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Ortmann L, Wehrmann M, Flores R, Kerns E. Impact of COVID-19 on the Diagnosis of Coarctation of the Aorta in Infants. Pediatr Cardiol 2024:10.1007/s00246-024-03658-8. [PMID: 39304575 DOI: 10.1007/s00246-024-03658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024]
Abstract
Newborns with coarctation of the aorta are a potentially vulnerable population whose diagnosis could have been impacted by the COVID-19 pandemic. The objectives of this study were to assess if there was delayed diagnosis of infants with coarctation and if they had higher acuity prior to repair after the start of the pandemic. The Pediatric Health Information Systems database was queried for patients less than three months of age who underwent surgical repair or palliation of coarctation of the aorta. Patients were divided into three time periods: (1) pre-COVID (October 2017-December 2019), (2) early COVID (January 2020-December 2020), and (3) late COVID (January 2021-December 2021). The outcomes were age at repair and pre-procedure acuity. Among the 4885 patients, the median time to repair was 10 days during all time periods. Use of pre-procedure mechanical ventilation, vasopressors, and extracorporeal membranous oxygenation did not increase after the start of the pandemic. Median length of hospital stay increased after the start of the pandemic and did not return to baseline (22 days, 24 days, and 25 days, sequentially, p < 0.01). When analyzing patients who presented to the surgical hospital after 3 days of life, there were no differences in age at repair, pre-procedural acuity, or other outcomes. Age at repair of coarctation of the aorta and acuity did not change after the start of the COVID-19 pandemic. This suggests that the safeguards in place to ensure timely diagnosis of critical heart disease were adequate during this time of disruption.
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Affiliation(s)
- Laura Ortmann
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
- Division of Care Transformation, Children's Nebraska, 8200 Dodge St., Omaha, NE, 68114, USA.
| | - Melissa Wehrmann
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ricky Flores
- Division of Care Transformation, Children's Nebraska, 8200 Dodge St., Omaha, NE, 68114, USA
| | - Ellen Kerns
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Care Transformation, Children's Nebraska, 8200 Dodge St., Omaha, NE, 68114, USA
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Clements K, Thapa A, Cowell A, Conway D, Douglas CM, Paterson C. Impact of the COVID-19 pandemic on stage and incidence of head and neck cancer: A rapid review and meta-analysis. Clin Otolaryngol 2024; 49:363-375. [PMID: 38514776 DOI: 10.1111/coa.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/24/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This rapid review aims to evaluate the impact of the COVID-19 pandemic on incidence of head and neck cancer (HNC) and stage distribution at diagnosis. DESIGN Rapid review and meta-analysis. PARTICIPANTS Comparative data for new HNC patients between a pre-pandemic cohort (before March 2020) and a pandemic cohort (after March 2020 during the lockdown period). MAIN OUTCOMES MEASURED Data on tumour stage, incidence, referral pathway (number of new patient referrals), or workload levels (number of HNC treatments). Data on stage were summarised as odds ratios (OR) with 95% confidence intervals (CI), and data related to changes in numbers of diagnoses, referrals, and workload levels were summarised as a narrative synthesis. RESULTS A total of 31 reports were included in this review. Individually 16 out of 23 studies did not show a significant impact on stage relative to the pre-pandemic period. However, the meta-analysis revealed that patients diagnosed with HNC during the pandemic were 16% more likely to have nodal involvement (OR = 1.16; 95% CI 1.00-1.35), 17% more likely to have a late overall stage (OR = 1.17; 95% CI 1.01-1.36), and 32% more likely to present with advanced tumour extent (T3 and T4 stage) (OR = 1.32; 95% CI 1.08-1.62). Data on incidence was extremely limited and not currently sufficient to assess trends in burden of disease. CONCLUSIONS This review indicates that during the COVID-19 pandemic, there was upstaging of HNC at diagnosis, suggesting the provision of care to HNC patients was significantly affected.
