessee Health Science Center, Memphis, TN USA
| | - Kinsey Pebley
- grid.56061.340000 0000 9560 654XDepartment of Psychology, University of Memphis, Memphis, TN USA
| | - Mehmet Kocak
- grid.411781.a0000 0004 0471 9346International School of Medicine, Biostatistics and Medical Informatics, Istanbul Medipol University, Uskudar, Istanbul, Turkey
| | - Rebecca A. Krukowski
- grid.27755.320000 0000 9136 933XDepartment of Public Health Sciences, University of Virginia, University of Virginia Cancer Center, Charlottesville, VA USA
| | - Teresa M. Waters
- grid.266539.d0000 0004 1936 8438Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY USA
| | - Gregory Vidal
- grid.488536.40000 0004 6013 2320West Cancer Center and Research Institute, Department of Medical Oncology, Germantown, TN USA
| | - Lee S. Schwartzberg
- grid.488536.40000 0004 6013 2320West Cancer Center and Research Institute, Department of Medical Oncology, Germantown, TN USA ,Medical Oncology and Hematology, Renown Institute for Cancer, Reno, USA
| | - Andrea N. Curry
- grid.488536.40000 0004 6013 2320West Cancer Center and Research Institute, Department of Medical Oncology, Germantown, TN USA
| | - Ilana Graetz
- grid.189967.80000 0001 0941 6502Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, GA USA
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54
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Wang Y, Yang Y, Yan C, Ma W, Yang J, Wei H, Li N. COVID-induced 3 weeks’ treatment delay may exacerbate breast cancer patient’s psychological symptoms. Front Psychol 2022; 13:1003016. [PMID: 36438374 PMCID: PMC9686281 DOI: 10.3389/fpsyg.2022.1003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
The delayed access to cancer treatment due to the outbreak of COVID-19 pandemic posed a unique challenge to breast cancer patients and caused a significant level of mental distress among them. In the current research, we examined the psychological impacts of COVID on a subpopulation of breast cancer patients from a hospital in Shaanxi province of China using Symptom Checklist-90-R (SCL-90-R). Participants were 195 breast cancer patients at the outpatient clinic of Xijing hospital, Xi’an, Shaanxi Province, China. We found that a treatment delay of more than 3 weeks may exacerbate breast cancer patients’ psychological symptoms, such as somatization, obsessive–compulsive disorder, interpersonal sensitivity, depression, hostility, phobic anxiety, paranoid ideation, and psychoticism, whereas a short-term delay of less than 3 weeks is less likely to have a significant effect on one’s mental well-being. Additionally, breast cancer survivors, especially those at more advance stages, tend to experience more elevated psychological symptoms with longer treatment delay, and whose treatments continues to be delayed reported stronger psychological symptoms than individuals whose treatment are resumed, regardless of treatment type.
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Affiliation(s)
- Yijia Wang
- Department of Psychology, Colorado College, Colorado Springs, CO, United States
| | - Yuqing Yang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Changjiao Yan
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Wen Ma
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jixin Yang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Hongliang Wei
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Nanlin Li
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
- *Correspondence: Nanlin Li,
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Naganathan G, Bilgen I, Cleland J, Reel E, Cil T. #COVID19 and #Breastcancer: A Qualitative Analysis of Tweets. Curr Oncol 2022; 29:8483-8500. [PMID: 36354729 PMCID: PMC9689212 DOI: 10.3390/curroncol29110669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Rapid and efficient communication regarding quickly evolving medical information was paramount for healthcare providers and patients throughout the COVID-19 pandemic. Over the last several years, social media platforms such as Twitter have emerged as important tools for health promotion, virtual learning among healthcare providers, and patient support. We conducted a qualitative thematic content analysis on tweets using the hashtags #BreastSurgery, #BreastCancer, #BreastOncology, #Pandemic, and #COVID19. Advocacy organizations were the most frequent authors of tweets captured in this dataset, and most tweets came from the United States of America (64%). Seventy-three codes were generated from the data, and, through iterative, inductive analysis, three major themes were developed: patient hesitancy and vulnerability, increased efforts in knowledge sharing, and evolving best practices. We found that Twitter was an effective way to share evolving best practices, education, and collective experiences among key stakeholders. As Twitter is increasingly used as a tool for health promotion and knowledge translation, a better understanding of how key stakeholders engage with healthcare-related topics on the platform can help optimize the use of this powerful tool.
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Affiliation(s)
| | - Idil Bilgen
- Koç University School of Medicine, 34450 Istanbul, Turkey
| | - Jordan Cleland
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Emma Reel
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Tulin Cil
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Division of General Surgery, Department of Surgery, University Health Network, Toronto, ON M5G 2C4, Canada
- Correspondence:
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Rising incidence of late stage breast cancer after COVID-19 outbreak. Real-world data from the Italian COVID-DELAY study. Breast 2022; 65:164-171. [PMID: 35998429 PMCID: PMC9388078 DOI: 10.1016/j.breast.2022.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
Purpose Methods Results Conclusions COVID-19 impacted on breast cancer (BC) diagnoses with a reduction of 25% in 2020. Fewer early-stage BC and more symptomatic patients were diagnosed during 2020. Timing of access to BC diagnosis, staging and treatment has not been affected by COVID-19. Less BC cases were reviewed in multidisciplinary tumor meetings during 2020.
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Pitakbut T, Nguyen GN, Kayser O. Activity of THC, CBD, and CBN on Human ACE2 and SARS-CoV1/2 Main Protease to Understand Antiviral Defense Mechanism. PLANTA MEDICA 2022; 88:1047-1059. [PMID: 34638139 DOI: 10.1055/a-1581-3707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
THC, CBD, and CBN were reported as promising candidates against SARS-CoV2 infection, but the mechanism of action of these three cannabinoids is not understood. This study aims to determine the mechanism of action of THC, CBD, and CBN by selecting two essential targets that directly affect the coronavirus infections as viral main proteases and human angiotensin-converting enzyme2. Tested THC and CBD presented a dual-action action against both selected targets. Only CBD acted as a potent viral main protease inhibitor at the IC50 value of 1.86 ± 0.04 µM and exhibited only moderate activity against human angiotensin-converting enzyme2 at the IC50 value of 14.65 ± 0.47 µM. THC acted as a moderate inhibitor against both viral main protease and human angiotensin-converting enzymes2 at the IC50 value of 16.23 ± 1.71 µM and 11.47 ± 3.60 µM, respectively. Here, we discuss cannabinoid-associated antiviral activity mechanisms based on in silico docking studies and in vitro receptor binding studies.
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Affiliation(s)
- Thanet Pitakbut
- Technical Biochemistry, Faculty of Biochemical and Chemical Engineering, TU Dortmund University, Dortmund, Germany
| | - Gia-Nam Nguyen
- Technical Biochemistry, Faculty of Biochemical and Chemical Engineering, TU Dortmund University, Dortmund, Germany
- MINDbioscience GmbH, Dortmund, Germany
| | - Oliver Kayser
- Technical Biochemistry, Faculty of Biochemical and Chemical Engineering, TU Dortmund University, Dortmund, Germany
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Betts AC, Shay LA, Allicock M, Preston SM, Grimes A, Murphy CC. Impacts of the Early COVID-19 Pandemic Among a National Sample of Adolescent and Young Adult Cancer Survivors in the United States. J Adolesc Young Adult Oncol 2022. [PMID: 36173754 DOI: 10.1089/jayao.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescent and young adult cancer survivors (AYAs) experience early-onset chronic conditions and disrupted psychosocial development. We report prevalence of disruptions in care delivery and social support during the early wave of the pandemic in a national sample of AYAs in the United States. Materials and Methods: We used data from the population-based National Health Interview Survey (NHIS; July-December 2020), which allows for nationally representative estimates, and included questions related to COVID-19. We identified 61 AYAs diagnosed with cancer between ages 15 and 39 years and not currently receiving cancer treatment and 244 age- and sex-matched controls. We compared the proportion of AYAs and controls reporting delayed care due to the pandemic, not getting needed care due to the pandemic, and changes in social and emotional support. Results: AYAs were predominantly non-Hispanic White (61.3%) and female (58.8%), with a median age at diagnosis of 28 years (interquartile range [IQR] 21-31 years). Fewer AYAs were employed (52.1% vs. 71.5%), and more lived in poverty (32.0% vs. 12.4%) and felt depressed daily (9.9% vs. 3.0%, all p < 0.05). The proportion of AYAs reporting delayed care (39.8% vs. 15.3%) and not getting needed care (31.7% vs. 10.4%) due to the pandemic was more than double that of controls (both p < 0.01). One in five AYAs experienced less social and emotional support compared to the prior year, although not significantly different from controls (21.6% vs. 12.4%, p = 0.10). Conclusions: The pandemic disrupted AYAs' care and exacerbated their psychosocial challenges. Providers and health systems should prioritize reconnecting AYAs to affordable and comprehensive care.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, San Antonio, Texas, USA.,Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA.,Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA.,Texas Center for Pediatric Population Health, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - Sharice M Preston
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA.,Texas Center for Pediatric Population Health, The University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas, USA
| | - Allison Grimes
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Texas Health Science Center at San Antonio, Texas, USA.,Greehey Children's Cancer Research Institute, San Antonio, Texas, USA
| | - Caitlin C Murphy
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA.,Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
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Yoshida S, Okubo R, Katanoda K, Tabuchi T. Impact of state of emergency for coronavirus disease 2019 on hospital visits and disease exacerbation: the Japan COVID-19 and Society Internet Survey. Fam Pract 2022; 39:883-890. [PMID: 35348670 PMCID: PMC9037356 DOI: 10.1093/fampra/cmac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies on the impact of coronavirus disease 2019 (COVID-19) on people's routine medical care are limited, and understanding the factors associated with medical care avoidance can inform us about the ongoing pandemic. OBJECTIVES We aimed to assess the impact of Japan's state of emergency and stay-at-home policy for COVID-19 on hospital visits and disease exacerbation; we also identified related factors. METHODS This cross-sectional study used data from the Japan COVID-19 and Society Internet Survey (JACSIS), which included randomly sampled research agency panellists in Japan. Among the 28,000 participants, we included 7,747 respondents who reported having any disease. We described baseline characteristics and avoidance-related hospital visit outcomes. We used multivariable logistic regression analyses to assess the association between chronic diseases and outcomes of hospital visit avoidance. RESULTS Among 7,747 participants, 17.7% of patients with chronic diseases avoided hospital visits, 2.1% of patients postponed hospitalization or surgery, 4.9% of patients ran out of drug, and 5.3% of patients experienced disease exacerbation during the COVID-19 pandemic in April and May 2020. Exacerbations occurred mostly in participants with mental diseases, chronic pain and headache, and diabetes (OR 3.33 [95% confidence interval (CI): 2.51-4.41], 2.83 [95% CI: 2.19-3.66], and 1.53 [95% CI: 1.10-2.13], respectively). Patients with cardiovascular disease or cancer did not experience exacerbation [OR 0.55 (95% CI: 0.31-0.97), 0.79 (95% CI: 0.43-1.45)]. CONCLUSIONS The rates of hospital visit avoidance and exacerbation varied among patients with different diseases under the COVID-19 stay-at-home policy in April and May 2020, and disease-specific preparedness may be necessary for the pandemic.
