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Elsayad K, Weishaupt C, Moustakis C, Danzer MF, Müller EC, Rolf D, Stranzenbach R, Livingstone E, Booken N, Stadler R, Eich HT. Ultrahypofractionated Low-Dose Total Skin Electron Beam in Advanced-Stage Mycosis Fungoides and Sézary Syndrome. Int J Radiat Oncol Biol Phys 2023; 117:164-170. [PMID: 36893819 DOI: 10.1016/j.ijrobp.2023.02.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE The aim of this study was to assess the safety and efficacy of an ultrahypofractionated low-dose total skin electron beam therapy (TSEBT) regimen in patients with advanced mycosis fungoides (MF) or Sézary syndrome (SS). METHODS AND MATERIALS In this multicenter observational study from 5 German centers, 18 total patients with MF or SS underwent TSEBT with a total dose of 8 Gy in 2 fractions. The primary endpoint was the overall response rate. RESULTS Fifteen of 18 patients with stage IIB-IV MF or SS were heavily pretreated with a median of 4 prior systemic therapies. The overall response rate was 88.9% (95% confidence interval [CI], 65.3-98.6), with 3 complete responses (16.9%; 95% CI, 3.6-41.4). At a median follow-up period of 13 months, the median time to next treatment (TTNT) was 12 months (95% CI, 8.2-15.8), and the median progression-free survival was 8 months (95% CI, 2-14). A significant reduction in the modified severity-weighted assessment tool, total Skindex-29 score (Bonferroni-corrected P < .005), and all subdomains (Bonferroni-corrected P < .05) was observed after TSEBT. Half of the irradiated patients (n = 9) developed grade 2 acute and subacute toxicities. One patient had confirmed grade 3 acute toxicity. Chronic grade 1 toxicity has been observed in 33% of patients. Patients with erythroderma/SS or prior radiation therapy appear at higher risk of skin toxicities. CONCLUSIONS TSEBT with 8 Gy in 2 fractions achieves good disease control and symptom palliation with acceptable toxicity, greater convenience, and fewer hospital visits.
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Affiliation(s)
- Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany.
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Munster, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
| | - Moritz Fabian Danzer
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | | | - Daniel Rolf
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
| | - Rene Stranzenbach
- Department of Dermatology, University Hospital of Bochum, Bochum, Germany
| | | | - Nina Booken
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Stadler
- Department of Dermatology, Johannes Wesling Medical Centre, University of Bochum, Minden, German
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
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2
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de Vasconcellos Ferreira PM, Gomes MDCMF, Almeida ACSM, Cornélio JS, Arruda TJ, Mafra A, Nunes MHS, Salera RB, Nogueira RF, Sclauser JMB, Drummond-Lage AP, Rezende BA. Evaluation of oral mucositis, candidiasis, and quality of life in patients with head and neck cancer treated with a hypofractionated or conventional radiotherapy protocol: a longitudinal, prospective, observational study. Head Face Med 2023; 19:7. [PMID: 36890527 PMCID: PMC9992900 DOI: 10.1186/s13005-023-00356-3] [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: 11/03/2022] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, recently, Radiotherapy (RT) protocols requiring fewer sessions (hypofractionated) have been used to shorten RT treatment and minimize patient exposure to medical centers, and decrease the risk of SARS-CoV-2 infection. METHODS This longitudinal, prospective, observational study aimed to compare the quality of life (QoL) and the incidence of oral mucositis and candidiasis in 66 patients with head and neck cancer (HNC) who undergo a hypofractionated RT protocol (GHipo), total of 55 Gy for 4 weeks, or a conventional RT protocol (GConv), total of 66 - 70 Gy for 6 - 7 weeks. PURPOSE To assess the incidence and severity of oral mucositis, the incidence of candidiasis, and QoL were evaluated using the World Health Organization scale, clinical evaluation, and the QLC-30 and H&N-35 questionnaires, respectively, at the beginning and the end of RT. RESULTS The incidence of candidiasis did not show differences between the two groups. However, at the end of RT, mucositis had a higher incidence (p < 0.01) and severity (p < 0.05) in GHipo. QoL was not markedly different between the two groups. Although mucositis worsened in patients treated with hypofractionated RT, QoL did not worsen for patients on this regimen. CONCLUSIONS Our results open perspectives for the potential use of RT protocols for HNC with fewer sessions in conditions that require faster, cheaper, and more practical treatments.
