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Gaetani RS, Ladin K, Abelson JS. Journey through the Decades: The Evolution in Treatment and Shared Decision Making for Locally Advanced Rectal Cancer. Cancers (Basel) 2024; 16:2807. [PMID: 39199579 PMCID: PMC11353159 DOI: 10.3390/cancers16162807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Abstract
The management of locally advanced rectal cancer has undergone significant transformations over the decades and optimal treatment approaches continue to evolve. There have been numerous advances in surgery, chemotherapy, and radiation therapy from the first description of the abdominoperineal resection in 1908, timing of chemotherapy and radiation therapy in the late 20th and early 21st century, and most recently, the introduction of organ preservation or nonoperative management in 2004. Alongside these advancements, the concept of shared decision making in medicine has evolved, prompting a focus on patient-centered care. This evolution in practice has been fueled by a growing recognition of the importance of patient autonomy and the alignment of treatment options with patients' values and preferences. With the growing number of possible treatment options, variability in patient counseling exists, highlighting the need for a standardized approach to shared decision making in locally advanced rectal cancer. This narrative review will describe the evolution of treatment options of locally advanced rectal cancer as well as the concept of shared decision making and decision aids, and will introduce a decision aid for patients with locally advanced rectal cancer who have achieved a complete clinical response and are eligible for watch and wait.
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Affiliation(s)
- Racquel S. Gaetani
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, MA 02155, USA
| | - Jonathan S. Abelson
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA;
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Ihnát P, Martínek L, Tulinský L, Kala Z, Grolich T, Gurlich R, Šturma J, Klos D, Špička P, Neoral Č, Černý V. Resilience in Rectal Cancer Treatment: Lessons from the COVID-19 Era in Czech Republic. Ther Clin Risk Manag 2024; 20:373-379. [PMID: 38912517 PMCID: PMC11192038 DOI: 10.2147/tcrm.s455332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction The management of patients with COVID-19 infection has placed great pressure on the healthcare systems around the world. The aim of this study was to investigate the impact of the COVID-19 pandemic on the treatment outcomes of patients with rectal cancer by comparing them to those of patients with the same diagnosis in the pre-pandemic period. Methods Retrospective data analysis of patients undergoing multimodal treatment for rectal cancer at the four university hospitals during the COVID-19 pandemic (2020-2021) and the 2-year pre-pandemic period (2018-2019). Results A total of 693 patients (319 in the pre-pandemic period and 374 in the pandemic period) with rectal cancer were included in the study. The demographic and clinical characteristics of patients in both study periods were comparable, as was the spectrum of surgical procedures. Palliative surgery was more common in the pandemic period (18% vs 13%, p=0.084). The proportion of patients undergoing minimally invasive surgery was higher during the COVID-19 pandemic (p=0.025). There were no statistically significant differences between the study periods in the incidence/severity of post-operative complications, 30-day mortality and length of hospital stay. The number of positive resection margins was similar (5% vs 5%). Based on these results, COVID-19 had no effect on the postoperative morbidity and mortality in patients undergoing surgery for rectal cancer. Neoadjuvant treatment was more common in the pre-pandemic period (50% vs 45%). Long-course RT was predominantly offered in the pre-pandemic period, short-course RT during the pandemic. Significantly shorter "diagnosis-surgery" intervals were observed during the pandemic (23 days vs 33 days, p=0.0002). The "surgery-adjuvant therapy" interval was similar in both analysed study periods (p=0.219). Conclusion Our study showed, that despite concerns about the COVID-19 pandemic, multimodal treatment of rectal cancer was associated with unchanged postoperative morbidity rates, increased frequency of short-course neoadjuvant RT administration and shorter "diagnosis-surgery" intervals.