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Affiliation(s)
- Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kota Katanoda
- Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Takahiro Tabuchi
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Onesti CE, Vari S, Nardozza F, Maggi G, Minghelli D, Rossi B, Sperati F, Checcucci E, Faltyn W, Cercato MC, Cosimati A, Biagini R, Ciliberto G, Ferraresi V. The impact of the COVID-19 pandemic on diagnosis and treatment of patients with soft tissue and bone sarcomas or aggressive benign musculoskeletal diseases: A single-center retrospective study (SarCorD study). Front Oncol 2022; 12:1000056. [PMID: 36249051 PMCID: PMC9559379 DOI: 10.3389/fonc.2022.1000056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic led to a rapid reorganization of healthcare activities, leading to reduced access to clinics, interruption of screenings, and treatment schedule modifications in several cancer types. Few data are available on sarcomas. We analyzed COVID-19-related diagnostic delay in a sarcoma referral center in Italy. Methods We retrospectively enrolled in this study patients with histological diagnosis of soft tissue or bone sarcoma and aggressive benign musculoskeletal diseases obtained during the first year of the pandemic (Covid group) or the year before (Control group) and followed at the Regina Elena National Cancer Institute in Rome. The primary endpoint was the time from the first symptom to histological diagnosis. Results We evaluated 372 patients, 185 of whom were eligible for primary endpoint analysis (92 patients in the Control group and 93 patients in the Covid group). The patients were affected by soft tissue sarcoma in most cases (63.0% and 66.7% in Covid and Control groups, respectively). We observed a diagnostic delay in the Covid group with a median time from the first symptom to the definitive histological diagnosis of 103.00 days (95% CI 92.77–113.23) vs. 90.00 days (95% CI 69.49–110.51) in the Control group (p = 0.024), but not a delay in treatment beginning (151 days, 95% CI 132.9–169.1 vs. 144 days, 95% CI 120.3–167.7, respectively, p = 0.208). No differences in stage at diagnosis were observed (12% vs. 16.5% of patients with metastatic disease at diagnosis in the Covid and Control groups, respectively, p = 0.380). Progression-free survival (p = 0.897) and overall survival (p = 0.725) were comparable in the subgroup of patients affected by soft tissue sarcoma. Conclusions A delay in sarcoma diagnosis but not in starting treatment has been observed during the first year of the COVID-19 pandemic. Nevertheless, no difference in stage at diagnosis or in terms of survival has been observed.
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Affiliation(s)
- Concetta Elisa Onesti
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Sabrina Vari
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Sabrina Vari,
| | - Francesca Nardozza
- Unità Operativa Semplice Dipartimentale (UOSD) Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriella Maggi
- Psychology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Denise Minghelli
- Psychology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Rossi
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Elisa Checcucci
- Epidemiology and Tumor Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Wioletta Faltyn
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Cecilia Cercato
- Epidemiology and Tumor Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Cosimati
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
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Yahi F, Lequesne J, Rigal O, Morel A, Leheurteur M, Grellard JM, Leconte A, Clarisse B, Joly F, Lefèvre-Arbogast S. Post-traumatic stress disorder symptoms and associated factors in breast cancer patients during the first COVID-19 lockdown in France. Front Psychol 2022; 13:768043. [PMID: 36186387 PMCID: PMC9521190 DOI: 10.3389/fpsyg.2022.768043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We aimed to study post-traumatic stress disorder (PTSD) symptoms in breast cancer (BC) patients during the coronavirus disease (COVID-19) pandemic. Materials and methods We included BC patients receiving medical treatment during the first COVID-19 lockdown in France. PTSD symptoms were evaluated using the Impact of Event Scale-Revised (IES-R) questionnaire. Quality of life [Functional Assessment of Cancer Therapy-General (FACT-G)], cognitive complaints [Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog)], insomnia [Insomnia Severity Index (ISI)], and psychosocial experiences during lockdown were also evaluated. Multivariable logistic regression was used to identify clinical factors (from medical records) and psychosocial factors (from questionnaires) associated with PTSD symptoms. Results Among the 253 included BC patients (mean age: 58), 46% had metastatic cancer and 52% were treated by chemotherapy alone. COVID-19-induced adjustments in medical oncology practices were experienced by 27% of patients (mainly teleconsultations). No case of COVID-19 was reported; 23% of BC patients had PTSD symptoms. Compared to other patients, patients with PTSD symptoms had more fears relative to COVID-19 infection (83 vs. 60%, p = 0.009), had more feeling of isolation (69 vs. 41%, p = 0.003), and had more prescription or increased use of psychotropic drugs (49 vs. 20%, p = 0.001). In the multivariable model adjusted for clinical factors, fears relative to COVID-19 and increased use of psychotropic drugs were independently associated with PTSD symptoms (OR [95% CI] = 3.01 [1.20–8.44] and 3.45 [1.48–8.17], respectively). Besides, patients with PTSD symptoms had poor quality of life (QoL), and more cognitive complaints and insomnia. Conclusion Post-traumatic stress disorder symptoms were observed in 23% of BC patients during the first COVID-19 lockdown in France. Psychological supports are needed for patients treated during the COVID-19 pandemic.
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Affiliation(s)
- Feriel Yahi
- Clinical Research Department, Centre François Baclesse, Caen, France
- Department of Health, University of Caen Normandie, Caen, France
| | - Justine Lequesne
- Clinical Research Department, Centre François Baclesse, Caen, France
- *Correspondence: Justine Lequesne,
| | - Olivier Rigal
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Adeline Morel
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | | | - Alexandra Leconte
- Clinical Research Department, Centre François Baclesse, Caen, France
| | | | - Florence Joly
- Clinical Research Department, Centre François Baclesse, Caen, France
- Department of Health, University of Caen Normandie, Caen, France
- Department of Medical Oncology, Centre François Baclesse, Caen, France
- INSERM U1086 ANTICIPE, Caen, France
| | - Sophie Lefèvre-Arbogast
- Clinical Research Department, Centre François Baclesse, Caen, France
- INSERM U1086 ANTICIPE, Caen, France
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Wu G, McBride K, Loudon J. Improving the use of patient-reported outcomes among patients receiving radiation therapy during the COVID-19 pandemic. J Med Imaging Radiat Sci 2022; 53:328-333. [PMID: 35725807 PMCID: PMC9130713 DOI: 10.1016/j.jmir.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022]
Abstract
Introduction The use of Patient-Reported Outcomes (PROs) is an important part of care for patients receiving radiation therapy. Established processes for patients to complete symptom screening using PROs were disrupted by the COVID-19 pandemic. This study reports the implementation of a Radiation Therapist led “champion” model to support the use of PROs during the COVID-19 pandemic. Methods Patient charts were audited May 3 to May 22, 2020 to measure the initial impact of the pandemic on weekly completion rates of PROs for patients receiving active radiation treatment. Beginning May 25, 2020, two Radiation Therapists acted as champions to promote the use of PROs among patients and staff. Weekly completion rates of PROs were monitored from May 25, 2020 to May 28, 2021. The type of Patient Reported Outcome Measure (PROM) utilized and treatment intent was also recorded. Results After implementing the champion model, the weekly completion of PROs increased to an average of 47.0 ± 11.7 (47.5 ± 12.6%) from the initial baseline average of 8.7 ± 1.5 (9.4 ± 2.1%). For PROs completed, the distribution of PROMs was an average of 37.2 ± 9.6 (47.7 ± 12.7%) and 9.8 ± 3.5 (47.0 ± 16.9%) for the Revised Edmonton Symptom Assessment Scale (ESAS-r) and the Expanded Prostate Cancer Index Composite (EPIC) respectively. An average of 5.1 ± 2.9 (26.3 ± 12.7%) and 41.9 ± 10.1 (52.4 ± 14.1%) was recorded for palliative and curative intent respectively. Discussion An increased number of PROs were completed after implementing the Radiation Therapist led champion model. Patients receiving a radical course of treatment more frequently completed PROs, which in part reflects the longer treatment courses with increased opportunity for PROs to be completed. Conclusion The Radiation Therapist led champion model supported ongoing monitoring and completion of PROs during the COVID-19 pandemic and has now been integrated into the department's standard clinical practice.
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Du S, Carfang L, Restrepo E, Benjamin C, Epstein MM, Fairley R, Roudebush L, Hertz C, Eshraghi L, Warner ET. Patient-Reported Experiences of Breast Cancer Screening, Diagnosis, and Treatment Delay, and Telemedicine Adoption during COVID-19. Curr Oncol 2022; 29:5919-5932. [PMID: 36005205 PMCID: PMC9406797 DOI: 10.3390/curroncol29080467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To evaluate and quantify potential sociodemographic disparities in breast cancer screening, diagnosis, and treatment due to the COVID-19 pandemic, and the use of telemedicine. Methods: We fielded a 52-item web-based questionnaire from 14 May 2020 to 1 July 2020 in partnership with several U.S.-based breast cancer advocacy groups. Individuals aged 18 or older were eligible for this study if they: (1) received routine breast cancer screening; OR (2) were undergoing diagnostic evaluation for breast cancer; OR (3) had ever been diagnosed with breast cancer. We used descriptive statistics to understand the extent of cancer care delay and telemedicine adoption and used multivariable logistic regression models to estimate the association of sociodemographic factors with odds of COVID-19-related delays in care and telemedicine use. Results: Of 554 eligible survey participants, 493 provided complete data on demographic and socioeconomic factors and were included in the analysis. Approximately half (n = 248, 50.3%) had a personal history of breast cancer. Overall, 188 (38.1%) participants had experienced any COVID-19-related delay in care including screening, diagnosis, or treatment, and 339 (68.8) reported having at least one virtual appointment during the study period. Compared to other insurance types, participants with Medicaid insurance were 2.58 times more likely to report a COVID-19-related delay in care (OR 2.58, 95% Cl: 1.05, 6.32; p = 0.039). Compared to participants with a household income of less than USD 50,000, those with a household income of USD 150,000 or more were 2.38 (OR 2.38, 95% Cl: 1.09, 5.17; p = 0.029) times more likely to adopt virtual appointments. Self-insured participants were 70% less likely to use virtual appointment compared to those in other insurance categories (OR 0.28, 95% Cl: 0.11, 0.73; p = 0.009). Conclusions: The COVID-19 pandemic has had a significant impact on breast cancer screening, diagnosis, and treatment, and accelerated the delivery of virtual care. Lower-income groups and patients with certain insurance categories such as Medicaid or self-insured could be more likely to experience care delay or less likely to use telemedicine. Careful attention must be paid to vulnerable groups to insure equity in breast cancer-related service utilization and telemedicine access during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Simo Du
- SurvivingBreastCancer.org, Boston, MA 02119, USA
| | | | - Emily Restrepo
- Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Mara M. Epstein
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester, MA 01605, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Ricki Fairley
- TOUCH, The Black Brest Cancer Alliance, Annapolis, MD 21403, USA
| | - Laura Roudebush
- Dr. Susan Love Foundation for Breast Cancer Research, West Hollywood, CA 90069, USA
| | - Crystal Hertz
- Dr. Susan Love Foundation for Breast Cancer Research, West Hollywood, CA 90069, USA
| | - Leah Eshraghi
- Dr. Susan Love Foundation for Breast Cancer Research, West Hollywood, CA 90069, USA
| | - Erica T. Warner
- Mongan Institute, Clinical Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence:
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Kripalani S, Kulshreshta S, Saracco B, Meterissian S. The effect of COVID-19 on breast cancer care and treatment in North America: A scoping review. Am J Surg 2022; 224:1222-1228. [PMID: 35945067 PMCID: PMC9347185 DOI: 10.1016/j.amjsurg.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
Background Methods Results Conclusion
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Street RL, Treiman K, Wu Q, Kranzler EC, Moultrie R, Mack N, Garcia R. Managing uncertainty and responding to difficult emotions: Cancer patients' perspectives on clinician response during the COVID-19 pandemic. PATIENT EDUCATION AND COUNSELING 2022; 105:2137-2144. [PMID: 35393231 PMCID: PMC8968177 DOI: 10.1016/j.pec.2022.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Patients undergoing cancer treatment during the COVID-19 pandemic have experienced stress and uncertainty with respect to disruptions in cancer care and COVID-19 related risks. We examined whether clinicians' responsiveness to patients' uncertainty and difficult emotions were associated with better health and well-being. METHODS Patients were recruited from cancer support communities and a market research firm. Respondents assessed clinicians communication that addressed uncertainty and difficult emotions. Health status measures included mental and physical health, coping during the pandemic, and psychological distress. RESULTS 317 respondents participated in the study. Patients' perceptions of their clinicians responsiveness to patient uncertainty and negative emotions were associated with better mental health, physical health, coping, and less psychological distress (all p-values <0.001). Respondents with greater self-efficacy and social support also reported better health. CONCLUSION Even when controlling for patients' personal and health-related characteristics, clinicians' communication addressing patients' uncertainty and difficult emotions predicted better health, better coping, and less psychological distress. Access to social support and self-efficacy also were associated with better health status. PRACTICE IMPLICATIONS Clinicians' communication focused on helping with uncertainty and difficult emotions is important to cancer patients, especially during the pandemic. Clinicians should also direct patients to resources for social support and patient empowerment.