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Affiliation(s)
- Kelten Clements
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Alekh Thapa
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna Cowell
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - David Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
| | - Catriona M Douglas
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
- Department of ENT-Head and Neck Surgery, Glasgow Royal Infirmary and Queen Elizabeth University Hospital, Glasgow, UK
| | - Claire Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
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Burus T, Lei F, Huang B, Christian WJ, Hull PC, Ellis AR, Slavova S, Tucker TC, Lang Kuhs KA. Undiagnosed Cancer Cases in the US During the First 10 Months of the COVID-19 Pandemic. JAMA Oncol 2024; 10:500-507. [PMID: 38386344 PMCID: PMC10884945 DOI: 10.1001/jamaoncol.2023.6969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 02/23/2024]
Abstract
Importance The COVID-19 pandemic disrupted the normal course of cancer screening and detection in the US. A nationwide analysis of the extent of this disruption using cancer registry data has not been conducted. Objective To assess the observed and expected cancer rate trends for March through December 2020 using data from all 50 US states and the District of Columbia. Design, Settings, and Participants This was a population-based cross-sectional analysis of cancer incidence trends using data on cases of invasive cancer diagnosis reported to the US Cancer Statistics from January 1, 2018, through December 31, 2020. Data analyses were performed from July 6 to 28, 2023. Exposure(s) Age, sex, race, urbanicity, and state-level response to the COVID-19 pandemic at the time of cancer diagnosis. Main Outcomes and Measures Used time-series forecasting methods to calculate expected cancer incidence rates for March 1 through December 31, 2020, from prepandemic trends (January 2018-February 2020). Measured relative difference between observed and expected cancer incidence rates and numbers of potentially missed cancer cases. Results This study included 1 297 874 cancer cases reported in the US from March 1 through December 31, 2020, with an age-adjusted incidence rate of 326.5 cases per 100 000 population. Of the observed cases, 657 743 (50.7%) occurred in male patients, 757 106 (58.3%) in persons 65 years or older, and 1 066 566 (82.2%) in White individuals. Observed rates of all-sites cancer incidence in the US were 28.6% (95% prediction interval [PI], 25.4%-31.7%) lower than expected during the height of the COVID-19 pandemic response (March-May 2020); 6.3% (95% PI, 3.8%-8.8%) lower in June to December 2020; and overall, 13.0% (95% PI, 11.2%-14.9%) lower during the first 10 months of the pandemic. These differences indicate that there were potentially 134 395 (95% PI, 112 544-156 680) undiagnosed cancers during that time frame. Prostate cancer accounted for the largest number of potentially missed cases (22 950), followed by female breast (16 870) and lung (16 333) cancers. Screenable cancers saw a total rate reduction of 13.9% (95% PI, 12.2%-15.6%) compared with the expected rate. The rate of female breast cancer showed evidence of recovery to previous trends after the first 3 months of the pandemic, but levels remained low for colorectal, cervical, and lung cancers. From March to May 2020, states with more restrictive COVID-19 responses had significantly greater disruptions, yet by December 2020, these differences were nonsignificant for all sites except lung, kidney, and pancreatic cancer. Conclusions and Relevance This cross-sectional analysis of cancer incidence trends found a substantial disruption to cancer diagnoses in the US during the first 10 months of the COVID-19 pandemic. The overall and differential findings can be used to inform where the US health care system should be looking to make up ground in cancer screening and detection.
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Affiliation(s)
- Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington
| | - Feitong Lei
- Markey Cancer Center, University of Kentucky, Lexington
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington
| | - W. Jay Christian
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Epidemiology & Environmental Health, College of Public Health, University of Kentucky, Lexington
| | - Pamela C. Hull
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington
| | - Amanda R. Ellis
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
| | - Svetla Slavova
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington
- Kentucky Injury Prevention & Research Center, University of Kentucky, Lexington
| | - Thomas C. Tucker
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Epidemiology & Environmental Health, College of Public Health, University of Kentucky, Lexington
| | - Krystle A. Lang Kuhs
- Markey Cancer Center, University of Kentucky, Lexington
- Department of Epidemiology & Environmental Health, College of Public Health, University of Kentucky, Lexington
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Gellrich D, Gröger M, Echternach M, Eder K, Huber P. Neonatal hearing screening - does failure in TEOAE screening matter when the AABR test is passed? Eur Arch Otorhinolaryngol 2024; 281:1273-1283. [PMID: 37831131 PMCID: PMC10857952 DOI: 10.1007/s00405-023-08250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Newborns who fail the transient evoked otoacoustic emissions (TEOAE) but pass the automatic auditory brainstem response (AABR) in universal newborn hearing screening (UNHS), frequently have no further diagnostic test or follow-up. The present study aimed to investigate whether hearing loss might be missed by ignoring neonatal TEOAE failure in the presence of normal AABR. METHODS A retrospective analysis was conducted in newborns presenting between 2017 and 2021 to a tertiary referral centre due to failure in the initial UNHS. The main focus was on infants who failed TEOAE tests, but passed AABR screening. The clinical characteristics and audiometric outcomes were analysed and compared with those of other neonates. RESULTS Among 1,095 referred newborns, 253 (23%) failed TEOAE despite passing AABR screening. Of the 253 affected infants, 154 returned for follow-up. At 1-year follow-up, 46 (28%) achieved normal audiometric results. 32 (21%) infants had permanent hearing loss (HL) confirmed by diagnostic ABR, 58 (38%) infants had HL solely due to middle ear effusion (MEE), and for 18 (12%) infants HL was suspected without further differentiation. The majority of permanent HL was mild (78% mild vs. 13% moderate vs. 9% profound). The rate of spontaneous MEE clearance was rather low (29%) leading to early surgical intervention in 36 children. The profile of the risk factors for hearing impairment was similar to that of newborns with failure in both, TEOAE and AABR; however, there was a stronger association between the presence of risk factors and the incidence of HL (relative risk 1.55 vs. 1.06; odds ratio 3.61 vs. 1.80). CONCLUSION In newborns, the discordance between a "refer" in TEOAE and a "pass" in AABR screening is associated with a substantial prevalence of hearing impairment at follow-up, especially in the presence of risk factors.