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Affiliation(s)
| | | | | | - Júlia Soares Cornélio
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil
| | - Thiago Jardim Arruda
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | - Arnoldo Mafra
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | | | - Rafael Borges Salera
- Mario Penna Institute, 901, Joaquim Candido Filho, Belo Horizonte, 30320-420, Brazil
| | | | | | - Ana Paula Drummond-Lage
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil
| | - Bruno Almeida Rezende
- School of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, Belo Horizonte, 27530130-110, Brazil.
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3
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Carola V, Vincenzo C, Morale C, Cecchi V, Rocco M, Nicolais G. Psychological Health in Intensive Care Unit Health Care Workers after the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:2201. [PMID: 36360545 PMCID: PMC9690339 DOI: 10.3390/healthcare10112201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Although the COVID-19 pandemic had an impact on the general population, health care workers (HCWs) constituted one of the groups that were most adversely affected by the associated risks, owing to the significant consequences on their mental health. This study examined these psychological effects on HCWs who cared for COVID-19 patients who were admitted to the intensive care unit in an Italian hospital. METHODS Subjects were administered several self-reported questionnaires: Kessler 10 Psychological Distress Scale (K10), Perceived Stress Scale-10 (PSS), Impact of Event Scale Revised (IES-R), and Post-traumatic Growth Inventory (PTGI), as well as two open-ended questions oriented toward understanding their positive and negative emotional experience and differentiating between two phases of the emergency. RESULTS Overall, 45% of HCWs showed medium-to-high anxiety/depressive symptoms, whereas 60% presented with medium-to-high levels of perceived stress. In addition, 37% of subjects developed symptoms of PTSD and 50% showed post-traumatic growth in the "appreciation of life" and "new possibilities" dimensions. With regard to the open-ended questions, three themes were identified: quality of workplace relationships, sense of emotional-relational competence, and sense of clinical-technical competence. In addition, two macrocategories of responses were identified in the answers: growth and block. CONCLUSIONS The mental health of HCWs who are involved in the front line of COVID-19 was significantly impacted by this experience, showing high levels of post-traumatic stress and anxiety and depressive symptoms more than 1 year after the emergency began. A qualitative analysis of staff experiences can be a useful guide for structuring interventions and prevention.
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Affiliation(s)
- Valeria Carola
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Cristina Vincenzo
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Chiara Morale
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Valentina Cecchi
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Monica Rocco
- Department of Clinical and Surgical Translational Medicine, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
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4
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Kapur A, Rudin B, Potters L. Post Traumatic Growth in Radiation Medicine following the COVID-19 Outbreak. Adv Radiat Oncol 2022; 7:100975. [PMID: 35464494 PMCID: PMC9014650 DOI: 10.1016/j.adro.2022.100975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose It has been reported that adversarial growth during traumatic events potentially enhances coping with sequelae. The purpose of this work was to assess posttraumatic growth (PTG) among radiation medicine staff members at the individual level as well as changes in perceptions of departmental culture after the COVID-19 pandemic. Methods and Materials An anonymous PTG inventory (PTGI) survey comprising 21 indicators was disseminated to all 213 members of our multicenter radiation department to measure perceptions of change in personal, interpersonal-relationship, and philosophy of life factors using principal-factor analysis. Additionally, 8 department safety-culture indicators from the National Hospital Patient Safety Culture Survey developed by the Agency for Healthcare Research and Quality were included to assess changes in department safety-culture perceptions verses a prepandemic survey. The survey was repeated 15 months later to assess longitudinal trends. Results With a 56.3% survey-response rate, PTGI factor analysis yielded Cronbach's alpha values exceeding 0.90 for the 3 aforementioned PTG factors. The average growth per indicator was 2.3 (out of 5.0), which fell between small and moderate. The values were 2.4 (personal), 2.1 (interpersonal), and 1.6 (philosophy) for the 3 factors. The total PTGI score (47.7 ± 28.3 out of 105 points) was lower for masked, patient-facing, frontline workers members (41.8 ± 28.4) compared with others (53.1 ± 27.3, P value .001). For the Agency for Healthcare Research and Quality survey there was an improvement of 15% in perceptions of department safety culture, and 7 of the 8 indicators showed improvements compared with baseline. The follow-up survey demonstrated overall sustained findings, albeit with a trend toward declining PTG scores for nonfrontline workers, notably in interpersonal relationships (47.4 ± 27.0, P value .05). Conclusions A fair-to-moderate degree of PTG was observed in personal and interpersonal relationship factors whereas least growth was noted in spiritual and religious beliefs. Perceptions of department patient-safety culture improved substantially. Sustained improvements were thus perceived at the individual and department levels.