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Affiliation(s)
| | | | | | - Elissa C Kranzler
- Cancer Support Community (Formerly), Currently Fors Marsh Group, USA
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66
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Baaske A, Brotto LA, Galea LAM, Albert AY, Smith L, Kaida A, Booth A, Gordon S, Sadarangani M, Racey CS, Gottschlich A, Ogilvie GS. Barriers to Accessing Contraception and Cervical and Breast Cancer Screening During the COVID-19 Pandemic. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1076-1083. [PMID: 35738558 PMCID: PMC9212845 DOI: 10.1016/j.jogc.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022]
Abstract
Objective This study sought to examine how access to contraception and cervical and breast cancer screening in British Columbia, Canada, has been affected by the COVID-19 pandemic. Methods From August 2020 to March 2021, 3691 female residents of British Columbia (age 25–69 y) participated in this study. We used generalized estimating equations to analyze the proportion of females accessing contraception and the proportion having difficulty accessing contraception across the different phases of pandemic control measures, and logistic regression to analyze attendance at cervical and breast cancer screening. We added sociodemographic and biological variables individually into the models. Self-reported barriers to accessing contraception and attending screening were summarized. Results During phases with the highest pandemic controls, self-reported access to contraception was lower (OR 0.94; 95% CI 0.90–0.98; P = 0.005) and difficulty with access was higher (OR 2.74; 95% CI 1.54–4.88; P = 0.001). A higher proportion of adults aged 25–34 years reported difficulty accessing contraception than those aged 35–39 years (P < 0.0001), and participants identifying as Indigenous had higher odds of access difficulties (OR 5.56; 95% CI 2.44–12.50; P < 0.001). Of those who required screening during the COVID-19 pandemic, 62% and 54.5% did not attend at least one of their cervical or breast screening appointments, respectively. Those with a history of breast cancer had significantly higher odds of self-reporting having attended their mammogram appointment compared with those without a history of breast cancer (OR 5.62; 95% CI 2.69–13.72; P < 0.001). The most common barriers to screening were difficulty getting an appointment and appointments being considered non-urgent. Conclusions The COVID-19 pandemic has uniquely affected access to contraception and cancer screening participation for various subgroups. Self-reported data present potential avenues for mitigating barriers.
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Affiliation(s)
| | - Lori A Brotto
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
| | - Liisa A M Galea
- Women's Health Research Institute, Vancouver, BC; Department of Psychology, University of British Columbia, Vancouver, BC
| | - Arianne Y Albert
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, BC; Cancer Control Research, BC, Cancer, Vancouver, BC
| | - Angela Kaida
- Women's Health Research Institute, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Amy Booth
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | | | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC
| | - C Sarai Racey
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Anna Gottschlich
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Gina S Ogilvie
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
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Carvalho AS, Brito Fernandes Ó, de Lange M, Lingsma H, Klazinga N, Kringos D. Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review. BMC Health Serv Res 2022; 22:786. [PMID: 35715795 PMCID: PMC9204363 DOI: 10.1186/s12913-022-08166-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators. METHODS Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway. RESULTS This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n = 64, 58%) and diagnoses (n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends (n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n = 9), and 70% (n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%(n = 82) of indicators concerning surgeries, 72%(n = 41) of indicators assessing radiotherapy, and 93%(n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%(n = 195) of indicators revealed changes in treatment. CONCLUSIONS This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.
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Affiliation(s)
- Ana Sofia Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands. .,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mats de Lange
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Effect of Coronavirus Disease 2019 (Covid-19), a Nationwide Mass Casualty Disaster on Intensive Care Units: Clinical Outcomes and Associated Cost-of-Care. Disaster Med Public Health Prep 2022; 17:e249. [PMID: 35703087 PMCID: PMC9353234 DOI: 10.1017/dmp.2022.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The COVID-19 pandemic resulted in millions of deaths worldwide and is considered a significant mass-casualty disaster (MCD). The surge of patients and scarcity of resources negatively impacted hospitals, patients and medical practice. We hypothesized ICUs during this MCD had a higher acuity of illness, and subsequently had increased lengths of stay (LOS), complication rates, death rates and costs of care. The purpose of this study was to investigate those outcomes. METHODS This was a multicenter, retrospective study that compared intensive care admissions in 2020 to those in 2019 to evaluate patient outcomes and cost of care. Data were obtained from the Vizient Clinical Data Base/Resource Manager (Vizient Inc., Irvine, Texas, USA). RESULTS Data included the number of ICU admissions, patient outcomes, case mix index and summary of cost reports. Quality outcomes were also collected, and a total of 1304981 patients from 333 hospitals were included. For all medical centers, there was a significant increase in LOS index, ICU LOS, complication rate, case mix index, total cost, and direct cost index. CONCLUSION The MCD caused by COVID-19 was associated with increased adverse outcomes and cost-of-care for ICU patients.
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Negrao EMS, Cabello C, Conz L, Mauad EC, Zeferino LC, Vale DB. The COVID-19 Pandemic Impact on Breast Cancer Diagnosis: A Retrospective Study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:871-877. [PMID: 35667376 PMCID: PMC9948273 DOI: 10.1055/s-0042-1749207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic profile of breast cancer cases during the coronavirus disease 2019 (COVID-19) pandemic compared with the previous year. METHODS It is a retrospective study of cases diagnosed by a reference service in the public health system of Campinas, SP, Brazil. Two periods were analyzed: March to October 2019 (preCOVID period) and March to October 2020 (COVID-period). All women diagnosed during the periods were included. The Chi-Squared or Fisher exact and Mann-Whitney tests were used. RESULTS In the preCOVID and COVID periods, breast cancers were diagnosed, respectively, in 115 vs 59 women, and the mean ages at diagnosis were 55 and 57 years (p = 0.339). In the COVID period, the family history of breast cancer was more observed (9.6% vs 29.8%, p < 0.001), cases were more frequently symptomatic (50.4% vs 79.7%, p < 0.001) and had more frequently palpable masses (56.5% vs 79.7%, p = 0.003). In symptomatic women, the mean number of days from symptom to mammography were 233.6 (458.3) in 2019 and 152.1 (151.5) in 2020 (p = 0.871). Among invasive tumors, the proportion of breast cancers in stages I and II was slightly higher in the COVID period, although not significantly (76.7% vs 82.4%, p = 0.428). Also in the COVID period, the frequency of luminal A-like tumors was lower (29.2% vs 11.8%, p = 0.018), of triple-negative tumors was twice as high (10.1% vs 21.6%, p = 0.062), and of estrogen receptor-positive tumors was lower (82.2% vs 66.0%, p = 0.030). CONCLUSION During the COVID-19 pandemic, breast cancer diagnoses were reduced. Cases detected were suggestive of a worse prognosis: symptomatic women with palpable masses and more aggressive subtypes. Indolent tumors were those more sensitive to the interruption in screening.
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Affiliation(s)
| | - Cesar Cabello
- Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Livia Conz
- Cancer Prevention Institute, Hospital do Câncer de Barretos Barretos, SP, Brazil.,Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Luiz Carlos Zeferino
- Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Diama Bhadra Vale
- Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Caswell-Jin JL, Shafaee MN, Xiao L, Liu M, John EM, Bondy ML, Kurian AW. Breast cancer diagnosis and treatment during the COVID-19 pandemic in a nationwide, insured population. Breast Cancer Res Treat 2022; 194:475-482. [PMID: 35624175 PMCID: PMC9140322 DOI: 10.1007/s10549-022-06634-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
Abstract
Purpose The early months of the COVID-19 pandemic led to reduced cancer screenings and delayed cancer surgeries. We used insurance claims data to understand how breast cancer incidence and treatment after diagnosis changed nationwide over the course of the pandemic. Methods Using the Optum Research Database from January 2017 to March 2021, including approximately 19 million US adults with commercial health insurance, we identified new breast cancer diagnoses and first treatment after diagnosis. We compared breast cancer incidence and proportion of newly diagnosed patients receiving pre-operative systemic therapy pre-COVID, in the first 2 months of the COVID pandemic and in the later part of the COVID pandemic. Results Average monthly breast cancer incidence was 19.3 (95% CI 19.1–19.5) cases per 100,000 women and men pre-COVID, 11.6 (95% CI 10.8–12.4) per 100,000 in April–May 2020, and 19.7 (95% CI 19.3–20.1) per 100,000 in June 2020–February 2021. Use of pre-operative systemic therapy was 12.0% (11.7–12.4) pre-COVID, 37.7% (34.9–40.7) for patients diagnosed March–April 2020, and 14.8% (14.0–15.7) for patients diagnosed May 2020–January 2021. The changes in breast cancer incidence across the pandemic did not vary by demographic factors. Use of pre-operative systemic therapy across the pandemic varied by geographic region, but not by area socioeconomic deprivation or race/ethnicity. Conclusion In this US-insured population, the dramatic changes in breast cancer incidence and the use of pre-operative systemic therapy experienced in the first 2 months of the pandemic did not persist, although a modest change in the initial management of breast cancer continued.
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Affiliation(s)
- Jennifer L Caswell-Jin
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Center for Clinical Sciences Research, Stanford University School of Medicine, Room 1145C, Stanford, CA, 94305-5405, USA.
| | - Maryam N Shafaee
- Dan L Duncan Cancer, Baylor College of Medicine, Houston, TX, USA
| | - Lan Xiao
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mina Liu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Esther M John
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa L Bondy
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Pichler T, Frank T, Maier S, Batenhorst I, Albawi-Daltrozzo T, Harbeck N, Algül H, Heinemann V, Hermelink K, Mumm F, Dinkel A. [The views of cancer out-patients on the impact of the COVID-19 pandemic]. Dtsch Med Wochenschr 2022; 147:41-49. [PMID: 35545063 PMCID: PMC9095066 DOI: 10.1055/a-1746-7534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hintergrund
Diese Studie untersucht aktuelle Bedürfnisse und Belastungen von ambulanten Krebspatienten im Rahmen der COVID-19-Pandemie.
Material und Methoden
Zwischen 11/2020 und 02/2021 wurden 122 ambulante Krebspatientinnen und -patienten des Comprehensive Cancer Center München in die Studie eingeschlossen und anhand eines standardisierten, halbstrukturierten Interviews zu Wissensstand und Informationsbedürfnissen in Bezug auf COVID-19, Risikowahrnehmung und Sorgen hinsichtlich der ambulanten Krebsbehandlung, COVID-19-spezifischen Belastungen sowie zum Vertrauen in das Gesundheitssystem und der Impfbereitschaft befragt. Zusätzlich wurde psychosozialer Distress anhand des Distress-Thermometers (DT) erhoben.
Ergebnisse
Über ein Drittel der Krebspatienten (34,2 %, n = 41/120) hatte noch Informationsbedarf hinsichtlich der Auswirkungen des Coronavirus auf ihre Erkrankung oder Behandlung. 17,2 % (n = 21/122) waren von Veränderungen der laufenden oder geplanten Krebstherapie betroffen. Bei n = 42/121 (34,7 %) der Patienten zeigte sich ein erhöhter psychosozialer Distress (DT ≥ 5). Die häufigste Corona-spezifische Belastung war die Angst vor einer Überlastung des Gesundheitssystems (77,9 %, n = 95/122), gefolgt von der Befürchtung, dass sich Angehörige noch größere Sorgen um die betroffenen Patienten machen (56,2 %, n = 68/121). 71,2 % (n = 74/104) der Patienten sind bereit, sich impfen zu lassen; 60 % (n = 18/30) der zum Zeitpunkt der Untersuchung Unentschlossenen oder Ablehner wünschen sich vor einer endgültigen Entscheidung für die Impfung ein Informationsgespräch mit ihrem Onkologen/ihrer Onkologin.