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Affiliation(s)
- Donata Gellrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - Moritz Gröger
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Echternach
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Katharina Eder
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
- Department of Pediatric Audiology, Kbo-Kinderzentrum München Gemeinnützige GmbH, Heiglhofstr. 65, 81377, Munich, Germany
| | - Patrick Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, University Hospital, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany
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Carré J, Herzog B, Reil D, Schneider C, Pflüger M, Löbel M, Herzog M. [Impact of the COVID-19 pandemic on the diagnosis and treatment of patients with head and neck cancer in Brandenburg and Berlin]. HNO 2024; 72:90-101. [PMID: 38117331 DOI: 10.1007/s00106-023-01396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on potential limitations to the diagnosis and treatment of patients with head and neck tumours has not yet been adequately investigated. There are contradictory data on this subject. Data from larger patient collectives do not exist for Germany so far. OBJECTIVE The aim of the survey was to clarify in a large cohort whether the COVID-19 pandemic had an influence on the diagnosis and treatment of patients with head and neck tumours. METHODS A retrospective data analysis of the reporting data of the Clinical and Epidemiological Cancer Registry of Brandenburg and Berlin (Klinisch-epidemiologischen Krebsregisters Brandenburg-Berlin, KKRBB) of 4831 cases with head and neck tumours from 2018 to 2020 was performed. The period before April 01, 2020, was evaluated as a prepandemic cohort and compared with the cases of the pandemic cohort from April 1, 2020, until December 31, 2020, in terms of patient-related baseline data, tumour location, tumour stage, tumour board and treatments administered. RESULTS No differences were observed between the prepandemic and pandemic cohorts with regard to patient-related baseline data, tumour localisation and tumour stage. Likewise, no temporal delay in diagnosis, tumour board and treatment was evident during the pandemic period. On the contrary, the time interval between diagnosis and start of therapy was shortened by an average of 2.7 days in the pandemic phase. Tumours with T4 stage were more frequently treated surgically during the pandemic compared to the period before (20.8% vs. 29.6%), whereas primary radio(chemo)therapy decreased during the pandemic (53.3% vs. 40.4%). For all other tumour stages and entities, there were no differences in treatment. CONCLUSION Contrary to initial speculation that the COVID-19 pandemic may have led to a decrease in tumour cases, larger tumour stages at initial presentation and a delay in diagnosis and treatment, the cohort studied for Brandenburg and Berlin showed neither a delay in tumour treatment nor an increase in tumour size and stage at initial presentation. The treatments performed, however, were subject to a change in favour of surgery and it remains to be seen whether this trend will be maintained in the long term.
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Affiliation(s)
- Julia Carré
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Beatrice Herzog
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Daniela Reil
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Constanze Schneider
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Maren Pflüger
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin gGmbH, Dreifertstr. 12, 03044, Cottbus, Deutschland
| | - Madlen Löbel
- Interdisziplinäre Studienzentrale des Carl-Thiem-Klinikums, Thiemstr. 111, 03048, Cottbus, Deutschland
| | - Michael Herzog
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 01620, Halle (Saale), Deutschland.
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Clementine M, Camille C, Swann A, Alavi Z, Remi M, Jean-Christophe L. COVID-19 impact on the management of head and neck cancer: a French single-centre experience. Eur Arch Otorhinolaryngol 2024; 281:873-882. [PMID: 37845381 DOI: 10.1007/s00405-023-08245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/13/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has caused unprecedented pressure on medical care resources and access. The aim of this study was to evaluate the time between the cancer symptoms' onset and the first ENT specialist consultation for patients with head and neck (HNC) and salivary glands cancers during the pandemic. METHODS The outcome measures evaluated were time to diagnosis, and time to treatment onset, as well as the COVID-19 impact on the proportion of both cancer patient groups: asymptomatic and advanced stages. This is single-centre retrospective cross-sectional study, including 473 patients who were treated in our University Hospital for HNC and salivary gland cancers, 171 in the COVID-19 pandemic group (C +), and 302 patients in the pre-pandemic group (C-). RESULTS There were no significant between-group differences in the delays between cancer symptoms' onset and ENT consultation, diagnostic workup and initial treatment onset, respectively. There was a suggestive reduction in the number of diagnostic panendoscopy performed in the C + group (62%) compared to the C- group (73%) as well as a suggestive increase in the delay to adjuvant radiotherapy onset. CONCLUSION The median delay between cancer symptoms' onset and ENT specialist consultation was not affected by the COVID-19 pandemic in our centre. Our results suggest an 11% decrease in diagnostic procedures performed independently, a decrease in the delay between the ENT consultation and surgical treatment onset and a 10-day increase in the delay to adjuvant radiotherapy onset.