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Affiliation(s)
- Peter Ihnát
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lubomír Martínek
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lubomír Tulinský
- Department of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Zdeněk Kala
- Department of Surgery, University Hospital Brno, Brno, Czech Republic
| | - Tomáš Grolich
- Department of Surgery, University Hospital Brno, Brno, Czech Republic
| | - Robert Gurlich
- Department of Surgery, University Hospital Královské Vinohrady, Praha, Czech Republic
| | - Jan Šturma
- Department of Surgery, University Hospital Královské Vinohrady, Praha, Czech Republic
| | - Dušan Klos
- 1st Department of Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Špička
- 1st Department of Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Čestmír Neoral
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
- 1st Department of Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Vladimir Černý
- Department of Anaesthesia and Intensive Care Medicine, Charles University in Prague, 3rd Faculty of Medicine, Prague, Czech Republic
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Tissera NS, Freile B, Waisberg F, Esteso F, Galli M, Loria FS, Luca R, Pedraza II, Enrico DH, Chacón C, Huertas E, Chacón MR, O’Connor JM. Short-course radiotherapy for rectal cancer: real-world evidence in Argentina. Ecancermedicalscience 2023; 17:1555. [PMID: 37396101 PMCID: PMC10310334 DOI: 10.3332/ecancer.2023.1555] [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] [Received: 04/12/2023] [Indexed: 07/04/2023] Open
Abstract
Background Short-course radiotherapy (SCRT) of 25 Gy in five daily fractions is a recommended strategy in the neoadjuvant setting for resectable locally advanced rectal cancer (LARC), as well as in cases of metastatic disease for local control. There is scarce information regarding the use of SCRT for patients who have received nonoperative management. Objectives To describe the characteristics of patients who received treatment with SCRT for LARC and metastatic rectal cancer, toxicity, and the approach after radiation treatment. Methods This is a retrospective analysis of all patients who underwent SCRT for rectal cancer at the Alexander Fleming Institute from March 2014 to June 2022. Results In total, 44 patients were treated with SCRT. The majority were male (29, 66%), with a median age of 59 years (interquartile range 46-73). Most patients had stage IV disease (26, 59.1%), followed by LARC (18, 40.9%). Most lesions were located in the middle rectum (30, 68%). The majority of LARC patients underwent SCRT followed by consolidation chemotherapy (ChT) (16/18, 89%), while most patients with metastatic disease underwent SCRT followed by consolidation ChT (14/26, 53.8%). A clinical complete response (cCR) was documented in 8/44, 18.2% of patients. Most patients with LARC and cCR were managed by a watch and wait approach (5/18, 27.7%). Local recurrence was observed in LARC cases (2/18, 11.1%). Patients who underwent SCRT following consolidation ChT were more likely to have adverse events (AEs) than those undergoing induction ChT following SCRT (11/30, 36.7% versus 3/12, 25%, p = 0.02). Conclusion In a subgroup of patients diagnosed with LARC and treated with SCRT followed by ChT, surgical treatment could be omitted after they achieved a cCR. Local recurrence was similar to that reported in a previous study. SCRT is a reasonable option for local disease control in stage IV disease, yielding low toxicity rates. Therefore, decisions must be made by a multidisciplinary team. Prospective studies are necessary to reach further conclusions.