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Affiliation(s)
- Ajay Kapur
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine, Hempstead, New York
| | - Brett Rudin
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine, Hempstead, New York
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine, Hempstead, New York
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5
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Pacheco RL, Martimbianco ALC, Roitberg F, Ilbawi A, Riera R. Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review. JCO Glob Oncol 2021; 7:342-352. [PMID: 33656910 PMCID: PMC8081509 DOI: 10.1200/go.20.00632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.
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Affiliation(s)
- Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Felipe Roitberg
- Instituto do Câncer do Estado de São Paulo/HCFMUSP, World Health Organization (WHO), São Paulo, Brazil.,Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland.,European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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6
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Zanville N, Cohen B, Gray TF, Phillips J, Linder L, Starkweather A, Yeager KA, Cooley ME. The Oncology Nursing Society Rapid Review and Research Priorities for Cancer Care in the Context of COVID-19. Oncol Nurs Forum 2021; 48:131-145. [PMID: 33600397 DOI: 10.1188/21.onf.131-145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify research priorities addressing COVID-19 that build on the 2019-2022 Oncology Nursing Society (ONS) Research Agenda, in alignment with ONS's mission to promote excellence in oncology nursing and quality cancer care. METHODS & VARIABLES Priority areas were identified using a multistep approach combining rapid review of the literature; consultation with experts/stakeholders; and review of priorities from other funding agencies, public health, and cancer-focused organizations. RESULTS The rapid research response team identified five priority areas for research related to COVID-19. IMPLICATIONS FOR NURSING Oncology nurses are well positioned to address the research priorities and cross-cutting themes identified through this review. The use of innovative methodologic approaches and attention to disparities are necessary to advance cancer care related to COVID-19.
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Teckie S, Andrews JZ, Chen WCY, Goenka A, Koffler D, Adair N, Potters L. Impact of the COVID-19 Pandemic Surge on Radiation Treatment: Report From a Multicenter New York Area Institution. JCO Oncol Pract 2021; 17:e1270-e1277. [PMID: 33529045 DOI: 10.1200/op.20.00619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE During the COVID-19 surge months of March and April 2020, our New York multicenter health system experienced an influx of cases with COVID-19. We sought to study the impact of the surge period on patients with cancer prescribed radiation treatment (RT). METHODS We reviewed our secure departmental quality assurance database for all patients who underwent RT planning simulations from March 6, 2020, through April 30, 2020. A priority level between 1 and 3 was prospectively assigned to each case based on faculty consensus to determine which patients required immediate RT. In May 2020, each faculty physician again retrospectively reviewed their patients from the database and provided additional commentary on how the COVID-19 pandemic had affected each patient's care. All statistics are descriptive. RESULTS A total of 412 RT courses in 406 unique patients were simulated for linear accelerator-based external beam RT. The median age was 66 years. Treatment intent was curative in 70.6% and palliative in 29.4%. Of the 412 cases, 66.7% were priority 1, 25% priority 2, and 7.8% priority 3. Two hundred thirty-nine cases (58%) underwent standard-of-care diagnosis, workup, and treatment plan. Seventeen patients (4.1%) electively canceled their RT, and 17 others (4.1%) electively delayed RT start. Thirty-four (8.3%) were prescribed hypofractionation to shorten their RT course, and 22 (5.3%) had a change in modality. Incomplete or delayed workup was identified in 19 cases (4.6%). CONCLUSION The COVID-19 pandemic surge resulted in 42% of our patients having a non-standard-of-care pathway. This outcome demonstrates a significant impact of the COVID-19 crisis on routine cancer care.