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Affiliation(s)
| | | | | | - Zarrin Alavi
- INSERM, CIC 1412, Brest University Hospital, Brest, France
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Galletti C, De Marco L, Ciodaro F, Freni F, Saraniti C, Galletti F, Galletti B. Impact of the Sars-COVID-19 Pandemic on the "Early Diagnosis" of Laryngeal Tumors: Data From Monocentric Tertiary Care Hospital of South Italy. J Voice 2024:S0892-1997(23)00404-6. [PMID: 38290926 DOI: 10.1016/j.jvoice.2023.12.013] [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: 10/21/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim of this retrospective case-control study is to investigate how the Sars-COVID-19 pandemic has influenced the delay in the early diagnosis of laryngeal cancer in patients who visited the University Hospital "G. Martino" in the last 3 years of the pandemic. It is also proposed to compare the diagnosis, surgical staging, and therapeutic approach offered to patients affected by laryngeal cancer in the years affected by the COVID-19 pandemic compared to cases treated during the 3 years preceding the pandemic METHODOLOGY/PRINCIPAL: A single-center retrospective study was carried out to analyze the effects of the COVID-19 pandemic on the diagnosis and treatment of patients with squamous cell carcinoma of the larynx at our Otorhinolaryngology Division of the "Gaetano Martino" University hospital. The research period, 6 years, was divided into two sub-periods of equal months for which we divided the patients into two groups "Before COVID-19" and "During COVID-19", defined, respectively, from February 2017 to March 2020 and from April 2020 to May 2023. Patients aged 18 years and older with a diagnosis of squamous cell carcinoma, seen and surgically treated at the Otorhinolaryngology division of the "Gaetano Martino" University Hospital and patients referred from other hospitals were included in the study population. Patients affected by malignancies in other sites with secondary laryngeal involvement, patients not amenable to surgical therapy, treated only with radio-chemotherapy therapy, and patients not amenable to surgical therapy were excluded from the study. RESULTS A total of 141 patients were recruited, divided into 76 patients in the "Before COVID-19" arm and 65 patients in the "During COVID-19" arm, with a male prevalence of 119 patients (84.4%). The mean age of our study population stands at a median of 69 years (percentile 25th 60.00 and percentile 75th 77.00). Smoking and alcohol are two predominant variables in our study population with a prevalence of 89.4% and 79.4%, respectively. A higher number of TNM stage IV cases was detected, 29.2% in the group "During COVID-19" compared to 5.3 detected in the group "Before COVID-19" (P = 0.005). In the "During COVID-19" group, we find an overall percentage of 61.5% for stages II-III-IV versus 36.9% present in the "Before COVID-19" group of patients. An adjuvant radiotherapy treatment was actuated in 30.26% of patients in the "Before COVID-19" versus 41.54% in "During COVID-19". CONCLUSIONS The most important result of our research was the statistically significant difference in tumor staging at the time of diagnosis between the "Before COVID-19" and "During COVID-19" groups, with a higher mean value in the latter. The current data confirm the previously exposed hypothesis according to which the COVID-19 pandemic has led to a delay in early diagnosis, negatively influencing the staging at the time of the first ENT visit and the subsequent therapeutic approach to be offered to the patient.
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Affiliation(s)
- Cosimo Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Laura De Marco
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Francesco Ciodaro
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Francesco Freni
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Carmelo Saraniti
- Division of Otorhinolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy.
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
| | - Bruno Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi", Unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125 Messina, ME, Italy.
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Malina SN, Flanagan JC, Loechner KJ, Wu M. Access to care among patients with osteogenesis imperfecta during the COVID-19 pandemic. Arch Osteoporos 2023; 18:143. [PMID: 38015270 PMCID: PMC10924804 DOI: 10.1007/s11657-023-01355-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Abstract
In a cross-sectional study assessing the experiences of individuals with osteogenesis imperfecta accessing care during the COVID-19 pandemic, participants reported high rates of delays in accessing medical care and high utilization of telehealth. Considering the needs of individuals with complex medical conditions is important when improving access to care. PURPOSE Individuals with osteogenesis imperfecta (OI) often have complex care needs requiring that they see a variety of specialists. The onset of the COVID-19 pandemic in March 2020 led to delays in medical care for many health conditions. The goal of this study was to describe the experiences of individuals with OI accessing medical care during this time. METHODS Responses to an electronic survey distributed via the OI Foundation mailing list were collected from August 2020 until February 2021. Participants were instructed to compare their experiences in the months since the start of the pandemic with their experiences prior to this date. Data were analyzed using descriptive statistics and were compared across demographic groups using logistic regression and chi-squared tests. RESULTS Surveys were completed by 110 participants. Most participants (72%) reported experiencing delays in accessing at least one care provider. The majority of participants reported less or similar amounts of bone pain (74.3%) and less or the same rate of fracture (88.6%) as before the start of the pandemic. CONCLUSION While most study participants experienced delays in care, they did not report an increase in symptoms associated with OI. They also frequently utilized telehealth as a tool to see their providers. Future research should focus on the impact of changes in telehealth legislation on patients' ability to access care. As methods for care delivery evolve, the needs of people with OI and other rare diseases should be considered and prioritized.
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Affiliation(s)
- Sara N Malina
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe St., Suite 3120, Baltimore, MD, 21287, USA
| | - Jill C Flanagan
- Children's Physician Group-Orthopedics and Sports Medicine at Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Karen J Loechner
- Division of Pediatric Endocrinology and Children's Healthcare of Atlanta Pediatric Bone Clinic, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Division of Pediatric Endocrinology, Department of Pediatrics, Connecticut Children's Hospital, Hartford, CT, USA
| | - Malinda Wu
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe St., Suite 3120, Baltimore, MD, 21287, USA.