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Affiliation(s)
- Natalia S Tissera
- Upper Gastrointestinal Cancer Translational Research Group, Vall´d Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
- https://orcid.org/0000-0002-3396-6878
| | - Berenice Freile
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-3192-126X
| | - Federico Waisberg
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-4435-5068
| | - Federico Esteso
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-1977-9846
| | - Mariana Galli
- Department of Radiotherapy, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-0147-2192
| | - Fernando Sanchez Loria
- Department of Surgery, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-9708-0649
| | - Romina Luca
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-8564-905X
| | - Ivana Inés Pedraza
- Department of Surgery, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-9679-8368
| | - Diego Hernán Enrico
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-4121-6855
| | - Carolina Chacón
- Department of Radiotherapy, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0009-0004-8556-6325
| | - Eduardo Huertas
- Department of Surgery, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0003-3473-0928
| | - Matías Rodrigo Chacón
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0001-6872-4185
| | - Juan Manuel O’Connor
- Department of Oncology, Alexander Fleming Institute, CABA C1426, Argentina
- https://orcid.org/0000-0002-6975-5466
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Kasai S, Yamauchi S, Tazawa M, Takaoka A, Hanaoka M, Iwata N, Masuda T, Tokunaga M, Kinugasa Y. Advantages of preoperative counseling with video for robotic rectal cancer surgery compared with conventional counseling: A randomized controlled trial. Asian J Endosc Surg 2022; 16:248-254. [PMID: 36433813 DOI: 10.1111/ases.13147] [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: 10/08/2022] [Revised: 11/04/2022] [Accepted: 11/16/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Surgeons should provide patients with appropriate explanations before surgery and obtain informed consent. However, this process requires time and effort and can be a great burden. The purpose of this study was to compare preoperative counseling with video (VC) and conventional counseling (CC) for rectal cancer patients. METHODS Rectal cancer patients indicated for surgery were included between April 2021 and March 2022, and eligible patients were randomly assigned to the CC and VC groups. The primary outcomes were the comprehension, satisfaction, and anxiety levels, and the secondary outcome was the preoperative counseling time. This exploratory study protocol was registered with the UMIN Clinical Trials Registry (UMIN000038133). RESULTS We included 13 patients in the CC group and 17 in the VC group. All eligible patients were scheduled for robotic rectal cancer surgery. There were no significant differences between the two groups, including patients' general condition, preoperative diagnosis, and planned procedures. Although the comprehension, satisfaction, and anxiety test scores were not significantly different between the groups, the preoperative counseling time was significantly shorter in the VC group than in the CC group (20 vs. 35 minutes, P = .002). A 4-year college degree significantly increased the counseling time, whereas VC significantly decreased it. CONCLUSION Using videos in preoperative counseling for rectal cancer patients is useful. This novel method could reduce the burden on surgeons during preoperative counseling in the era of robotic surgery and work style reforms.
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Affiliation(s)
- Shunsuke Kasai
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Yamauchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miyako Tazawa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayumi Takaoka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Marie Hanaoka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriko Iwata
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taiki Masuda
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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de Brito BB, Marques HS, Silva FAFD, Cordeiro Santos ML, Araújo GRL, Valente LDA, Freire de Melo F. Influence of the COVID-19 pandemic in the gastrointestinal oncology setting: An overview. World J Gastrointest Pathophysiol 2022; 13:157-169. [PMID: 36187602 PMCID: PMC9516457 DOI: 10.4291/wjgp.v13.i5.157] [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] [Received: 03/21/2022] [Revised: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 02/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been impacting healthcare in various ways worldwide and cancer patients are greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. The reorganization of the health facilities in order to supply the high demand resulting from the aforementioned infection as well as the social isolation measures led to impairments for the diagnosis and follow-up of patients with gastrointestinal cancers, which has had an impact on the prognosis of the oncologic patients. In that context, health authorities and organizations have elaborated new guidelines with specific recommendations for the management of individuals with gastrointestinal neoplasms during the pandemic. Of note, oncologic populations seem to be more susceptible to unfavorable outcomes when exposed to SARS-CoV-2 infection and some interactions involving virus, tumor, host immune system and anticancer therapies are probably related to the poorer prognosis observed in those COVID-19 patients. Moreover, vaccination stands out as the main prevention method against severe SARS-CoV-2 infection and some particularities have been observed regarding the seroconversion of vaccinated oncologic patients including those with gastrointestinal malignancies. In this minireview, we gather updated information regarding the influence of the pandemic in the diagnosis of gastrointestinal neoplasms, new recommendations for the management of gastrointestinal cancer patients, the occurrence of SARS-CoV-2 infection in those individuals and the scenario of the vaccination against the virus in that population.