Schlussfolgerung
Corona-spezifische Belastungen von Krebspatienten betreffen insbesondere den Verlauf der Therapie, aber auch eine mögliche Überlastung des Gesundheitssystems. Onkologische Behandler-Teams sollten Fragen ihrer Patienten Raum geben, mögliche Unsicherheiten anerkennen, emotionale Unterstützung leisten und auf valide Informationsquellen aufmerksam machen.
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Affiliation(s)
| | - Tamara Frank
- Comprehensive Cancer Center München, Deutschland.,Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Deutschland
| | | | | | - Tanja Albawi-Daltrozzo
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Deutschland
| | - Nadia Harbeck
- Comprehensive Cancer Center München, Deutschland.,Brustzentrum, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München, Deutschland
| | - Hana Algül
- Comprehensive Cancer Center München, Deutschland.,Mildred-Scheel-Professur für Tumormetabolismus, Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Volker Heinemann
- Comprehensive Cancer Center München, Deutschland.,Medizinische Klinik und Poliklinik III, Klinikum der Universität München, LMU München, Deutschland
| | - Kerstin Hermelink
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Universität München, LMU München, Deutschland
| | - Friederike Mumm
- Comprehensive Cancer Center München, Deutschland.,Medizinische Klinik und Poliklinik III, Klinikum der Universität München, LMU München, Deutschland
| | - Andreas Dinkel
- Comprehensive Cancer Center München, Deutschland.,Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Deutschland
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72
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Bogaert B, Buisson V, Kozlakidis Z, Saintigny P. Organisation of cancer care in troubling times: A scoping review of expert guidelines and their implementation during the COVID-19 pandemic. Crit Rev Oncol Hematol 2022; 173:103656. [PMID: 35337970 PMCID: PMC8942466 DOI: 10.1016/j.critrevonc.2022.103656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
This scoping review mapped the main themes in existing expert guidelines for cancer care issued during the COVID-19 crisis from the period of March 2020-August 2021. The guidelines published during the research period principally relate to the first two waves in Europe and until the beginning of the vaccination campaign. They elaborated recommendations for cancer care reorganisation, in particular triage and quality of care issues. The article highlights the ethical, epistemological, as well as practical reasons that guidelines were not always followed to provide some lessons learned for future crises to enable better guideline development processes. We also elaborate early evidence on the impact of triage decisions and different perspectives on cancer care reorganisation from ethics and social science literature.
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Affiliation(s)
- Brenda Bogaert
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Victoria Buisson
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Zizis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - Pierre Saintigny
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.
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73
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Cavalcante FP, Abdala E, Weissmann L, Ferreira CEDS, Amorim G, de Oliveira VM, Guilgen G, Landeiro L, Pinho JRR, Pulchinelli Á, Ribeiro H, Souza R, Rosa DD. Impact of COVID-19 Disease in Early Breast Cancer Management: A Summary of the Current Evidence. JCO Glob Oncol 2022; 8:e2100357. [PMID: 35594492 PMCID: PMC9173577 DOI: 10.1200/go.21.00357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
An expert panel on breast cancer and COVID-19 disease was convened to address the impact of the COVID-19 pandemic for early breast cancer (eBC) management.
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Affiliation(s)
| | - Edson Abdala
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Leonardo Weissmann
- Emílio Ribas Infectious Disease Institute, São Paulo, SP, Brazil
- Unaerp School of Medicine, Guarujá, SP, Brazil
- Brazilian Society of Infectology, São Paulo, SP, Brazil
| | | | - Gilberto Amorim
- Oncologia D'Or, Rio de Janeiro, RJ, Brazil
- Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, RS, Brazil
| | - Vilmar Marques de Oliveira
- Brazilian Society of Mastology, Rio de Janeiro, RJ, Brazil
- Santa Casa de São Paulo Hospital, São Paulo, SP, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | - Gisah Guilgen
- Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, RS, Brazil
- Curitiba Cancer and Transplant Institute, Curitiba, PR, Brazil
- Nossa Senhora das Graças Hospital, Curitiba, PR, Brazil
| | - Luciana Landeiro
- Núcleo de Oncologia da Bahia (NOB)—Oncoclínicas Group, Salvador, BA, Brazil
| | - João Renato Rebello Pinho
- Albert Einstein Hospital, São Paulo, SP, Brazil
- Hospital das Clínicas, São Paulo, SP, Brazil
- School of Medicine, Medical Research Laboratories LIM 03/07, University of São Paulo, São Paulo, SP, Brazil
| | - Álvaro Pulchinelli
- Brazilian Society of Clinical Pathology/Laboratory Medicine, Rio de Janeiro, RJ, Brazil
- Fleury Group, São Paulo, SP, Brazil
- School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Heber Ribeiro
- Brazilian Society of Oncology Surgery, Rio de Janeiro, RJ, Brazil
- AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rafael Souza
- Cancer Treatment Institute (ITC), Campo Grande, MS, Brazil
| | - Daniela Dornelles Rosa
- Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, RS, Brazil
- Moinhos de Vento Hospital, Porto Alegre, RS, Brazil
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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74
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Yamaguchi S, Okada A, Sunaga S, Ikeda Kurakawa K, Yamauchi T, Nangaku M, Kadowaki T. Impact of COVID-19 pandemic on healthcare service use for non-COVID-19 patients in Japan: retrospective cohort study. BMJ Open 2022; 12:e060390. [PMID: 35466081 PMCID: PMC9058318 DOI: 10.1136/bmjopen-2021-060390] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We aimed to investigate the impact of the first and second waves of the COVID-19 pandemic on healthcare service use by non-COVID-19 patients. DESIGN Retrospective cohort study. SETTING Hospital-based claims database from anonymised hospitals in Japan. PARTICIPANTS Patients (n=785 495) who visited and/or were hospitalised in 26 anonymised hospitals in Japan between January 2017 and November 2020. OUTCOME MEASURES We compared changes in the monthly number of hospitalisations (overall or by diagnosis), outpatient visits, endoscopic fibrescopies (EFs), rehabilitations, outpatient chemotherapy treatments, maintenance haemodialysis treatments and outpatient prescriptions between pre-COVID-19 years and the same period in 2020. RESULTS The overall number of hospitalisations and outpatient visits decreased by 27% and 22%, respectively, in May 2020, of which the most substantial decrease was observed in the paediatrics department (65% and 51%, respectively). The number of hospitalisations for respiratory diseases, circulatory diseases, malignant neoplasms and digestive diseases decreased by a maximum of 55%, 32%, 10% and 26%, respectively, in 2020. The number of hospitalisations for non-COVID-19 pneumonia in patients aged <16 years, patients aged ≥16 years and patients with asthma decreased by 93%, 43% and 80%, respectively, in May 2020. EFs and outpatient rehabilitations decreased by >30%. In contrast, outpatient chemotherapy and maintenance haemodialysis treatments decreased by <10%, if at all. Outpatient prescriptions decreased by a maximum of 20% in 2020, with the largest decrease observed in drugs for obstructive airway diseases and cough and cold preparations. CONCLUSIONS The use of healthcare services by non-COVID-19 patients was most affected during the first wave of the COVID-19 pandemic in May 2020. The number of hospitalisations for respiratory diseases, particularly non-COVID-19 pneumonia and asthma, drastically decreased, while the number of hospitalisations and outpatient chemotherapies for malignant neoplasms or maintenance haemodialysis was less affected.
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Affiliation(s)
- Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Toranomon Hospital, Tokyo, Japan
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75
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Horta BL, Silveira MF, Barros AJD, Hartwig FP, Dias MS, Menezes AMB, Hallal PC. COVID-19 and outpatient care: a nationwide household survey. CAD SAUDE PUBLICA 2022; 38:e00194121. [PMID: 35442261 DOI: 10.1590/0102-311x00194121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/27/2021] [Indexed: 12/31/2022] Open
Abstract
We aimed to assess the proportion of the population in 133 Brazilian municipalities who - from March to August 2020 - had a health problem but failed to seek care or failed to attend to a health service for routine appointment or examination. We conducted a household survey from August 24-27 in 133 Brazilian cities by asking the subjects if, since the beginning of the COVID-19 pandemic in March 2020, they had suffered from a health problem but did not seek care or failed to attend to a routine or screening examination. Poisson regression was used for the analyses. We interviewed 33,250 subjects and 11.8% (95%CI: 11.4-12.1) reported that, since March 2020, they failed to seek care despite being ill, 17.3% (95%CI: 16.9-17.7) failed to attend to a routine or screening examination and 23.9% (95%CI: 23.4-24.4) reported one or both outcomes. Health service closure and fear of the COVID-19 infection were the main reasons for not seeking care. Women and the poorest were more likely to not look for a health service, despite having a health problem or a scheduled routine appointment. On the other hand, those subjects who self-identified as white were less likely to not look for a health service. The COVID-19 pandemic is more critical for the indigenous people and the poorest, and these people are also more likely to not seek care for other health conditions during the pandemic.
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76
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Treiman K, Kranzler EC, Moultrie R, Arena L, Mack N, Fortune E, Garcia R, Street RL. Patients’ Experiences with Cancer Care: Impact of the COVID-19 Pandemic. J Patient Exp 2022; 9:23743735221092567. [PMID: 35480966 PMCID: PMC9036334 DOI: 10.1177/23743735221092567] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic heightened the psychosocial impact of a cancer diagnosis as patients face concerns about the risk of infection and serious disease and uncertainties about the impact on their treatment. We conducted an online survey (n = 317) and focus groups (n = 19) with patients to examine their experiences with cancer care during the pandemic. Most survey respondents (68%) reported one or more disruptions or delays in care, including appointments switched to telehealth (49%). Patients perceived both benefits (e.g., convenience) and drawbacks (e.g., more impersonal) to telehealth. For many patients, COVID-19-related restrictions on bringing family members to support them during appointments was a major concern and left them feeling alone and vulnerable during treatment. Patients’ self-reported coping during the pandemic was positively associated with age, education, and income (P < .05 for each) and better communication with their doctors during telehealth sessions (P < .001). Study findings highlight the importance of patient-centered care and communication to help patients cope with the challenges of the pandemic. Further research is needed to develop guidelines for use of telehealth as part of patient-centered cancer care.
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Affiliation(s)
- Katherine Treiman
- Translation Health Science Division, RTI International, Research Triangle Park, NC, USA
| | - Elissa C. Kranzler
- Fors Marsh Group, formerly Cancer Support Community, Philadelphia, PA, USA
| | - Rebecca Moultrie
- Translation Health Science Division, RTI International, Research Triangle Park, NC, USA
| | - Laura Arena
- Translation Health Science Division, RTI International, Research Triangle Park, NC, USA
| | - Nicole Mack
- Social Statistics Program, RTI International, Research Triangle Park, NC, USA
| | - Erica Fortune
- Cancer Support Community, Research and Training Institute, Philadelphia, PA, USA
| | - Reese Garcia
- Fight Colorectal Cancer, Research Advocacy Training and Support Program, Springfield, MO, USA
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
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77
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Dhanani R, Wasif M, Pasha HA, Ghaloo SK, Hussain M, Shah Vardag AB. Ethical Dilemmas in the Management of Head and Neck Cancers in the Era of the COVID-19 Pandemic. Turk Arch Otorhinolaryngol 2022; 60:42-46. [PMID: 35634234 PMCID: PMC9103564 DOI: 10.4274/tao.2022.2021-11-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/26/2022] [Indexed: 12/01/2022] Open
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78
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Parikh RB, Takvorian SU, Vader D, Paul Wileyto E, Clark AS, Lee DJ, Goyal G, Rocque GB, Dotan E, Geynisman DM, Phull P, Spiess PE, Kim RY, Davidoff AJ, Gross CP, Neparidze N, Miksad RA, Calip GS, Hearn CM, Ferrell W, Shulman LN, Mamtani R, Hubbard RA. Impact of the COVID-19 Pandemic on Treatment Patterns for Patients With Metastatic Solid Cancer in the United States. J Natl Cancer Inst 2022; 114:571-578. [PMID: 34893865 PMCID: PMC9002283 DOI: 10.1093/jnci/djab225] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 12/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the COVID-19 pandemic's impact on time to treatment initiation (TTI) and treatment selection for patients newly diagnosed with metastatic solid cancer. METHODS We used an electronic health record-derived longitudinal database curated via technology-enabled abstraction to identify 14 136 US patients newly diagnosed with de novo or recurrent metastatic solid cancer between January 1 and July 31 in 2019 or 2020. Patients received care at approximately 280 predominantly community-based oncology practices. Controlled interrupted time series analyses assessed the impact of the COVID-19 pandemic period (April-July 2020) on TTI, defined as the number of days from metastatic diagnosis to receipt of first-line systemic therapy, and use of myelosuppressive therapy. RESULTS The adjusted probability of treatment within 30 days of diagnosis was similar across periods (January-March 2019 = 41.7%, 95% confidence interval [CI] = 32.2% to 51.1%; April-July 2019 = 42.6%, 95% CI = 32.4% to 52.7%; January-March 2020 = 44.5%, 95% CI = 30.4% to 58.6%; April-July 2020 = 46.8%, 95% CI= 34.6% to 59.0%; adjusted percentage-point difference-in-differences = 1.4%, 95% CI = -2.7% to 5.5%). Among 5962 patients who received first-line systemic therapy, there was no association between the pandemic period and use of myelosuppressive therapy (adjusted percentage-point difference-in-differences = 1.6%, 95% CI = -2.6% to 5.8%). There was no meaningful effect modification by cancer type, race, or age. CONCLUSIONS Despite known pandemic-related delays in surveillance and diagnosis, the COVID-19 pandemic did not affect TTI or treatment selection for patients with metastatic solid cancers.
