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Heymann D. The Elderly and the COVID 19 Crisis: A Chronicle of Deaths Foretold, in Isolation and Total Indifference. Front Public Health 2021; 8:602982. [PMID: 33490021 PMCID: PMC7820755 DOI: 10.3389/fpubh.2020.602982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/07/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Dominique Heymann
- Université de Nantes, Institut de Cancérologie de l'Ouest, Saint-Herblain, France.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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Cherif MA, Loganadane G, Debbi K, Coraggio G, Ghith S, Hadhri A, Hassani W, Grellier N, To NH, Belkacemi Y. Radiation Therapy Delivery Challenges in Older Patients During Coronavirus Disease 2019 Pandemic. Adv Radiat Oncol 2020; 6:100626. [PMID: 33313442 PMCID: PMC7718104 DOI: 10.1016/j.adro.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The management of older patients in radiation therapy (RT) departments has been challenging in the context of the Coronavirus Disease 2019 (COVID-19) outbreak. We report our experience of RT adapted schedules or strategy changes in older patients during the COVID-19 pandemic. Methods and Materials Patients aged ≥75 years were recruited during weekly chart rounds. All were potentially eligible for a specific intervention to reduce the frequency of patients' visits to the hospital. The effect of deferring radiation and hypofractionation of RT schedules was assessed in terms of the number of courses initially planned and replanned during the lockdown. Results Twenty patients were identified during the official lockdown in France (March 17 to May 11). Median age was 78 years (75-95 years). Most patients were male (n = 12, 60%) being treated in the postoperative setting (n = 17, 85%). RT was delayed in 11 cases (55%) with hormonal therapy prescribed in 10 cases (50%). Altered RT fractionation was proposed for 5 cases (25%); combinations of altered fractionation and deferral of radiation were applied in 3 cases (15%). The number of radiation courses initially planned and replanned according to the pandemic context: 563 and 197, respectively (-62%; P < .001). None presented recurrence when RT was initiated, and no patient developed symptomatic COVID-19 infection. Conclusions In the context of the COVID-19 outbreak, individual risk-based radiation therapy seems to be safe. Systematic screening of patients for COVID-19 before starting radiation therapy is mandatory. In our department the oncogeriatrics expertise availability for daily practice was of great use during the pandemic. Other prospective studies are needed to validate such strategies in case of resurgence of similar outbreaks.
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Affiliation(s)
- Mohamed Aziz Cherif
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
| | - Gokoulakrichenane Loganadane
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Kamel Debbi
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Gabriele Coraggio
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
| | - Sahar Ghith
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Asma Hadhri
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Wissal Hassani
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
| | - Noémie Grellier
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
| | - Nhu Hanh To
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- INSERM Unit 955; Team 21, IMRB, University of Paris-Est (UPEC), Creteil, France
| | - Yazid Belkacemi
- AP-HP, Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France
- Association of Radiation therapy and Oncology of the Mediterranean Area and Transatlantic Radiation Oncology Network
- INSERM Unit 955; Team 21, IMRB, University of Paris-Est (UPEC), Creteil, France
- Corresponding author: Yacid Belkacemi MD, PhD
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Haase KR, Kain D, Merchant S, Booth C, Koven R, Brundage M, Galica J. Older survivors of cancer in the COVID-19 pandemic: Reflections and recommendations for future care. J Geriatr Oncol 2020; 12:461-466. [PMID: 33303410 PMCID: PMC7713572 DOI: 10.1016/j.jgo.2020.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 02/08/2023]
Abstract
Purpose Although the year after cancer treatment is challenging for all cancer survivors, older adults (≥60 years) face additional challenges due to age-related decline and high rates of comorbidity. There is a paucity of research on how health service interruptions from the COVID-19 pandemic have impacted the experience of older cancer survivors. In this study we explore older cancer survivors' reflections on the pandemic and their suggestions for future care delivery when traditionally offered resources are not available. Methods We conducted 1:1 telephone interviews with adults 60 years and older previously diagnosed with breast and colorectal cancer and recently (≤12 months) discharged from their cancer care team. We analyzed the data using descriptive thematic analysis. Results The mean sample (n = 30) age was 72.1 years (SD 5.8, Range 63–83) of whom 57% identified as female. Participants described personal and societal implications of the pandemic. that affected their ability to navigate social support, and public and clinical landscapes. These reflections informed their suggestions for future health care delivery, such as how they could have been better prepared to self-manage their post-cancer treatment journey. Participants recommendations were grouped into four sub-themes: 1) enhanced baseline information; 2) facilitate caregiver support and engagement; 3) greater technology integration; and 4) sustained use and public appreciation of personal protective equipment. Conclusion Older cancer survivors appreciate the needed shift to virtual appointments and services during the COVID-19 pandemic. Specific strategies to bolster older adults existing strengths and improve their readiness to engage in these measures are critical.