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Affiliation(s)
- Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45055-380, Bahia, Brazil
| | | | - Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lara de Araujo Valente
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45055-380, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Brazil
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Chen MZ, Tay YK, Teoh WMK, Kong JCH, Carne P, D'Souza B, Chandra R, Bui A. Melbourne colorectal collaboration: a multicentre review of the impact of COVID-19 on colorectal cancer in Melbourne, Australia. ANZ J Surg 2022; 92:1110-1116. [PMID: 35393720 PMCID: PMC9111459 DOI: 10.1111/ans.17603] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/07/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND As coronavirus (COVID-19) cases continue to rise, healthcare workers have been working overtime to ensure that all patients receive care in a timely manner. Our study aims to identify the impact and outcomes of COVID-19 on colorectal cancers presentations across the five major colorectal units in Melbourne, Australia. METHODS This is a retrospective study from a prospectively collected database from the binational colorectal cancer audit (BCCA) registry, as well as inpatient records. All patients with colorectal cancer between Pre-COVID-19 period (1 July 2018-2030 June 2019) and COVID-19 period (1 July 2020-2030 June 2021) were compared. Benign pathology and other cancer types were excluded. RESULTS A total of 1609 patients were included in the study (700 Pre-COVID-19 period, 906 COVID-19 period). During COVID-19 period, there was a higher proportion of emergency surgery (28.1% vs. 19.8%; P < 0.001), a higher nodal (P = 0.024) and metastatic stage (P = 0.018) at presentation, but no increase in the rate of return to operating theatres (P = 0.240), inpatient death (P = 0.019) or 30-day readmission (P = 0.000). There was also no difference in the post-operative surgical complications (P = 0.118). Utility of neoadjuvant therapy did not increase during the pandemic (P = 0.613). CONCLUSION The heightened measures in the healthcare system ensured CRC patients still received their surgery in a timely fashion. With the current rise in the new strain of COVID-19 (Omicron), we have to continue to come up with new strategies to provide timely access to CRC care.
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Affiliation(s)
| | - Yeng Kwang Tay
- Department of Colorectal SurgeryMonash HealthVictoriaAustralia
| | - Wiliam MK Teoh
- Department of Colorectal SurgeryMonash HealthVictoriaAustralia
| | - Joseph CH Kong
- Division of Cancer SurgeryPeter MacCallum Cancer CentreMelbourne, VictoriaAustralia
- Department of Colorectal SurgeryAlfred HospitalMelbourne, VictoriaAustralia
- Central Clinical SchoolAlfred Hospital, Monash UniversityMelbourne, VictoriaAustralia
| | - Peter Carne
- Department of Colorectal SurgeryAlfred HospitalMelbourne, VictoriaAustralia
- Central Clinical SchoolAlfred Hospital, Monash UniversityMelbourne, VictoriaAustralia
| | - Basil D'Souza
- Department of Colorectal SurgeryNorthern HospitalVictoriaAustralia
- Department of Colorectal SurgerySt Vincent's HospitalMelbourne, VictoriaAustralia
| | - Raaj Chandra
- Department of Colorectal SurgeryEastern Health, Boxhill HospitalMelbourne, VictoriaAustralia
| | - Andrew Bui
- Department of Colorectal SurgeryNorthern HospitalVictoriaAustralia
- Department of Colorectal SurgeryAustin HospitalMelbourne, VictoriaAustralia