- Division of Pediatric Endocrinology and Children's Healthcare of Atlanta Pediatric Bone Clinic, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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Kohan A, Menon S, Murad V, Mirshahvalad SA, Kulanthaivelu R, Farag A, Ortega C, Metser U, Veit-Haibach P. Impact of the COVID-19 Pandemic on Staging Oncologic PET/CT Imaging and Patient Outcome in a Public Healthcare Context: Overview and Follow Up of the First Two Years of the Pandemic. Cancers (Basel) 2023; 15:5358. [PMID: 38001619 PMCID: PMC10670509 DOI: 10.3390/cancers15225358] [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: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
To assess the impact of the COVID-19 pandemic on the diagnosis, staging and outcome of a selected population throughout the first two years of the pandemic, we evaluated oncology patients undergoing PET/CT at our institution. A retrospective population of lung cancer, melanoma, lymphoma and head and neck cancer patients staged using PET/CT during the first 6 months of the years 2019, 2020 and 2021 were included for analysis. The year in which the PET was performed was our exposure variable, and our two main outcomes were stage at the time of the PET/CT and overall survival (OS). A total of 1572 PET/CTs were performed for staging purposes during the first 6 months of 2019, 2020 and 2021. The median age was 66 (IQR 16), and 915 (58%) were males. The most prevalent staged cancer was lung cancer (643, 41%). The univariate analysis of staging at PET/CT and OS by year of PET/CT were not significantly different. The multivariate Cox regression of non-COVID-19 significantly different variables at univariate analysis and the year of PET/CT determined that lung cancer (HR 1.76 CI95 1.23-2.53, p < 0.05), stage III (HR 3.63 CI95 2.21-5.98, p < 0.05), stage IV (HR 11.06 CI95 7.04-17.36, p < 0.05) and age at diagnosis (HR 1.04 CI95 1.02-1.05, p < 0.05) had increased risks of death. We did not find significantly higher stages or reduced OS when assessing the year PET/CT was performed. Furthermore, OS was not significantly modified by the year patients were staged, even when controlled for non-COVID-19 significant variables (age, type of cancer, stage and gender).
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Affiliation(s)
- Andres Kohan
- Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University Medical Imaging Toronto, Toronto, ON M5T 1W7, Canada
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10
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Tasoulas J, Schrank TP, Smith BD, Agala CB, Kim S, Sheth S, Shen C, Yarbrough WG, Hackman T, Sullivan CB. Time to treatment patterns of head and neck cancer patients before and during the Covid-19 pandemic. Oral Oncol 2023; 146:106535. [PMID: 37625360 DOI: 10.1016/j.oraloncology.2023.106535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES The delivery of healthcare has changed significantly over the past decades. This study analyzes the clinicodemographic factors and treatment patterns of head and neck squamous cell carcinoma (HNSCC) patients between 2004 and 2020. MATERIALS AND METHODS Retrospective cohort analysis of HNSCC patients from the National Cancer Data Base from 2004 to 2020. RESULTS A total of 164,290 patients were included. Increased times from diagnosis to definitive surgery (TTS) were seen across all facility types (academic centers, AC; non-academic centers, NAC) between 2004 and 2019, with NAC affected more. TTS < 15 days (RR = 1.05, 95%CI:1.05-1.09) and > 75 days (1.07, 95%CI:1.05-1.09) were associated with increased mortality risk. This association was more prominent among HPV + HNSCC (RR = 1.45; 95%CI:1.18-1.78). Treatment in AC was associated with a decreased mortality risk (RR = 0.94, 95%CI:0.93-0.95). Despite the universal increase in wait times from 2004 to 2019, short-term mortality was significantly decreased from 2016 to 2019, relative to 2004-2007 (3-month mortality: RR = 0.77, 95%CI:0.70-0.85; 12-month mortality: RR = 0.80, 95%CI:0.77-0.84). Wait times decreased in 2020. CONCLUSIONS TTS increased between 2004 and 2019, with NAC affected more. However, despite longer wait times, short-term survival increased significantly. Very short (<15 days) and very long (>75 days) TTS were associated with increased mortality risk. Patients with HPV + HNSCC have the highest increase among those treated > 75 days from diagnosis. Treatment at AC was associated with improved survival, which could be explained by the presence of multidisciplinary teams and subspecialists that may be less available at NAC. The 2021 NCDB data are required for a comprehensive analysis of wait times in 2020.
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Affiliation(s)
- Jason Tasoulas
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Travis P Schrank
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Blaine D Smith
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris B Agala
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sulgi Kim
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siddharth Sheth
- Division of Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor Hackman
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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11
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Yagiz Agayarov O, Arslan IB, Gumussoy M, Guclu G, Cukurova I. The Impact of the COVID-19 Pandemic on Urgent Awake Tracheotomies in Adults. Cureus 2023; 15:e44015. [PMID: 37753000 PMCID: PMC10519441 DOI: 10.7759/cureus.44015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Objective This study aims to investigate the impact of the COVID-19 pandemic on urgent awake tracheotomies (UATs) in adults in a reference center. Methodology During the pandemic (between March 2020 and May 2022) and before the pandemic (between January 2018 and March 2020), medical charts of patients who underwent UATs were reviewed. The analysis focused on demographic characteristics, indications, COVID-19 positivity status, surgical procedures, and complications. Results During the pandemic, 67 UATs (age 62.04 ± 11.9 years) were performed. Of the indications, 56 (83.5%) were malignancy. Before the pandemic, 22 UATs (age 63.86 ± 15.1 years) were performed, of which 14 UATs (63.6%) were due to malignancy. There was a significant increase in UATs and their indications in patients with head and neck malignancies (P < 0.05). Stay suture (65, 97%) and suture ligation of the thyroidal isthmus (61, 91%) were significantly performed during the pandemic (P < 0.05). Conclusions A significant increase in UAT was detected, especially in patients with advanced head and neck cancer. Pandemic conditions and the risk of viral transmission have led to more conservative UAT techniques.