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Affiliation(s)
- Ravi B Parikh
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel U Takvorian
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Vader
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy S Clark
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Lee
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Gaurav Goyal
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Daniel M Geynisman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Pooja Phull
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Roger Y Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy J Davidoff
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Cary P Gross
- Cancer Outcomes Public Policy and Effectiveness Research, Yale School of Medicine, New Haven, CT, USA
| | - Natalia Neparidze
- Cancer Outcomes Public Policy and Effectiveness Research, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Caleb M Hearn
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Will Ferrell
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronac Mamtani
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania, Philadelphia, PA, USA
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Kaneda Y, Ozaki A, Wada M, Kurokawa T, Sawano T, Tsubokura M, Tanimoto T, Kanemoto Y, Ejiri T, Kanzaki N. Possible association of Typhoon Hagibis and the COVID‐19 pandemic on patient delay in breast cancer patients: A case report. Clin Case Rep 2022; 10:e05621. [PMID: 35356170 PMCID: PMC8939041 DOI: 10.1002/ccr3.5621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Little is known on how different types of disasters interact in their impacts on patient care. We experienced a breast cancer patient whose initial presentation was delayed for 2 years due to the COVID‐19 pandemic and Typhoon Hagibis. Increasing awareness is needed on the combined impacts of disasters on breast cancer management.
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Affiliation(s)
- Yudai Kaneda
- School of Medicine Hokkaido University Sapporo Hokkaido Japan
| | - Akihiko Ozaki
- Department of Breast Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
| | - Masahiro Wada
- Department of Breast Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
- Department of Breast Surgery Sano Kosei General Hospital Sano Tochigi Japan
| | - Tomohiro Kurokawa
- Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
| | - Toyoaki Sawano
- Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
- Department of Radiation Health Management Fukushima Medical University School of Medicine Iwaki Fukushima Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management Fukushima Medical University School of Medicine Iwaki Fukushima Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
| | - Yoshiaki Kanemoto
- Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
| | - Tomozo Ejiri
- Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
| | - Norio Kanzaki
- Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki Fukushima Japan
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80
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Morais S, Antunes L, Rodrigues J, Fontes F, Bento MJ, Lunet N. The impact of the coronavirus disease 2019 pandemic on the diagnosis and treatment of cancer in Northern Portugal. Eur J Cancer Prev 2022; 31:204-214. [PMID: 34267109 PMCID: PMC8808756 DOI: 10.1097/cej.0000000000000686] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/07/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has affected the availability of healthcare resources, and adjustments to cancer care have been necessary considering the risk of morbidity by COVID-19 and of cancer progression. This study aims to quantify the impact of the COVID-19 pandemic on the care of patients with cancer by comparing a period of 4 months after the outbreak began (2 March 2020) with an equal period from 2019. METHODS Cancer cases of the esophagus, stomach, colon and rectum, pancreas, lung, skin-melanoma, breast, cervix, prostate, non-Hodgkin lymphoma, and leukemia from the Portuguese Oncology Institute of Porto, and diagnosed between 2 March and 1 July 2019 (before COVID-19) and 2020 (after COVID-19) were identified. Those with the first treatment outside the Portuguese Oncology Institute of Porto were excluded. Sociodemographic, clinical and treatment characteristics were obtained from the cancer registry database and clinical files. RESULTS The absolute number of new cancer cases decreased nearly 40% after the COVID-19 pandemic (from 1430 to 866). The largest decreases were observed for cervical (-74.3%) and prostate (-71.7%) cancers. Cases were more often diagnosed at more advanced stages in 2020 (P = 0.001), and the proportion of patients not starting any treatment until 1 July was just under 20% in 2019 and nearly 40% in 2020. The median times from symptoms onset, first medical exam and first appointment to diagnosis, and from diagnosis to first appointment, multidisciplinary tumor board meeting and first treatment were shorter after COVID-19. CONCLUSIONS There was a notable overall decrease in cancer diagnoses after COVID-19, with changes in the characteristics of incident cases.
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Affiliation(s)
- Samantha Morais
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n°135
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro
| | - Luís Antunes
- Grupo de Epidemiologia do Cancro, Centro de Investigação do Instituto Português de Oncologia do Porto, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida
| | - Jéssica Rodrigues
- Grupo de Epidemiologia do Cancro, Centro de Investigação do Instituto Português de Oncologia do Porto, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida
| | - Filipa Fontes
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n°135
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro
- Serviço de Imagem, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida
| | - Maria José Bento
- Grupo de Epidemiologia do Cancro, Centro de Investigação do Instituto Português de Oncologia do Porto, Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida
- Departamento de Estudos de Populações, Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, Porto, Portugal
| | - Nuno Lunet
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n°135
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro
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Fox L, Monroy-Iglesias MJ, Aggarwal A, Haire K, Purushotham A, Spicer J, Papa S, Rigg A, Dolly S, Sullivan R, Van Hemelrijck M. Association between COVID-19 burden and delays to diagnosis and treatment of cancer patients in England. J Cancer Policy 2022; 31:100316. [PMID: 35559868 PMCID: PMC8653402 DOI: 10.1016/j.jcpo.2021.100316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
Background Methods Results Conclusion Policy summary
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Affiliation(s)
- Louis Fox
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK
| | - Maria J Monroy-Iglesias
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK.
| | - Ajay Aggarwal
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Kate Haire
- Southeast London Cancer Alliance, London, UK
| | - Arnie Purushotham
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - James Spicer
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sophie Papa
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anne Rigg
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), London, UK
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Kara H, Arikan AE, Dulgeroglu O, Tutar B, Tokat F, Uras C. Has the COVID-19 Pandemic Affected Breast Cancer Stage and Surgical Volume? Front Surg 2022; 9:811108. [PMID: 35198597 PMCID: PMC8859320 DOI: 10.3389/fsurg.2022.811108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute. Methods Data of 332 patients who were diagnosed and treated for breast cancer between December 2019 and November 2020 were evaluated retrospectively according to periods of pandemic. Results A significant decrease in the number of operations, especially upfront surgeries rather than surgeries after neoadjuvant chemotherapy, was detected in the early period of the COVID-19 pandemic. It was found that patients with complaints were mostly admitted during this period (p = 0.024). No statistical significance was found for age, sex, side of the tumor, type of tumor, surgery to breast, and axilla. Following the early period of the pandemic, it was observed that patients with mostly luminal, early-stage, and less axillary nodal involvement (p < 0.05) were admitted, and as a result, it was founded that upfront surgeries increased, although no change in TNM staging was observed. However, it did affect the decision of initial treatment. Thus, the number of upfront surgeries was significantly higher than the NCT group (p = 0.027) following the early period. Conclusion Surgical volume is significantly affected in the early period of the COVID-19 pandemic. To overcome overload due to delayed surgeries related to pandemics, some hospitals should be spared for oncological treatments. Following the early period, mostly luminal type, early-stage patients were admitted, probably because of increased self-awareness and short wave duration, but the breast cancer stage was not affected.
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Affiliation(s)
- Halil Kara
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Akif Enes Arikan
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- *Correspondence: Akif Enes Arikan
| | - Onur Dulgeroglu
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Burcin Tutar
- Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Fatma Tokat
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of Pathology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cihan Uras
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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83
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Cantini L, Mentrasti G, Russo GL, Signorelli D, Pasello G, Rijavec E, Russano M, Antonuzzo L, Rocco D, Giusti R, Adamo V, Genova C, Tuzi A, Morabito A, Gori S, Verde NL, Chiari R, Cortellini A, Cognigni V, Pecci F, Indini A, De Toma A, Zattarin E, Oresti S, Pizzutilo EG, Frega S, Erbetta E, Galletti A, Citarella F, Fancelli S, Caliman E, Della Gravara L, Malapelle U, Filetti M, Piras M, Toscano G, Zullo L, De Tursi M, Di Marino P, D'Emilio V, Cona MS, Guida A, Caglio A, Salerno F, Spinelli G, Bennati C, Morgillo F, Russo A, Dellepiane C, Vallini I, Sforza V, Inno A, Rastelli F, Tassi V, Nicolardi L, Pensieri V, Emili R, Roca E, Migliore A, Galassi T, Rocchi MLB, Berardi R. Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario. ESMO Open 2022; 7:100406. [PMID: 35219245 PMCID: PMC8810307 DOI: 10.1016/j.esmoop.2022.100406] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. Methods Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Results A slight reduction (−6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop −12% versus −3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). Conclusions Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts. The COVID-19 outbreak had an impact on access to lung cancer (LC) diagnosis and treatment. A slight reduction (−6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019. Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease. The Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts. A reverse migration from high-volume to low-volume cancer centers was noted during the pandemic.
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Affiliation(s)
- L Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy. https://twitter.com/LucaCantiniMD
| | - G Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - G L Russo
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - D Signorelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - E Rijavec
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Russano
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - L Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - D Rocco
- Department of Pulmonology and Oncology, AORN dei Colli Monaldi, Naples, Italy
| | - R Giusti
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - V Adamo
- Oncologia Medica, A.O.Papardo & Università di Messina, Messina, Italy
| | - C Genova
- UOC Clinica di Oncologia Medica, IRCCS Ospedale San Martino, Department of Internal Medicine and Medical Specialties (DIMI), Università degli Studi di Genova, Genoa, Italy
| | - A Tuzi
- Oncologia Medica, ASST Sette Laghi, Varese, Italy
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - S Gori
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - N La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - A Cortellini
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy
| | - V Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - F Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - A Indini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A De Toma
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - E Zattarin
- Oncologia Medica 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - S Oresti
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - E G Pizzutilo
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - S Frega
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - E Erbetta
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - A Galletti
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - F Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - S Fancelli
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - E Caliman
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - L Della Gravara
- Dipartment of Experimental Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - U Malapelle
- Department of Public Health, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - M Filetti
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - M Piras
- UOC Oncologia Medica, Azienda Ospedaliero Universitaria Sant'Andrea, Università La Sapienza, Rome, Italy
| | - G Toscano
- Oncologia Medica, A.O.Papardo, Messina, Italy
| | - L Zullo
- UOC Oncologia Medica 2, IRCCS Ospedale San Martino, Genoa, Italy
| | - M De Tursi
- Department of Innovative Technologies in Medicine & Dentistry, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - P Di Marino
- Department of Innovative Technologies in Medicine & Dentistry, Università G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - V D'Emilio
- UOC Pneumologia, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - M S Cona
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milan, Italy
| | - A Guida
- Oncologia Medica e Traslazionale, AO Santa Maria, Terni, Italy
| | - A Caglio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - F Salerno
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - G Spinelli
- UOC Territorial Oncology, University "Sapienza", AUSL Latina, Cds Aprilia, Aprilia, Italy
| | - C Bennati
- Department of Onco-Hematology, AUSL della Romagna, Ravenna, Italy
| | - F Morgillo
- UOC Oncologia ed Ematologia, Department of Precision Medicine, Università degli studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - A Russo
- Oncologia Medica, A.O.Papardo, Messina, Italy
| | - C Dellepiane
- UOC Oncologia Medica 2, IRCCS Ospedale San Martino, Genoa, Italy
| | - I Vallini
- Oncologia Medica, ASST Sette Laghi, Varese, Italy
| | - V Sforza
- Thoracic Medical Oncology, Istituto Nazionale Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - A Inno
- UOC Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - F Rastelli
- UOC Oncologia, Ospedale Mazzoni, Ascoli Piceno, Italy
| | - V Tassi
- Chirurgia Toracica, AO Santa Maria, Terni, Italy
| | - L Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - V Pensieri
- Medical Oncology, St Salvatore Hospital, L'Aquila, Italy
| | - R Emili
- Operative Oncology Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - E Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera Del Garda, Italy
| | - A Migliore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - T Galassi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - M L Bruno Rocchi
- Biomolecular Sciences Department, University of Urbino, Urbino, Italy
| | - R Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy.