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Freund MR, Kent I, Horesh N, Smith T, Zamis M, Meyer R, Yellinek S, Wexner SD. The effect of the first year of the COVID-19 pandemic on sphincter preserving surgery for rectal cancer: A single referral center experience. Surgery 2022; 171:1209-1214. [PMID: 35337683 PMCID: PMC8849841 DOI: 10.1016/j.surg.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Background COVID-19 has significantly impacted healthcare worldwide. Lack of screening and limited access to healthcare has delayed diagnosis and treatment of various malignancies. The purpose of this study was to determine the effect of the first year of the COVID-19 pandemic on sphincter-preserving surgery in patients with rectal cancer. Methods This was a single-center retrospective study of patients undergoing surgery for newly diagnosed rectal cancer. Patients operated on during the first year of the COVID-19 pandemic (March 2020–February 2021) comprised the study group (COVID-19 era), while patients operated on prior to the pandemic (March 2016–February 2020) served as the control group (pre–COVID-19). Results This study included 234 patients diagnosed with rectal cancer; 180 (77%) patients in the pre–COVID-19 group and 54 patients (23%) in the COVID-19–era group. There were no differences between the groups in terms of mean patient age, sex, or body mass index. The COVID-19–era group presented with a significantly higher rate of locally advanced disease (stage T3/T4 79% vs 58%; P = .02) and metastatic disease (9% vs 3%; P = .05). The COVID-19–era group also had a much higher percentage of patients treated with total neoadjuvant therapy (52% vs 15%; P = .001) and showed a significantly lower rate of sphincter-preserving surgery (73% vs 86%; P = .028). Time from diagnosis to surgery in this group was also significantly longer (median 272 vs 146 days; P < .0001). Conclusion Patients undergoing surgery for rectal cancer during the first year of the COVID-19 pandemic presented later and at a more advanced stage. They were more likely to be treated with total neoadjuvant therapy and were less likely candidates for sphincter-preserving surgery.
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Affiliation(s)
- Michael R Freund
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/mikifreund
| | - Ilan Kent
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ilan_kent
| | - Nir Horesh
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/nirhoresh
| | - Timothy Smith
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Marcella Zamis
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Ryan Meyer
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL
| | - Shlomo Yellinek
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. https://twitter.com/SYellinek
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL.
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Kim H, Kim H, Lee HJ, Cho E, Koh SJ, Ahmed O, Chung S. The Validation Study of the Stress and Anxiety to Viral Epidemics-6 Scale Among Patients With Cancer in the COVID-19 Pandemic. Front Psychiatry 2022; 13:811083. [PMID: 35492734 PMCID: PMC9046784 DOI: 10.3389/fpsyt.2022.811083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/18/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The study aimed to explore the psychometric properties of the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) scale among patients with cancer who are in serious situations in the current COVID-19 pandemic. METHODS The survey included questions on the participants' demographic information, clinical history of cancer (including cancer type, stage, current treatment or diagnosis of complete remission), and scores on rating scales, including the SAVE-6 scale, Coronavirus Anxiety Scale (CAS), and the Patient Health Questionnaire-9 (PHQ-9). RESULTS The confirmatory factor analysis (CFA) results determined that the model fits the single factor structure of the SAVE-6 scale among patients with cancer. The multi-group CFA showed that SAVE-6 can measure the anxiety response in a similar way across multiple variables, such as sex, presence of clinical depression, being in a state of complete remission, or currently undergoing cancer treatment. The SAVE-6 scale showed good reliability (Cronbach's alpha = 0.819) and convergent validity with the rating scales, such as CAS [r = 0.348 (95% CI, 0.273-0.419), p < 0.001] and PHQ-9 items score [r = 0.251 (95% CI, 0.172-0.328), p < 0.001]. CONCLUSIONS This study confirms SAVE-6 as a reliable and valid rating scale for measuring the anxiety response of patients with cancer during the current COVID-19 pandemic.