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Affiliation(s)
- Sewit Teckie
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Janna Zeola Andrews
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - William Chun-Ying Chen
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Anuj Goenka
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Daniel Koffler
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Nilda Adair
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Louis Potters
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
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8
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Donnelly MR, Barie PS, Grigorian A, Kuza CM, Schubl S, de Virgilio C, Lekawa M, Nahmias J. New York State and the Nation: Trends in Firearm Purchases and Firearm Violence During the COVID-19 Pandemic. Am Surg 2020; 87:690-697. [PMID: 33233940 DOI: 10.1177/0003134820954827] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The impacts of social stressors on violence during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We hypothesized that firearm purchases and violence would increase surrounding the pandemic. This study determined the impact of COVID-19 and shelter-in-place (SIP) orders on firearm purchases and incidents in the United States (US) and New York State (NYS). METHODS Scatterplots reflected trends in firearm purchases, incidents, and deaths over a 16-month period (January 2019 to April 2020). Bivariate comparisons of SIP and non-SIP jurisdictions before and after SIP (February 2020 vs. April 2020) and April 2020 vs. April 2019 were performed with the Mann-Whitney U test. RESULTS The incidence of COVID-19 in the US increased between February and April 2020 from 24 to 1 067 660 and in NYS from 0 to 304 372. When comparing February to March to April in the US, firearm purchases increased 33.6% then decreased 22.0%, whereas firearm incidents increased 12.2% then again increased by 3.6% and firearm deaths increased 23.8% then decreased in April by 3.8%. In NYS, comparing February to March to April 2020, firearm purchases increased 87.6% then decreased 54.8%, firearm incidents increased 110.1% then decreased 30.8%, and firearm deaths increased 57.1% then again increased by 6.1%. In both SIP and non-SIP jurisdictions, April 2020 firearm purchases, incidents, deaths, and injuries were similar to April 2019 and February 2020 (all P = NS). DISCUSSION Coronavirus disease 2019-related stressors may have triggered an increase in firearm purchases nationally and within NYS in March 2020. Firearm incidents also increased in NYS. SIP orders had no effect on firearm purchases and firearm violence.
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Affiliation(s)
- Megan R Donnelly
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, 12295Weill Cornell Medicine, New York, NY, USA.,Division of Medical Ethics, Department of Medicine, 12295Weill Cornell Medicine, New York, NY, USA
| | - Areg Grigorian
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Catherine M Kuza
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sebastian Schubl
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | | | - Michael Lekawa
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Orange, CA, USA
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9
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Rolf D, Elsayad K, Eich HT. Acute and sub-acute toxicity profile of ultra-hypofractionated low-dose total skin electron beam with two 4 Gy fractions for cutaneous T cell lymphoma. J Cancer Res Clin Oncol 2020; 147:1757-1761. [PMID: 33219856 PMCID: PMC7680066 DOI: 10.1007/s00432-020-03449-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/31/2020] [Indexed: 12/14/2022]
Abstract
Purpose Low-dose total skin electron beam therapy (TSEBT) over 3 weeks has proved to be a safe and effective treatment for cutaneous T cell lymphomas (CTCL). In this prospective trial, we examined the feasibility of ultra-hypofractionated low-dose TSEBT regimen in two fractions with 4 Gy combined with systemic therapy to minimize the number of visits to radiation centers. Patients and methods Six patients with mycosis fungoides (MF) or Sézary syndrome (SS) received TSEBT with a total radiation dose of 8 Gy in two fractions between April 2020 and June 2020. Patient and treatment characteristics, tumor burden, the impact on the quality of life using Skindex-29 questionnaires, and acute toxicities were analyzed. Results During TSEBT, all patients developed grade 1 toxicities while two patients developed grade 2 toxicities. One patient experienced sepsis. The most common adverse effects were erythema and edema. All grade 2 toxicities regressed after 4 weeks following TSEBT. Based on the reported symptoms measured by Skindex-29, we detected a significant reduction in total Skindex-29 score after 8 weeks of radiation (P = 0.03), particularly in the symptoms (P = 0.01) and emotional domains (P = 0.04). Conclusion Ultra-hypofractionated low-dose TSEBT followed by systemic therapy seems to be a safe and feasible alternative to conventional fractionated TSEBT for patients with MF/SS. The skin tumor burden and the health-related quality of life have been significantly improved within 8 weeks following radiotherapy.