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Childhood cancer survivorship care during the COVID-19 pandemic: an international report of practice implications and provider concerns. J Cancer Surviv 2022; 16:1390-1400. [PMID: 35020136 PMCID: PMC8753338 DOI: 10.1007/s11764-021-01120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/09/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE Long-term follow-up (LTFU) care is essential to optimise health outcomes in childhood cancer survivors (CCS). We aimed to assess the impact of the COVID-19 pandemic on LTFU services and providers. METHODS A COVID-19 working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) distributed a questionnaire to LTFU service providers in 37 countries across Europe, Asia, North America, Central/South America, and Australia. The questionnaire assessed how care delivery methods changed during the pandemic and respondents' level of worry about the pandemic's impact on LTFU care delivery, their finances, their health, and that of their family and friends. RESULTS Among 226 institutions, providers from 178 (79%) responded. Shortly after the initial outbreak, 42% of LTFU clinics closed. Restrictions during the pandemic resulted in fewer in-person consultations and an increased use of telemedicine, telephone, and email consultations. The use of a risk assessment to prioritise the method of LTFU consultation for individual CCS increased from 12 to 47%. While respondents anticipated in-person consultations to remain the primary method for LTFU service delivery, they expected significantly increased use of telemedicine and telephone consultations after the pandemic. On average, respondents reported highest levels of worry about psychosocial well-being of survivors. CONCLUSIONS The pandemic necessitated changes in LTFU service delivery, including greater use of virtual LTFU care and risk-stratification to identify CCS that need in-person evaluations. IMPLICATIONS FOR CANCER SURVIVORS Increased utilisation of virtual LTFU care and risk stratification is likely to persist post-pandemic.
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85
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Tang A, Neeman E, Vuong B, Arasu VA, Liu R, Kuehner GE, Savitz AC, Lyon LL, Anshu P, Seaward SA, Patel MD, Habel LA, Kushi LH, Mentakis M, Thomas ES, Kolevska T, Chang SB. Care in the time of COVID-19: impact on the diagnosis and treatment of breast cancer in a large, integrated health care system. Breast Cancer Res Treat 2022; 191:665-675. [PMID: 34988767 PMCID: PMC8731186 DOI: 10.1007/s10549-021-06468-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSES To delineate operational changes in Kaiser Permanente Northern California breast care and evaluate the impact of these changes during the initial COVID-19 Shelter-in-Place period (SiP, 3/17/20-5/17/20). METHODS By extracting data from institutional databases and reviewing electronic medical charts, we compared clinical and treatment characteristics of breast cancer patients diagnosed 3/17/20-5/17/20 to those diagnosed 3/17/19-5/17/2019. Outcomes included time from biopsy to consultation and treatment. Comparisons were made using Chi-square or Wilcoxon rank-sum tests. RESULTS Fewer new breast cancers were diagnosed in 2020 during the SiP period than during a similar period in 2019 (n = 247 vs n = 703). A higher percentage presented with symptomatic disease in 2020 than 2019 (78% vs 37%, p < 0.001). Higher percentages of 2020 patients presented with grade 3 (37% vs 25%, p = 0.004) and triple-negative tumors (16% vs 10%, p = 0.04). A smaller percentage underwent surgery first in 2020 (71% vs 83%, p < 0.001) and a larger percentage had neoadjuvant chemotherapy (16% vs 11%, p < 0.001). Telehealth utilization increased from 0.8% in 2019 to 70.0% in 2020. Times to surgery and neoadjuvant chemotherapy were shorter in 2020 than 2019 (19 vs 26 days, p < 0.001, and 23 vs 28 days, p = 0.03, respectively). CONCLUSIONS During SiP, fewer breast cancers were diagnosed than during a similar period in 2019, and a higher proportion presented with symptomatic disease. Early-stage breast cancer diagnoses decreased, while metastatic cancer diagnoses remained similar. Telehealth increased significantly, and times to treatment were shorter in 2020 than 2019. Our system continued to provide timely breast cancer treatment despite significant pandemic-driven disruption.
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Affiliation(s)
- Annie Tang
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Elad Neeman
- Department of Medical Oncology, San Francisco Medical Center, Kaiser Permanente, San Francisco, USA
| | - Brooke Vuong
- Department of Surgery, South Sacramento Medical Center, Kaiser Permanente, Sacramento, USA
| | - Vignesh A Arasu
- Department of Radiology, Kaiser Permanente Vallejo Medical Center, Vallejo, USA
| | - Raymond Liu
- Department of Medical Oncology, San Francisco Medical Center, Kaiser Permanente, San Francisco, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Gillian E Kuehner
- Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, USA
| | - Alison C Savitz
- Department of Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, USA
| | - Liisa L Lyon
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Prachi Anshu
- Department of Surgery, Fremont Medical Center, Kaiser Permanente, Fremont Medical Center - 39400 Paseo Padre Pkwy, Fremont, CA, 94538, USA
| | - Samantha A Seaward
- Department of Radiation Oncology, Kaiser Permanente Oakland Medical Center, Oakland, USA
| | - Milan D Patel
- Department of Radiation Oncology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, USA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Margaret Mentakis
- Department of Surgery, South Sacramento Medical Center, Kaiser Permanente, Sacramento, USA
| | - Eva S Thomas
- Department of Medical Oncology, Kaiser Permanente Oakland Medical Center, Oakland, USA
| | - Tatjana Kolevska
- Department of Medical Oncology, Kaiser Permanente Vallejo Medical Center, Vallejo, USA
| | - Sharon B Chang
- Department of Surgery, Fremont Medical Center, Kaiser Permanente, Fremont Medical Center - 39400 Paseo Padre Pkwy, Fremont, CA, 94538, USA.
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86
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Stevens MN, Patro A, Rahman B, Gao Y, Liu D, Cmelak A, Wiggleton J, Kim YJ, Langerman A, Mannion K, Sinard RJ, Netterville JL, Rohde SL, Topf MC. Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma. Am J Otolaryngol 2022; 43:103263. [PMID: 34653954 PMCID: PMC8500684 DOI: 10.1016/j.amjoto.2021.103263] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, maintenance of safe and timely oncologic care has been challenging. The goal of this study is to compare presenting symptoms, staging, and treatment of head and neck mucosal squamous cell carcinoma during the pandemic with an analogous timeframe one year prior. MATERIALS AND METHODS Retrospective cohort study at a single tertiary academic center of new adult patients evaluated in a head and neck surgical oncology clinic from March -July 2019 (pre-pandemic control) and March - July 2020 (COVID-19 pandemic). RESULTS During the pandemic, the proportion of patients with newly diagnosed malignancies increased by 5%, while the overall number of new patients decreased (n = 575) compared to the control year (n = 776). For patients with mucosal squamous cell carcinoma (SCC), median time from referral to initial clinic visit decreased from 11 days (2019) to 8 days (2020) (p = 0.0031). There was no significant difference in total number (p = 0.914) or duration (p = 0.872) of symptoms. During the pandemic, patients were more likely to present with regional nodal metastases (adjusted odds ratio (OR) 2.846, 95% CI 1.072-3.219, p = 0.028) and more advanced clinical nodal (N) staging (p = 0.011). No significant difference was seen for clinical tumor (T) (p = 0.502) or metastasis (M) staging (p = 0.278). No significant difference in pathologic T (p = 0.665), or N staging (p = 0.907) was found between the two periods. CONCLUSION Head and neck mucosal SCC patients presented with more advanced clinical nodal disease during the early months of the COVID-19 pandemic despite no change in presenting symptoms.
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Affiliation(s)
- Madelyn N Stevens
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Ankita Patro
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Bushra Rahman
- Vanderbilt University School of Medicine, 1161 21st Ave S, Nashville, TN 37232, USA
| | - Yue Gao
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University, 2525 West End Ave Ste 1100, Nashville, TN 37203, USA
| | - Anthony Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 37232, USA
| | - Jamie Wiggleton
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Young J Kim
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Alexander Langerman
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Kyle Mannion
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Robert J Sinard
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - James L Netterville
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Sarah L Rohde
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
| | - Michael C Topf
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, 7th floor 1215 21st Ave S, Nashville, TN 37232, USA
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87
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Kirtane K, Geiss C, Arredondo B, Hoogland AI, Chung CH, Muzaffar J, Patel KB, Gonzalez BD, Jim HSL, Oswald LB. "I have cancer during COVID; that's a special category": a qualitative study of head and neck cancer patient and provider experiences during the COVID-19 pandemic. Support Care Cancer 2022; 30:4337-4344. [PMID: 35091844 PMCID: PMC8799415 DOI: 10.1007/s00520-021-06773-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/18/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The COVID-19 pandemic has drastically changed cancer care delivery strategies. Patients with locally advanced head and neck cancer (LA-HNC) may be particularly affected by the COVID-19 pandemic, as they often undergo treatments that require daily clinic visits (e.g., radiation therapy). The goal of this study was to characterize the lived experience of LA-HNC patients and their healthcare providers during the COVID-19 pandemic. METHODS LA-HNC patients who completed a full course of chemotherapy and radiation therapy during the COVID19 pandemic (N = 20) and LA-HNC healthcare providers (N = 13) participated in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed for qualitative themes. RESULTS The COVID-19 pandemic had a significant impact on patients' overall quality of life and health care. Results were organized in four main themes: (1) increased psychological distress; (2) exacerbated social isolation; (3) added stress in clinic for patients and providers; and (4) delays in health care. CONCLUSIONS Findings highlight myriad ways LA-HNC patients and providers have been affected by the COVID-19 pandemic. Results can inform the development of supportive interventions to assist LA-HNC in managing COVID-19-related stress and unmet needs related to social isolation and in-clinic support.
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Affiliation(s)
- Kedar Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| | - Carley Geiss
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Brandy Arredondo
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Jameel Muzaffar
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Krupal B Patel
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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88
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Disparities in Time to Treatment for Breast Cancer: Existing Knowledge and Future Directions in the COVID-19 Era. CURRENT BREAST CANCER REPORTS 2022; 14:213-221. [PMID: 36530340 PMCID: PMC9735127 DOI: 10.1007/s12609-022-00469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
Purpose of Review Despite significant advances in detection and treatment for breast cancer, the breast cancer mortality rate for Black women remains 40% higher than that for White women. Timely work-up and treatment improve outcomes, yet no gold standard exists for which to guide providers. Recent Findings A large body of literature demonstrates disparities in time to treatment for breast cancer, and most studies show that Black women receive treatment later than their White counterparts. The COVID-19 pandemic has been projected to worsen these disparities, but the extent of this impact remains unknown. Summary In this review, we describe the available evidence on disparities in time to treatment, potential drivers, and possible mitigation strategies. Future research must address how the COVID-19 pandemic has impacted the timely treatment of breast cancer patients, particularly populations vulnerable to disparate outcomes. Improved access to multidisciplinary breast programs, patient navigation services, and establishment of standards for timely treatment are necessary.