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Affiliation(s)
- Hyeyeong Kim
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyuk Joo Lee
- Department of Public Medical Service, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eulah Cho
- Department of Psychiatry, Seoul Medical Center, Seoul, South Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram, Bangladesh.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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9
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Rashid MU, Raza SS, Thomas P, Vakis S. Comparison of Colorectal Cancer Surgery Services During COVID-19 First Wave With Pre-COVID Time. Cureus 2021; 13:e17585. [PMID: 34522556 PMCID: PMC8425080 DOI: 10.7759/cureus.17585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction The first confirmed case of COVID-19 in the United Kingdom (UK) was reported on 29 January 2020. The country saw the peak of infection between March and May of 2020. The result was a change in the practice of how we treat most surgical conditions including cancer. We continued providing service to our colorectal cancer patients at a District General Hospital. The aim of this study was to compare our provision of colorectal cancer service during the peak of the pandemic to that of the pre-COVID time in our hospital. Methods We collected data of all colorectal cancer patients who underwent surgery between 1 March 2020 and 30 April 2020 in our hospital. The comparative data were collected for similar patients during the same time frame in 2019. A detailed data set was compiled on Microsoft Excel (Microsoft Corp, Washington) and analysed using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012. IBM Corp, Armonk, NY). Results The two groups were comparable in demographics including age, BMI, gender, and Charlson comorbidity index. Time from decision- to-treat to surgery, post-operative HDU/ITU stay, and overall length of stay was shorter in the COVID group than the Pre-COVID group without any significant statistical difference. There was no statistically significant difference between the two groups in Calvien-Dindo complications grade 1 and 2. No mortality was reported due to direct or indirect consequences of COVID-19 infection. More open procedures were performed in our department during the first wave of COVID-19 in the UK compared to Pre-COVID time. Conclusions Despite the challenges we faced during the peak of the COVID-19 pandemic, we managed to provide standard care to our colorectal cancer patients with comparable post-operative surgical and oncological outcomes.
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Affiliation(s)
- Muhammad Umair Rashid
- General Surgery, University Hospitals of Derby and Burton NHS Trust, Staffordshire, GBR
| | - Syed Soulat Raza
- Surgery, University Hospitals of Birmingham NHS Trust, Birmingham, GBR
| | - Pradeep Thomas
- General Surgery, University Hospitals of Derby and Burton NHS Trust, Staffordshire, GBR
| | - Stelios Vakis
- General and Colorectal Surgery, University Hospitals of Derby and Burton NHS Trust, Staffordshire, GBR
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10
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Mukherji R, Marshall JL. Lessons Learned in Managing Patients with Colorectal Cancer During the COVID-19 Pandemic. Curr Treat Options Oncol 2021; 22:93. [PMID: 34424418 PMCID: PMC8381863 DOI: 10.1007/s11864-021-00888-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT The COVID-19 pandemic forced us to rapidly and dramatically shift our medical priorities and decision making. With little literature or experience to rely on, the initial priority was to minimize patient exposure to the hospital and to others. It remains unclear whether cancer patients are at higher risk of infection or serious complications, or if it is our traditional therapies that place them to be at higher risk. By far, the greatest negative impact was on screening. Routine colonoscopies were considered elective, and as a result, delays in diagnosis will be felt for years to come. The most positive changes were the incorporation of tele-visits, increased use of oral therapies, alterations in treatment schedules of both chemotherapy and radiation, and an increased emphasis on neoadjuvant therapy. These too will be felt for years to come. The colorectal cancer medical community has responded collaboratively and effectively to maintain treatment and to optimize outcomes for our patients during the COVID-19 pandemic.
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Affiliation(s)
- Reetu Mukherji
- Department of Hematology and Oncology, Georgetown University Medical Center, Washington, DC, 20057, USA
| | - John L Marshall
- Department of Hematology and Oncology, Georgetown University Medical Center, Washington, DC, 20057, USA.
- Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road, Washington, DC, 20057, USA.
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Deschner BW, VanderWalde NA, Grothey A, Shibata D. Evolution and Current Status of the Multidisciplinary Management of Locally Advanced Rectal Cancer. JCO Oncol Pract 2021; 17:383-402. [PMID: 33881906 DOI: 10.1200/op.20.00885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The management of locally advanced rectal cancer has grown in both complexity and quality since the first proctectomy. What once was a malignancy with a fairly consistent treatment algorithm for decades, a recent paradigm shift in the care of these patients has led to a more personalized, multidisciplinary approach with variations in timing, sequence, duration, and potential exclusion of multimodality therapies. This review summarizes the most important evidence behind these developing overarching concepts to provide a context for this paradigm shift.