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Affiliation(s)
- Ozlem Yagiz Agayarov
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Ilker Burak Arslan
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Murat Gumussoy
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Gulay Guclu
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Ibrahim Cukurova
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
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12
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Wilhelm C, Radeloff K, Scherzad A, Scheich M, Hagen R. [COVID-19: Collateral damage in head and neck oncology and preventive measures for future pandemics]. Laryngorhinootologie 2023; 102:104-110. [PMID: 36750111 DOI: 10.1055/a-2007-2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The start of the COVID-19 pandemic led to enormous challenges for global healthcare, as capacities and resources had to be made available quickly for the treatment of COVID-19 patients. As a result, restrictions had to be accepted, especially in the care of oncological patients. The collateral damage of these limitations inevitably also affects patients with head and neck cancer. This review article summarizes the development of tumor incidences during the pandemic, internationally developed guidelines for the care of patients with head and neck cancer and studies on the delay in oncological therapies and mortality. In addition, the effects on the mental health of the patients, the psychosocial consequences and ethical issues are examined. In perspective, preventive measures for such negative collateral effects in future pandemics are discussed using the example of a concept for application software (app)-based digital care for patients with head and neck cancer.
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Affiliation(s)
- Christian Wilhelm
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Katrin Radeloff
- Universitätsklinik für Hals-Nasen-Ohrenheilkunde, Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany
| | - Agmal Scherzad
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Matthias Scheich
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg, Germany
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13
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Muacevic A, Adler JR, Wang K, Lewis GD. The Effects of the COVID-19 Pandemic on Cancer Staging in Patients Diagnosed With Head and Neck Cancer. Cureus 2023; 15:e34190. [PMID: 36843727 PMCID: PMC9951633 DOI: 10.7759/cureus.34190] [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: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose The healthcare system across the world was forced to implement new policies, guidelines, and procedures due to the coronavirus disease 2019 (COVID-19) pandemic, which led many patients to make an impossible choice about their health. For various reasons, many patients chose to remain at home and delay any interaction at medical facilities to protect themselves or others from the virus. Patients managing chronic diseases faced unprecedented challenges during this period, and the long-term effects on these patient populations remain unclear. Oncology patients, specifically those diagnosed with head and neck cancers, require prompt diagnosis and initiation of treatment for better outcomes. While the overall impact of how the pandemic has affected oncology patients is unknown, this retrospective study examined how the staging of head and neck tumors at our institution has been impacted since the beginning of the pandemic. Methods Available patient data (from August 1, 2019, through June 28, 2021) were collected from medical records and compared to determine statistical significance. Patients were categorized into a Pre-pandemic group, Pandemic group, and Vaccine-approved group, and patient and treatment characteristics were analyzed to look for patterns. The pre-pandemic period was defined as the period from August 1, 2019, to March 16, 2020, the pandemic period was defined as the period from March 17, 2020, to December 31, 2020, and the vaccine-approved period was defined as the period from January 1, 2021, to June 28, 2021. Results Fisher's exact tests were used to compare tumor, node, metastasis (TNM) staging distributions between the three groups. In the Pre-pandemic group, out of 67 patients, 33 patients (55.0%) were diagnosed with a T stage of 0-2 and 27 patients (45.0%) were diagnosed with a T stage of 3-4. In the Pandemic and Vaccine-approved groups, out of 139 patients, 50 patients (39.1%) were diagnosed with a T stage of 0-2 and 78 patients (60.9%) were diagnosed with a T stage of 3-4; these differences were statistically significant (P-value = 0.0426). The Pre-pandemic group had 25 patients (41.7%) diagnosed with a group stage of 0-2 and 35 patients (58.3%) diagnosed with a group stage of 3-4. The Pandemic and Vaccine-approved groups had 36 patients (28.1%) diagnosed with a group stage of 0-2 and 92 patients (71.9%) diagnosed with a group stage of 3-4; these results trended to statistically significant (P-value = 0.0688). Conclusions Our findings suggest that there have been a higher number of patients with head and neck cancer diagnosed with a T stage of 3 or 4 since the start of the COVID-19 pandemic. The effects of the COVID-19 pandemic are ongoing and will need further evaluation to determine the overall effects on oncology patients. Increased morbidity and mortality rates may be a potential result in the years to come.
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Griewing S, Lingenfelder M, Kalder M, Wagner U, Gremke N. Gesundheitsökonomischer Vergleich von onkologischen und
COVID-19-Patienten. GESUNDHEITSÖKONOMIE & QUALITÄTSMANAGEMENT 2022. [DOI: 10.1055/a-1945-6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Zusammenfassung
Zielsetzung Ziel der Studie ist es die Auswirkungen der COVID-19 Pandemie
auf die stationär behandelten Patienten eines universitären
Maximalversorgers mit einer Krebs- und/oder COVID-19-Erkrankung zu
untersuchen. Unterscheiden sich die Patientenkollektive
gesundheitsökonomisch und ergeben sich aus den Resultaten administrative
Konsequenzen für eine proaktive Steuerung der regionalen
Krebsversorgung.