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89
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Marks DK, Budhathoki N, Kucharczyk J, Fa’ak F, D’Abreo N, Kwa M, Plasilova M, Dhage S, Soe PP, Becker D, Hindenburg A, Lee J, Winner M, Okpara C, Daly A, Shah D, Ramdhanny A, Meyers M, Oratz R, Speyer J, Novik Y, Schnabel F, Jones SA, Adams S. OUP accepted manuscript. Oncologist 2022; 27:89-96. [PMID: 35641208 PMCID: PMC8895753 DOI: 10.1093/oncolo/oyab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Provide real-world data regarding the risk for SARS-CoV-2 infection and mortality in breast cancer (BC) patients on active cancer treatment. Methods Clinical data were abstracted from the 3778 BC patients seen at a multisite cancer center in New York between February 1, 2020 and May 1, 2020, including patient demographics, tumor histology, cancer treatment, and SARS-CoV-2 testing results. Incidence of SARS-CoV-2 infection by treatment type (chemotherapy [CT] vs endocrine and/or HER2 directed therapy [E/H]) was compared by Inverse Probability of Treatment Weighting. In those diagnosed with SARS-CoV-2 infection, Mann–Whitney test was used to a assess risk factors for severe disease and mortality. Results Three thousand sixty-two patients met study inclusion criteria with 641 patients tested for SARS-COV-2 by RT-PCR or serology. Overall, 64 patients (2.1%) were diagnosed with SARS-CoV-2 infection by either serology, RT-PCR, or documented clinical diagnosis. Comparing matched patients who received chemotherapy (n = 379) with those who received non-cytotoxic therapies (n = 2343) the incidence of SARS-CoV-2 did not differ between treatment groups (weighted risk; 3.5% CT vs 2.7% E/H, P = .523). Twenty-seven patients (0.9%) expired over follow-up, with 10 deaths attributed to SARS-CoV-2 infection. Chemotherapy was not associated with increased risk for death following SARS-CoV-2 infection (weighted risk; 0.7% CT vs 0.1% E/H, P = .246). Advanced disease (stage IV), age, BMI, and Charlson’s Comorbidity Index score were associated with increased mortality following SARS-CoV-2 infection (P ≤ .05). Conclusion BC treatment, including chemotherapy, can be safely administered in the context of enhanced infectious precautions, and should not be withheld particularly when given for curative intent.
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Affiliation(s)
- Douglas K Marks
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
- Corresponding author: Douglas K. Marks, Department of Medicine, NYU Long Island School of Medicine, 120 Mineola Blvd, Suite 500 Mineola, NY 11501, USA.
| | | | | | - Faisal Fa’ak
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Nina D’Abreo
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Maryann Kwa
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Magdalena Plasilova
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Shubhada Dhage
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Phyu Phyu Soe
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Daniel Becker
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Alexander Hindenburg
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Johanna Lee
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Megan Winner
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY,USA
| | | | - Alison Daly
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Darshi Shah
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | | | - Marleen Meyers
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Ruth Oratz
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - James Speyer
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Yelena Novik
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Freya Schnabel
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Simon A Jones
- Department of Population Health, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Sylvia Adams
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
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90
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The effects of the COVID-19 pandemic on psychological stress in breast cancer patients. BMC Cancer 2021; 21:1356. [PMID: 34972520 PMCID: PMC8719114 DOI: 10.1186/s12885-021-09012-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023] Open
Abstract
Background The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels pre-COVID-19 pandemic. Methods Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network® (NCCN®) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23. Results Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms. Conclusions This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created “COVID-19 pandemic questionnaire” could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support. Trial registration DRKS-ID: DRKS00022507. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09012-y.
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91
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Blaise D, Berger P, Mokart D, Camerlo J, Fougereau E, Giovannini M, Houvenaeghel G, Turrini O, Chabannon C, Piana G, Brenot-Rossi I, Tallet A, Gonçalves A, Charbonnier A, Vey N, Grossi S, Viens P. The Management of a Comprehensive Cancer Center during the First Six Months of the COVID-19 Pandemic in the South of France: Lessons from the Paoli-Calmettes Institute's Experience. Clin Hematol Int 2021; 3:119-129. [PMID: 34938984 PMCID: PMC8690701 DOI: 10.2991/chi.k.210919.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/05/2021] [Indexed: 12/15/2022] Open
Abstract
During the COVID-19 pandemic, it was rapidly established that cancer patients have an increased risk of developing severe forms of the 2019 coronavirus disease (COVID-19) due to a backlog of cancer diagnostics and immunosuppressive treatments. Cancer centers had to quickly adapt to continue cancer therapies despite the high infection risks and major disruptions in the French healthcare system. We described and analyzed the impact of the pandemic in our institution: management adjustments, COVID-19 infection rates in patients and staff, and impacts on clinical activities and finances during the first wave of the pandemic from March to September 2020. We also compared the results to the clinical activity data from preceding periods. A crisis unit was rapidly created that met 27 times over 66 days, generating numerous changes in hospital protocol. While our area was devastated by the pandemic, the infection rate of our staff and patients remained low (less than 1.5% of all employees). However, the lockdown period was accompanied with a reduction of most clinical activities, leading to decreases of 43%, 36%, 36%, 1%, and 10% in surgery, endoscopy, radiotherapy, and in- and out-patient chemotherapy sessions, respectively, with substantial financial loss. Our report highlights the need for the rapid creation, implementation, and adaptation of new protocols during a pandemic’s evolution to prevent disease transmission. Lessons from this situation should provide motivation to better prepare for/limit the dismantling of cancer therapies that can dramatically impact patient care and have deleterious consequences on an institution’s financial situation.
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Affiliation(s)
- Didier Blaise
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France.,Centre de Recherche en Cancerologie de Marseille (CRCM), Inserm, CNRS, Marseille, France.,Aix-Marseille University (AMU), Marseille, France
| | - Pierre Berger
- Infectious Diseases Committee, Institut Paoli-Calmettes, Marseille, France
| | - Djamel Mokart
- Department of Anesthesiology and Critical Care, Institut Paoli-Calmettes, Marseille, France
| | - Jacques Camerlo
- Department of Cancer Ambulatory Care, Institut Paoli-Calmettes, Marseille, France
| | | | - Marc Giovannini
- Medical and Surgical Endoscopy Cancer Unit, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Houvenaeghel
- Aix-Marseille University (AMU), Marseille, France.,Department of Cancer Surgery 2, Institut Paoli-Calmettes, Marseille, France
| | - Olivier Turrini
- Aix-Marseille University (AMU), Marseille, France.,Department of Cancer Surgery 1, Institut Paoli-Calmettes, Marseille, France
| | - Christian Chabannon
- Centre de Recherche en Cancerologie de Marseille (CRCM), Inserm, CNRS, Marseille, France.,Aix-Marseille University (AMU), Marseille, France.,Cellular Therapy Platform, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Piana
- Department of Cancer Imagery, Institut Paoli-Calmettes, Marseille, France
| | | | - Agnès Tallet
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | - Anthony Gonçalves
- Centre de Recherche en Cancerologie de Marseille (CRCM), Inserm, CNRS, Marseille, France.,Aix-Marseille University (AMU), Marseille, France.,Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Aude Charbonnier
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Norbert Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France.,Centre de Recherche en Cancerologie de Marseille (CRCM), Inserm, CNRS, Marseille, France.,Aix-Marseille University (AMU), Marseille, France
| | - Sabrina Grossi
- General Direction, Institut Paoli-Calmettes, Marseille, France
| | - Patrice Viens
- Aix-Marseille University (AMU), Marseille, France.,Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France.,General Direction, Institut Paoli-Calmettes, Marseille, France.,Sport Cancer Laboratory EA4670, Luminy Campus, Aix-Marseille University, Marseille
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92
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Ludwigson A, Huynh V, Myers S, Hampanda K, Christian N, Ahrendt G, Romandetti K, Tevis S. Patient Perceptions of Changes in Breast Cancer Care and Well-Being During COVID-19: A Mixed Methods Study. Ann Surg Oncol 2021; 29:1649-1657. [PMID: 34928479 PMCID: PMC8685309 DOI: 10.1245/s10434-021-11209-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/01/2021] [Indexed: 12/20/2022]
Abstract
Background Widespread healthcare restructuring due to the COVID-19 pandemic led to modifications in the timing and delivery of care for breast cancer patients. Our study explores patient concerns relating to COVID-19, breast cancer, and changes to breast cancer care. Patients and Methods Breast cancer patients who presented for surgical consultation at an academic, multidisciplinary clinic completed the electronically distributed validated COVID-19 Impact and Healthcare Related Quality of Life questionnaire between August 2020 and February 2021. This questionnaire uses Likert score responses to assess COVID-specific concerns within domains, including distress and financial hardship. Scale scores were determined by averaging items within each domain, and scores > 2 indicated greater disruption. Semistructured interviews were conducted with patients who indicated interest in participating in the questionnaire. Results Of 381 patients recruited, 133 patients completed the questionnaire and 20 patients completed interviews. Sixty-three percent of survey participants reported attending a telemedicine appointment for their cancer care, and the majority (67%) were satisfied with their experience. Half of the participants (50%) reported fear about how the COVID-19 pandemic will impact their cancer care or recovery, and 66% reported anxiety about contracting COVID-19. Twenty-two percent of participants reported decreased income due to COVID-19. Patient interviews revealed tangible changes to care and provided in-depth information on the advantages and disadvantages of telehealth. Conclusions Breast cancer patients report anxiety about COVID-19 infection and potential care modifications. Our study identifies impacts on patients’ care and quality of life. Further investigation will inform interventions to improve psychosocial outcomes for patients and the telehealth experience. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-11209-1.
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Affiliation(s)
| | - Victoria Huynh
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Sara Myers
- Department of Surgery, University of Pittsburg, Pittsburg, PA, USA
| | - Karen Hampanda
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA
| | | | | | | | - Sarah Tevis
- Department of Surgery, University of Colorado, Aurora, CO, USA.
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93
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Acquati C, Chen TA, Martinez Leal I, Connors SK, Haq AA, Rogova A, Ramirez S, Reitzel LR, McNeill LH. The Impact of the COVID-19 Pandemic on Cancer Care and Health-Related Quality of Life of Non-Hispanic Black/African American, Hispanic/Latina and Non-Hispanic White Women Diagnosed with Breast Cancer in the U.S.: A Mixed-Methods Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413084. [PMID: 34948695 PMCID: PMC8702073 DOI: 10.3390/ijerph182413084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has had critical consequences for cancer care delivery, including altered treatment protocols and delayed services that may affect patients’ quality of life and long-term survival. Breast cancer patients from minoritized racial and ethnic groups already experience worse outcomes, which may have been exacerbated by treatment delays and social determinants of health (SDoH). This protocol details a mixed-methods study aimed at comparing cancer care disruption among a diverse sample of women (non-Hispanic White, non-Hispanic Black/African American, and Hispanic/Latina) and assessing how proximal, intermediate, and distal SDoH differentially contribute to care continuity and health-related quality of life. An embedded mixed-methods design will be implemented. Eligible participants will complete an online survey, followed by a semi-structured interview (with a subset of participants) to further understand factors that influence continuity of care, treatment decision-making, and self-reported engagement. The study will identify potentially modifiable factors to inform future models of care delivery and improve care transitions. These data will provide the necessary evidence to inform whether a subsequent, multilevel intervention is warranted to improve quality of care delivery in the COVID-19 aftermath. Additionally, results can be used to identify ways to leverage existing social resources to help manage and support patients’ outcomes.
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Affiliation(s)
- Chiara Acquati
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX 77204, USA
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-743-4343
| | - Tzuan A. Chen
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Isabel Martinez Leal
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Arooba A. Haq
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Anastasia Rogova
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Stephanie Ramirez
- College of Natural Sciences and Mathematics, University of Houston, 3507 Cullen Blvd, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, 4849 Calhoun Road, Houston, TX 77204, USA; (T.A.C.); (I.M.L.); (L.R.R.)