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Affiliation(s)
- Benjamin W Deschner
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Noam A VanderWalde
- Radiation Oncology and Medical Oncology, West Cancer Center and Research Institute, Memphis, TN
| | - Axel Grothey
- Radiation Oncology and Medical Oncology, West Cancer Center and Research Institute, Memphis, TN
| | - David Shibata
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
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Spinelli A, Carvello M, Carrano FM, Pasini F, Foppa C, Taffurelli G, Ugolini G, Montroni I. Reduced duration of stay after elective colorectal surgery during the peak phase of COVID-19 pandemic: A positive effect of infection risk awareness? Surgery 2020; 170:558-562. [PMID: 33714617 PMCID: PMC7757347 DOI: 10.1016/j.surg.2020.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 01/23/2023]
Abstract
Background While elective surgery was shut down in most settings during the 2019 novel coronavirus pandemic, some referral centers were designated as surgery hubs. We sought to investigate how the pandemic scenario impacted the quality of a long-established enhanced recovery protocol colorectal surgery program in 2 referral centers, designated as colorectal surgery hubs, located in the epicentral Italian regions hardest hit by the pandemic. Methods We compared short-term outcomes of patients undergoing major colorectal surgery with a long-established enhanced recovery protocol during the coronavirus disease 2019 outbreak occurred in 2020 (group A) with the correspondent timeframe of 2019 (group B). Primary outcomes were morbidity and mortality, duration of stay, and readmission rate. Results One hundred and thirty-six patients underwent major colorectal surgery in group A and 173 in group B. Postoperative complications and readmission rate were comparable between the 2 groups. Oncologic case-log was predominant in group A compared with group B (73.5 vs 61%; P = .01). A significantly shorter overall duration of stay was found in group A (P < .001). Uncomplicated patients of group A had a shorter duration of stay when compared with uncomplicated patients of group B (P = .008). Conclusion Under special precautionary measures, major colorectal surgery can be undertaken on elective basis even during coronavirus disease 2019 pandemic with reasonable results. A reduction of duration of stay within a long-established enhanced recovery protocol colorectal surgery program was observed during the coronavirus disease 2019 pandemic occurred in 2020 in comparison with the correspondent timeframe of the previous year without compromising short-term outcomes. The pandemic uncovered the positive impact of patients’ commitment to reducing duration of stay as the empowered risk awareness likely promoted their compliance to the enhanced recovery protocol.
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Affiliation(s)
- Antonino Spinelli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Pieve Emanuele, Italy.
| | - Michele Carvello
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Pieve Emanuele, Italy
| | | | | | - Caterina Foppa
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Lewis S, Talapatra K. Radiotherapy management of rectal cancer in the backdrop of the COVID pandemic. Cancer Rep (Hoboken) 2020; 4:e1320. [PMID: 33295140 PMCID: PMC7883038 DOI: 10.1002/cnr2.1320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/02/2020] [Accepted: 10/27/2020] [Indexed: 12/30/2022] Open
Abstract
Background COVID‐19 outbreak was declared as a pandemic by the World Health Organization in March 2020. Over the last 3 months, the pandemic has challenged the diagnosis and treatment of all cancer, including rectal cancer. Constraints in resources call for a change in the treatment strategy without compromising efficacy. Recent Findings Delivery of shorter treatment schedules for radiotherapy offers advantages like short overall treatment time, improved throughput on the machine, improved compliance and reduced risk of transmission of COVID 19. Other strategies include delaying surgery, reducing the intensity of chemotherapy and adoption of organ preservation approach. Conclusion The curative treatment of rectal cancer should not be hindered during the COVID pandemic, and modifications in the multi‐modality treatment will help achieve quality care.