Methodik Es wurde eine retrospektive, deskriptive Datenanalyse klinischer
und gesundheitsökonomischer Parameter aller am
Universitätsklinikum Marburg stationär aufgenommenen
onkologischen und COVID-19-postiven Patienten sowie der Kombination von
onkologischen Patienten mit einer COVID-19-Erkrankung innerhalb des
Beobachtungszeitraums von 2017 bis 2021 durchgeführt.
Ergebnisse Es wurde ein Rückgang onkologisch behandelter Patienten
über den gesamten Zeitraum der COVID-19-Pandemie beobachtet.
Onkologische Patienten mit einer COVID-19-Erkrankung stellen das
Patientenkollektiv mit dem höchsten Schweregrad der Erkrankung dar,
gefolgt von der COVID-19- und rein onkologischen Patienten. Dies spiegelt sich
gleichsam in den ökonomischen Leistungskennzahlen wider. Die
chronologischen Verläufe des DRG-Erlöses und Case Mix Index pro
COVID-19-Patienten weisen Unterschiede für Zeitabschnitte des
Pandemiegeschehens in Deutschland auf.
Schlussfolgerung Der Vergleich der Patientenkollektive bestätigt
das hohes Gefährdungspotential von onkologischen Patienten, welches sich
in einer gesundheitsökonomisch aufwendigen Behandlung widerspiegelt.
Nationale Maßnahmen, Kontaktbeschränkungen oder pandemische
Ereignisse lassen sich am chronologischen Verlauf der klinischen und
wirtschaftlichen Parameter nachvollziehen. Trotz des internationalen
Rückgangs an ambulanten und stationären onkologischen Patienten
ist die „state-of-the-art“ Krebsversorgung in pandemischen
Zeiten realisierbar. Aufgrund dessen besteht die Handlungsnotwendigkeit
für einen stationären Maximalversorger durch Kommunikation und
Versorgungsmodellierung die onkologische Versorgung proaktiver zu steuern.
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Affiliation(s)
- Sebastian Griewing
- Institut für Health Care Management e.V., Lehrstuhl für
Allgemeine Betriebswirtschaftslehre, Philipps-Universität Marburg,
Marburg, Germany
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
| | - Michael Lingenfelder
- Institut für Health Care Management e.V., Lehrstuhl für
Allgemeine Betriebswirtschaftslehre, Philipps-Universität Marburg,
Marburg, Germany
| | - Matthias Kalder
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
| | - Uwe Wagner
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
| | - Niklas Gremke
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Marburg, Philipps-Universität Marburg,
Marburg, Germany
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Jacob L, Kalder M, Kostev K. Decrease in the number of patients diagnosed with cancer during the COVID-19 pandemic in Germany. J Cancer Res Clin Oncol 2022; 148:3117-3123. [PMID: 35041059 PMCID: PMC8764247 DOI: 10.1007/s00432-022-03922-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/11/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Little is known on how coronavirus disease 2019 (COVID-19) has impacted cancer diagnosis in Germany since the first lockdown in March 2020. Therefore, this retrospective study aimed to compare the number of patients newly diagnosed with cancer in general and specialized practices in Germany between April 2020-March 2021 and April 2019-March 2020. METHODS Patients aged ≥ 18 years with at least 1 visit to 1 of 1403 general and specialized practices in Germany in April 2020-March 2021 (n = 3,804,596) and April 2019-March 2020 (n = 3,913,386) were included in this retrospective study. Specialized practices were composed of gynecology, dermatology and urology practices. Cancer diagnoses included all types of cancer documented using the International Classification of Diseases, 10th revision (ICD-10 codes: C00-C97). The number of patients newly diagnosed with cancer per practice was compared between April 2020-March 2021 and April 2019-March 2020 using Wilcoxon tests. RESULTS There were 126,379 and 138,996 patients diagnosed with cancer in April 2020-March 2021 and April 2019-March 2020, respectively. The number of patients diagnosed with cancer decreased in all types of practice, and this decrease was significant in general practices (- 7.1%, p value = 0.038). In terms of cancer type, this decrease was particularly pronounced for skin cancers (- 12.8%, p value = 0.025). CONCLUSION The COVID-19 pandemic has been associated with a decrease in the number of patients newly diagnosed with cancer in general and specialized practices in Germany. Public health interventions are urgently warranted to mitigate the deleterious effects of this health crisis on cancer diagnosis.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-le-Bretonneux, France
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps University of Marburg, 35037, Marburg, Germany
| | - Karel Kostev
- Department of Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany.
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Beydoun HA, Beydoun MA, Alemu BT, Weiss J, Hossain S, Gautam RS, Zonderman AB. Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006-2020 Health and Retirement Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12059. [PMID: 36231360 PMCID: PMC9566439 DOI: 10.3390/ijerph191912059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The coronavirus disease 19 (COVID-19) was declared a global pandemic on 11 March 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, ≥50 years of age. METHODS Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006-2018) linked to the 2020 HRS COVID-19 Project (57% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services ("Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?" and "What type of care did you delay") using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data. RESULTS Nearly 32.7% delayed healthcare services, 5.8% delayed surgical services and 31.4% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60-70% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays. CONCLUSION Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions.