- Department of Psychological, Health and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (S.K.C.); (A.A.H.); (A.R.)
| | - Lorna H. McNeill
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
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94
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Caston NE, Lawhon VM, Smith KL, Gallagher K, Angove R, Anderson E, Balch A, Azuero A, Huang CHS, Rocque GB. Examining the association among fear of COVID-19, psychological distress, and delays in cancer care. Cancer Med 2021; 10:8854-8865. [PMID: 34845860 PMCID: PMC8683527 DOI: 10.1002/cam4.4391] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background Given the high risk of COVID‐19 mortality, patients with cancer may be vulnerable to fear of COVID‐19, adverse psychological outcomes, and health care delays. Methods This longitudinal study surveyed the pandemic's impact on patients with cancer (N= 1529) receiving Patient Advocate Foundation services during early and later pandemic. Generalized estimating equation with repeated measures was conducted to assess the effect of COVID‐19 on psychological distress. Logistic regression with repeated measures was used to assess the effect of COVID‐19 on any delays in accessing health care (e.g., specialty care doctors, laboratory, or diagnostic testing, etc.). Results Among 1199 respondents, 94% considered themselves high risk for COVID‐19. Respondents with more fear of COVID‐19 had a higher mean psychological distress score (10.21; 95% confidence intervals [CI] 9.38–11.03) compared to respondents with less fear (7.55; 95% CI 6.75–8.36). Additionally, 47% reported delaying care. Respondents with more fear of COVID‐19 had higher percentages of delayed care than those with less (56; 95% CI 39%–72% vs. 44%; 95% CI 28%–61%). These relationships persisted throughout the pandemic. For respondents with a COVID‐19 diagnosis in their household (n = 116), distress scores were similar despite higher delays in care (58% vs. 27%) than those without COVID‐19. Conclusions Fear of COVID‐19 is linked to psychological distress and delays in care among patients with cancer. Furthermore, those who are personally impacted see exacerbated cancer care delays. Timely psychosocial support and health care coordination are critical to meet increased care needs of patients with cancer during the COVID‐19 pandemic.
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Affiliation(s)
- Nicole E Caston
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Valerie M Lawhon
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Karen Lisa Smith
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Alan Balch
- Patient Advocate Foundation, Hampton, Virginia, USA
| | - Andres Azuero
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Chao-Hui Sylvia Huang
- Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Gabrielle B Rocque
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
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95
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Lee H, Singh GK. Monthly Trends in Access to Care and Mental Health Services by Household Income Level During the COVID-19 Pandemic, United States, April: December 2020. Health Equity 2021; 5:770-779. [PMID: 34909547 PMCID: PMC8665787 DOI: 10.1089/heq.2021.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: Since the start of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, ∼40% of U.S. adults have experienced delayed medical care. Rates of uninsurance, delayed care, and utilization of mental health services during the course of the pandemic have not been analyzed in detail. We examined monthly trends and disparities in access to care by household income levels in the United States. Methods: Using Census Bureau's nationally representative pooled 2020 Household Pulse Survey from April to December, 2020 (N=778,819), logistic regression models were used to analyze trends and inequalities in various access to care measures. Results: During the COVID-19 pandemic, the odds of being uninsured, having a delayed medical care due to pandemic, delayed care of something other than COVID-19, or delayed mental health care were, respectively, 5.54, 1.50, 1.85, and 2.18 times higher for adults with income <$25,000, compared to those with incomes ≥$200,000, controlling for age, sex, race/ethnicity, education, marital status, housing tenure, region of residence, and survey month. Income inequities in mental health care widened over the course of the pandemic, while the probability of delayed mental health care increased for all income groups. Although the odds of taking prescription medication for mental health were higher for low-income adults, the odds of receiving mental health services were generally lower for lower income adults, controlling for all covariates. Conclusion: In light of our findings on persistent health care inequities during the pandemic, increased policy efforts are needed to improve access to care in low-income populations as an equitable COVID-19 recovery response.
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Affiliation(s)
- Hyunjung Lee
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA
- US Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity, Rockville, Maryland, USA
| | - Gopal K. Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity, Rockville, Maryland, USA
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96
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Liu H, Zhan L, Guo L, Yu X, Li L, Feng H, Yang D, Xu Z, Tu Y, Chen C, Sun S. More Aggressive Cancer Behaviour in Thyroid Cancer Patients in the Post-COVID-19 Pandemic Era: A Retrospective Study. Int J Gen Med 2021; 14:7197-7206. [PMID: 34737615 PMCID: PMC8558635 DOI: 10.2147/ijgm.s339998] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Many thyroid cancer patients have suffered from treatment delays caused by the coronavirus disease 2019 pandemic. Although there have been many reviews, recommendations, or clinical experiences, clinical evidence that evaluates patient disease status is lacking. The aim of our research was to evaluate thyroid cancer behaviour in the post-COVID-19 era. Patients and Methods A retrospective study was conducted and thyroid cancer patient data from February 1, 2017 to September 15, 2020 were pooled for analysis. The demographic, ultrasound and pathological data of the pre- and post-COVID-19 groups were compared. Lymph node metastases, tumour size, extrathyroidal extension, and multifocality were compared year-by-year to evaluate annual changes in patient characteristics. Regression analyses were adopted to reveal cancer behaviour along with the admission date interval and to reveal risk factors for lymph node metastasis. Patient ultrasound data were compared before and after the lockdown to assess tumour progression. The outcomes of delays in treatment ≤180 days were then studied. Results The post-lockdown patients were more likely to have multiple lesions (31.2% vs 36.5%, p = 0.040), extrathyroidal extension (65.5% vs 72.2%, p = 0.011) and lymph node metastases (37.7% vs 45.0%, p = 0.007), while tumour size remained stable (1.01cm vs.1.02cm, p = 0.758). The lymph node metastasis rate increased by year (p < 0.001). The tumour size correlated negatively with the post-lockdown admission date (p = 0.002). No significant difference in tumour size, multifocality or lymph node metastasis on ultrasound was revealed between the pre- and post-lockdown group. No significant difference in tumour size, multifocality, extrathyroidal extension or lymph node metastasis was revealed among patients with a delayed treatment time ≤180 days. Conclusion Patients with a COVID-19-induced treatment delay had more aggressive cancer behaviour. Rebound medical visits and annually increasing aggressiveness may be potential reasons for this observation, as individual patient tumour did not progress during the delay.
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Affiliation(s)
- Hanqing Liu
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Ling Zhan
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Liantao Guo
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Xizi Yu
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Lingrui Li
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Hongfang Feng
- Department of Thyroid and Breast Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi, 435000, Hubei, People's Republic of China
| | - Dan Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Zhiliang Xu
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Yi Tu
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Chuang Chen
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
| | - Shengrong Sun
- Department of Thyroid and Breast Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China
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97
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Alagoz O, Lowry KP, Kurian AW, Mandelblatt JS, Ergun MA, Huang H, Lee SJ, Schechter CB, Tosteson ANA, Miglioretti DL, Trentham-Dietz A, Nyante SJ, Kerlikowske K, Sprague BL, Stout NK. Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling. J Natl Cancer Inst 2021; 113:1484-1494. [PMID: 34258611 PMCID: PMC8344930 DOI: 10.1093/jnci/djab097] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. METHODS Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. RESULTS By 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic's disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months. CONCLUSIONS Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.
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Affiliation(s)
- Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Allison W Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Mehmet A Ergun
- Department of Industrial Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Hui Huang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandra J Lee
- Department of Data Science, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Diana L Miglioretti
- Department of Public Health Sciences, University of California at Davis, Davis, CA, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and the Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Sarah J Nyante
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology/Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Brian L Sprague
- Department of Surgery and the University of Vermont Cancer Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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98
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Rodriguez GM, Ferguson JM, Kurian A, Bondy M, Patel MI. The Impact of COVID-19 on Patients With Cancer: A National Study of Patient Experiences. Am J Clin Oncol 2021; 44:580-587. [PMID: 34519677 PMCID: PMC8541895 DOI: 10.1097/coc.0000000000000865] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic abruptly disrupted cancer care. The impact of these disruptions on patient experiences remain relatively understudied. The objective of this study was to assess patients' perspectives regarding the impact of COVID-19 on their experiences, including their cancer care, emotional and mental health, and social determinants of health, and to evaluate whether these outcomes differed by cancer stage. MATERIALS AND METHODS We conducted a survey among adults with cancer across the United States from April 1, 2020 to August 26, 2020 using virtual snowball sampling strategy in collaboration with professional organizations, cancer care providers, and patient advocacy groups. We analyzed data using descriptive statistics, χ2 and t tests. RESULTS Three hundred twelve people with cancer participated and represented 38 states. The majority were non-Hispanic White (n=183; 58.7%) and female (n=177; 56.7%) with median age of 57 years. Ninety-one percent spoke English at home, 70.1% had health insurance, and 67% had access to home internet. Breast cancer was the most common diagnosis (n=67; 21.5%). Most had Stage 4 disease (n=80; 25.6%). Forty-six percent (n=145) experienced a change in their care due to COVID-19. Sixty percent (n=187) reported feeling very or extremely concerned that the pandemic would affect their cancer and disproportionately experienced among those with advanced cancer stages compared with earlier stages (P<0.001). Fifty-two percent (n=162) reported impact of COVID-19 on 1 or more aspects of social determinants of health with disproportionate impact among those with advanced cancer stages compared with earlier stages. CONCLUSIONS COVID-19 impacted the care and well-being of patients with cancer and this impact was more pronounced among people with advanced cancer stages. Future work should consider tailored interventions to mitigate the impact of COVID-19 on patients with cancer.
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Affiliation(s)
| | - Jacqueline M. Ferguson
- Center for Population Health Sciences, Stanford University, Stanford
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Allison Kurian
- Division of Oncology, Department of Medicine
- Center for Population Health Sciences, Stanford University, Stanford
| | - Melissa Bondy
- Center for Population Health Sciences, Stanford University, Stanford
| | - Manali I. Patel
- Division of Oncology, Department of Medicine
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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99
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Haileamlak A. The impact of COVID-19 on health and health systems. Ethiop J Health Sci 2021; 31:1073-1074. [PMID: 35392335 PMCID: PMC8968362 DOI: 10.4314/ejhs.v31i6.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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100
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Iles KA, Thornton M, Park J, Roberson M, Spanheimer PM, Ollila DW, Gallagher K. Bridging Endocrine Therapy for HR+/HER2- Resectable Breast Cancer: Is it Safe? Am Surg 2021; 88:471-479. [PMID: 34587799 DOI: 10.1177/00031348211047205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has required new treatment paradigms to limit exposures and optimize hospital resources, including the use of neoadjuvant endocrine therapy (NAET) as bridging therapy for HR+/HER2-invasive tumors and DCIS. While this approach has been used in locally advanced disease, it is unclear how it may affect outcomes in resectable HR+/HER2- tumors. METHODS Women ≥18 years diagnosed with in situ (Tis) or non-metastatic HR+/HER2- breast cancer from March-May 2019 and 2020 were included. Fisher's exact test and two-sample t test were used to compare baseline characteristics and surgical outcomes between strata. Sub-analysis was performed between patients who received primary surgery vs a bridging NAET approach. RESULTS Despite similar clinical characteristics, patients in 2019 were more likely to have a surgery-first approach (75% vs 42%, P-value = .0007), receive surgery sooner (22 vs 29 days, P-value < .001), and within 60 days from diagnosis date (100% vs 85%, P-value = .0301). Neoadjuvant endocrine therapy was a more prevalent approach in 2020 (48% vs 7%, P-value < .0001). Rates of clinical to pathologic up-staging remained consistent across primary surgery vs bridging NAET subgroups (P-value = .9253). DISCUSSION Pandemic-driven treatment protocols provide a unique opportunity to assess the utility of bridging endocrine therapy for resectable HR+/HER2- tumors. Differences in clinical and pathologic staging were similar across groups and did not appear to be affected by receipt of NAET. Our limited cohort demonstrates this strategic therapeutic avenue can optimize health care utilization and may be a reasonable approach when delaying surgery is preferred.
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Affiliation(s)
- Kathleen A Iles
- Department of Surgery, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Madeline Thornton
- Department of Surgery, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jihye Park
- Department of Epidemiology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mya Roberson
- Department of Epidemiology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip M Spanheimer
- Department of Surgical Oncology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David W Ollila
- Department of Surgical Oncology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristalyn Gallagher
- Department of Surgical Oncology, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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