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Affiliation(s)
- Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kaustav Talapatra
- Department of Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
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Recommendations on Management of Locally Advanced Rectal Cancer During the COVID-19 Pandemic: an Iranian Consensus. J Gastrointest Cancer 2020; 51:800-804. [PMID: 32656628 PMCID: PMC7355082 DOI: 10.1007/s12029-020-00454-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. Methods In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. Results We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. Conclusion Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.
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Akula SM, Abrams SL, Steelman LS, Candido S, Libra M, Lerpiriyapong K, Cocco L, Ramazzotti G, Ratti S, Follo MY, Martelli AM, Blalock WL, Piazzi M, Montalto G, Cervello M, Notarbartolo M, Basecke J, McCubrey JA. Cancer therapy and treatments during COVID-19 era. Adv Biol Regul 2020; 77:100739. [PMID: 32773105 PMCID: PMC7319627 DOI: 10.1016/j.jbior.2020.100739] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 04/12/2023]
Abstract
The COVID-19 pandemic has put a serious strain on health treatments as well at the economies of many nations. Unfortunately, there is not currently available vaccine for SARS-Cov-2/COVID-19. Various types of patients have delayed treatment or even routine check-ups and we are adapting to a virtual world. In many cases, surgeries are delayed unless they are essential. This is also true with regards to cancer treatments and screening. Interestingly, some existing drugs and nutraceuticals have been screened for their effects on COVID-19. Certain FDA approved drugs, vitamin, natural products and trace minerals may be repurposed to treat or improve the prevention of COVID-19 infections and disease progression. This review article will summarize how the treatments of various cancer patients has changed during the COVID-19 era as well as discuss the promise of some existing drugs and other agents to be repurposed to treat this disease.
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Affiliation(s)
- Shaw M Akula
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA
| | - Stephen L Abrams
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA
| | - Linda S Steelman
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA
| | - Saverio Candido
- Department of Biomedical and Biotechnological Sciences-Oncological, Clinical and General Pathology Section, University of Catania, Catania, Italy; Research Center for Prevention, Diagnosis and Treatment of Cancer (PreDiCT), University of Catania, Catania, Italy
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences-Oncological, Clinical and General Pathology Section, University of Catania, Catania, Italy; Research Center for Prevention, Diagnosis and Treatment of Cancer (PreDiCT), University of Catania, Catania, Italy
| | - Kvin Lerpiriyapong
- Center of Comparative Medicine and Pathology, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medicine and the Hospital for Special Surgery, New York City, NY, USA
| | - Lucio Cocco
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Giulia Ramazzotti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Stefano Ratti
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Matilde Y Follo
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Alberto M Martelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - William L Blalock
- Istituto di Genetica Molecolare-Luigi Luca Cavalli Sforza, UOS Bologna, Consiglio Nazionale Delle Ricerche (IGM-CNR), Bologna, Italy; IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manuela Piazzi
- Istituto di Genetica Molecolare-Luigi Luca Cavalli Sforza, UOS Bologna, Consiglio Nazionale Delle Ricerche (IGM-CNR), Bologna, Italy; IRCCS, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Montalto
- Department of Health Promotion, Maternal and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy; Institute for Biomedical Research and Innovation, National Research Council (CNR), Palermo, Italy
| | - Melchiorre Cervello
- Institute for Biomedical Research and Innovation, National Research Council (CNR), Palermo, Italy
| | - Monica Notarbartolo
- Department of Biological, Chemical and Pharmaceutical Science and Technology (STEBICEF), University of Palermo, Palermo, Italy
| | - Jorg Basecke
- Sankt-Josefs Hospital, Krankenhausstrasse 13, 49661, Cloppenburg, Germany
| | - James A McCubrey
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, 27858, USA.
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