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Affiliation(s)
- Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21225, USA
| | - Brook T. Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, NC 28723, USA
| | - Jordan Weiss
- Department of Demography, University of California Berkeley, Berkeley, CA 94720, USA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21225, USA
| | - Rana S. Gautam
- Department of Sociology and Human Services, University of North Georgia, Dahlonega, GA 30597, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD 21225, USA
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Griewing S, Wagner U, Lingenfelder M, Fischer R, Kalder M. Chronological development of in-patient oncology in times of COVID-19: a retrospective analysis of hospitalized oncology and COVID-19 patients of a German University Hospital. J Cancer Res Clin Oncol 2022; 149:2551-2558. [PMID: 35771262 PMCID: PMC9244885 DOI: 10.1007/s00432-022-04044-8] [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: 04/04/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
Purpose The goal of this study is to examine the chronological development of hospitalized oncology and COVID-19 patients, and compare effects on oncology sub-disciplines for pre-pandemic (2017–19) and pandemic (2020–21) years in the setting of a German university maximum care provider. Methods Data were retrospectively retrieved from the hospital performance controlling system for patient collectives with oncological main (nOnco) and COVID-19 secondary diagnosis (nCOVID-19). Data analysis is based on descriptive statistical assessment. Results The oncology patient collective (nOnco = 27,919) shows a decrease of hospitalized patients for the whole pandemic (− 4% for 2020 and − 2,5% for 2021 to 2019). The number of hospitalized COVID-19 patients increases from first to second pandemic year by + 106.71% (nCOVID-19 = 868). Maximum decline in monthly hospitalized oncology patients amounts to − 19% (May 2020) during the first and − 21% (December 2020) during the second lockdown. Relative monthly hospitalization levels of oncology patients reverted to pre-pandemic levels from February 2021 onwards. Conclusion The results confirm a decline in hospitalized oncology patients for the entire pandemic in the setting of a maximum care provider. Imposed lockdown and contact restrictions, rising COVID-19 case numbers, as well as discovery of new virus variants have a negative impact on hospitalized treated oncological patients.
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Affiliation(s)
- Sebastian Griewing
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany. .,Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany.
| | - Uwe Wagner
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Michael Lingenfelder
- Chair of General Business Administration, Institute for Health Care Management e.V., Philipps-University Marburg, Universitätsstraße 24, 35037, Marburg, Germany
| | - Rebecca Fischer
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps-University Marburg, Baldingerstraße, 35043, Marburg, Germany
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18
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Popovic M, Fiano V, Moirano G, Chiusa L, Conway DI, Garzino Demo P, Gilardetti M, Iorio GC, Moccia C, Ostellino O, Pecorari G, Ramieri G, Ricardi U, Riva G, Virani S, Richiardi L. The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis. Front Public Health 2022; 10:809283. [PMID: 35265573 PMCID: PMC8899030 DOI: 10.3389/fpubh.2022.809283] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
Background The COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region. Methods This study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period. Results There were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62-0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89-1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76-1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84-1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80-0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave. Conclusions The COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.
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Affiliation(s)
- Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Valentina Fiano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Luigi Chiusa
- Pathology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - David I. Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Paolo Garzino Demo
- Maxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Gilardetti
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | | | - Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Oliviero Ostellino
- Oncology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giancarlo Pecorari
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Maxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Giuseppe Riva
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Shama Virani
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
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Clemente-Suárez VJ, Martínez-González MB, Benitez-Agudelo JC, Navarro-Jiménez E, Beltran-Velasco AI, Ruisoto P, Diaz Arroyo E, Laborde-Cárdenas CC, Tornero-Aguilera JF. The Impact of the COVID-19 Pandemic on Mental Disorders. A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10041. [PMID: 34639341 PMCID: PMC8507604 DOI: 10.3390/ijerph181910041] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has impacted the lives of the worldwide population. Citizens suffer the social, economic, physiological, and psychological effects of this pandemic. Primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages were used for a consensus critical review. The method was a narrative review of the available literature to summarize the existing literature addressing mental health concerns and stressors related to the COVID-19 pandemic. The main search engines used in the present research were PubMed, SciELO, and Google Scholar. We found the pandemic has had a direct impact on psychopathologies such as anxiety, increasing its ratios, and depression. Other syndromes such as burnout and post-traumatic stress disorder have increased with the pandemic, showing a larger incidence among medical personnel. Moreover, eating disorders and violence have also increased. Public authorities must prepare healthcare systems for increasing incidences of mental pathologies. Mental health apps are one of the tools that can be used to reach the general population.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
- Studies Centre in Applied Combat (CESCA), 45007 Toledo, Spain
| | - Marina Begoña Martínez-González
- Departamento de Ciencias Sociales, Facultad de Ciencias Sociales y Humanas, Universidad de la Costa, Barranquilla 080002, Colombia; (M.B.M.-G.); (J.C.B.-A.)
| | - Juan Camilo Benitez-Agudelo
- Departamento de Ciencias Sociales, Facultad de Ciencias Sociales y Humanas, Universidad de la Costa, Barranquilla 080002, Colombia; (M.B.M.-G.); (J.C.B.-A.)
| | | | | | - Pablo Ruisoto
- Department of Health Sciences, Public University of Navarre, 31006 Pamplona, Spain;
| | | | | | - Jose Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain;
- Studies Centre in Applied Combat (CESCA), 45007 Toledo, Spain
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