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Affiliation(s)
- Kristen R Haase
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Canada.
| | - Danielle Kain
- Division of Palliative Medicine, Departments of Medicine and Oncology, School of Medicine, Queen's University, Canada
| | - Shaila Merchant
- Division of General Surgery and Surgical Oncology, Queen's University, Canada
| | - Christopher Booth
- Canada Research Chair in Population Cancer Care; Principal Investigator, Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Departments of Oncology and Medicine, School of Medicine, Queen's University, Canada
| | - Rachel Koven
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Canada
| | - Michael Brundage
- Department of Oncology, School of Medicine, Queen's University, Canada; Department of Public Health Sciences, School of Medicine, Queen's University, Canada; Kingston Regional Cancer Centre, Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Canada
| | - Jacqueline Galica
- Division of Cancer Care & Epidemiology, Queen's Cancer Research Institute, Canada; School of Nursing, Queen's University, Canada
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O'Donovan A, Leech M. Personalised treatment for older adults with cancer: The role of frailty assessment. Tech Innov Patient Support Radiat Oncol 2020; 16:30-38. [PMID: 33102819 PMCID: PMC7568178 DOI: 10.1016/j.tipsro.2020.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
Abstract
It is widely accepted in clinical practice that chronological age is a poor predictor of treatment tolerance and outcomes in older adults with cancer. Intrinsic vulnerability is more a function of underlying frailty, rather than chronological age. Frailty is a state of increased vulnerability to stressors, such as cancer and its treatment, which can lead to adverse health outcomes for patients. Capturing this heterogeneity in reserve capacity is the cornerstone of management in geriatricmedicine, but remains poorly understood or adopted in radiation oncology. A two-step approach, using a shorter screening tool, followed by full assessment for those who need it, is the mostresourceful way of implementing frailty assessment in radiotherapy departments. It is important for radiation oncology professionals to identify frailty and to use this information in multidisciplinary decision making in order to develop a personalised radiotherapy approach for the older person. There are many ways we can effectively use this information, such as considering treatment fractionation schedules that would limit the burden of travel for those with social frailty, or reviewing the range of modalities at our disposal, which might limit toxicity in the older person at high risk of deterioration during treatment. Frailty assessment is not carried out in many radiotherapy departments presently, but there are many international models to use as exemplars as to how it may be implemented in clinical practice. There are many opportunities for further research and role development in this field at the current time.
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Jammu AS, Chasen MR, Lofters AK, Bhargava R. Systematic rapid living review of the impact of the COVID-19 pandemic on cancer survivors: update to August 27, 2020. Support Care Cancer 2020; 29:2841-2850. [PMID: 33242162 PMCID: PMC7690065 DOI: 10.1007/s00520-020-05908-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022]
Abstract
Background The COVID-19 pandemic has resulted in drastic changes in the global healthcare delivery landscape and has had practical repercussions for cancer survivors. This systematic rapid living review has been undertaken to synthesise the available knowledge regarding the impact of the COVID-19 pandemic in a timely manner. This initial rapid review will present the findings of literature published up to August 27, 2020. Design A systematic search of PubMed, Scopus and Google Scholar databases was conducted to identify all articles, available in English language, regarding the impact of the COVID-19 pandemic on cancer survivors published between December 2019 and August 27, 2020. The search strategy employed the following search strings: “covid-19 OR coronavirus OR sars-cov-2” with “cancer survivors OR cancer survivorship”. Results The database search yielded 1639 articles, of which 19 were included. Of the 19 selected articles, there were 12 expert opinion articles, two literature reviews, two prospective cohort studies, one retrospective cohort study, one descriptive study and one pooled meta-analysis that comment on the impact of the COVID-19 pandemic on the physical wellbeing (16 articles), psychosocial wellbeing (15 articles) and financial wellbeing of cancer survivors (3 articles). Conclusions Limited definitive evidence exists regarding the impact of the COVID-19 pandemic on cancer survivors. Currently available literature provides preliminary indications of wide-ranging impacts of the pandemic on cancer survivors with respect to the requirement to adapt to new means of healthcare delivery as well as their physical, psychosocial and economic wellbeing. The pandemic has left survivors dealing with the consequences of rigorous cancer treatment in the context of new challenges related to social isolation, financial hardship and uncertainty with respect to their ongoing care. Additional rigorously designed research initiatives are required to elucidate the impact of the pandemic on cancer survivors.
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Affiliation(s)
- Anish Singh Jammu
- Global Health Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Martin Robert Chasen
- Division of Palliative Care, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON, L6R 3J7, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
- The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, Ontario, Canada.
| | - Aisha Kamilah Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Family Practice Health Centre, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Ravi Bhargava
- The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, Ontario, Canada
- PHMI Program Queen's University, Kingston, ON, Canada
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Sim AJ, Redler G, Peacock J, Naso C, Wasserman S, McNitt KB, Hoffe SE, Johnstone PAS, Harrison LB, Rosenberg SA. Harnessing COVID-Driven Technical Innovations for Improved Multi-Disciplinary Cancer Care in the Post-COVID Era: The Virtual Patient Room. Cancer Control 2020; 27:1073274820964800. [PMID: 33023342 PMCID: PMC7791470 DOI: 10.1177/1073274820964800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Emergence of the COVID-19 crisis has catalyzed rapid paradigm shifts throughout medicine.
Even after the initial wave of the virus subsides, a wholesale return to the prior status
quo is not prudent. As a specialty that values the proper application of new technology,
radiation oncology should strive to be at the forefront of harnessing telehealth as an
important tool to further optimize patient care. We remain cognizant that telehealth
cannot and should not be a comprehensive replacement for in-person patient visits because
it is not a one for one replacement, dependent on the intention of the visit and patient
preference. However, we envision the opportunity for the virtual patient “room” where
multidisciplinary care may take place from every specialty. How we adapt is not an
inevitability, but instead, an opportunity to shape the ideal image of our new normal
through the choices that we make. We have made great strides toward genuine
multidisciplinary patient-centered care, but the continued use of telehealth and virtual
visits can bring us closer to optimally arranging the spokes of the provider team members
around the central hub of the patient as we progress down the road through treatment.
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Affiliation(s)
- Austin J Sim
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Gage Redler
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jeffrey Peacock
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Cristina Naso
- Virtual Health, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Stuart Wasserman
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Khadija B McNitt
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Sarah E Hoffe
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Peter A S Johnstone
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Louis B Harrison
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Stephen A Rosenberg
- Depatment of Radiation Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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