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Affiliation(s)
- Daniel Rolf
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Muenster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Muenster, Germany.
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Building A1, 1 Albert Schweitzer Campus, 48149, Muenster, Germany
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10
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Goenka A, Ma D, Teckie S, Alfano C, Bloom B, Hwang J, Potters L. Implementation of Telehealth in Radiation Oncology: Rapid Integration During COVID-19 and Its Future Role in Our Practice. Adv Radiat Oncol 2020; 6:100575. [PMID: 33073060 PMCID: PMC7546643 DOI: 10.1016/j.adro.2020.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose The widespread coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes in care delivery among radiation oncology practices and has demanded the rapid incorporation of telehealth. However, the impact of a large-scale transition to telehealth in radiation oncology on patient access to care and the viability of care delivery are largely unknown. In this manuscript, we review our implementation and report data on patient access to care and billing implications. Because telehealth is likely to continue after COVID-19, we propose a radiation oncology–specific algorithm for telehealth. Methods and Materials In March 2020, our department began to use telehealth for all new consults, posttreatment encounters, and follow-up appointments. Billable encounters from January to April 2020 were reviewed and categorized into 1 of the following visit types: in-person, telephonic, or 2-way audio-video. Logistic regression models tested whether visit type differed by patient age, income, or provider. Results There was a 35% decrease in billable activity from January to April. In-person visits decreased from 100% to 21%. Sixty percent of telehealth appointments in April were performed with 2-way audio-video and 40% by telephone only. In-person consultation visits were associated with higher billing codes compared with 2-way audio-video telehealth visits (P < .01). No difference was seen for follow-up visits. Univariate and multivariable analysis identified that older patient age was associated with reduced likelihood of 2-way audio-video encounters (P < .01). The physician conducting the telehealth appointment was also associated with the type of visit (P < .01). Patient income was not associated with the type of telehealth visit. Conclusions Since the onset of the COVID-19 pandemic, we have been able to move the majority of patient visits to telehealth but have observed inconsistent utilization of the audio-video telehealth platform. We present guidelines and quality metrics for incorporating telehealth into radiation oncology practice, based on type of encounter and disease subsite.
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Affiliation(s)
- Anuj Goenka
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Daniel Ma
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Sewit Teckie
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Catherine Alfano
- Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
| | - Beatrice Bloom
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Jamie Hwang
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
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11
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Elliott JA, Kenyon R, Kelliher G, Gillis AE, Tierney S, Ridgway PF. Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality: analysis of 14 798 procedures. THE BRITISH JOURNAL OF SURGERY 2020; 107:1708-1712. [PMID: 33031569 PMCID: PMC7675297 DOI: 10.1002/bjs.12053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023]
Abstract
This study used a national administrative database to estimate perioperative SARS-CoV-2 infection risk, and associated mortality, relative to nosocomial transmission rates. The impact of nosocomial transmission was greatest after major emergency surgery, whereas laparoscopic surgery may be protective owing to reduced duration of hospital stay. Procedure-specific risk estimates are provided to facilitate surgical decision-making and informed consent. Estimated risks.
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Affiliation(s)
- J A Elliott
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - R Kenyon
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - G Kelliher
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - A E Gillis
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - S Tierney
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
| | - P F Ridgway
- Department of Surgery, Tallaght University Hospital, Dublin, 24, Ireland
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12
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Jazieh AR, Akbulut H, Curigliano G, Rogado A, Alsharm AA, Razis ED, Mula-Hussain L, Errihani H, Khattak A, De Guzman RB, Mathias C, Alkaiyat MOF, Jradi H, Rolfo C. Impact of the COVID-19 Pandemic on Cancer Care: A Global Collaborative Study. JCO Glob Oncol 2020; 6:1428-1438. [PMID: 32986516 PMCID: PMC7529504 DOI: 10.1200/go.20.00351] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The COVID-19 pandemic affected health care systems globally and resulted in the interruption of usual care in many health care facilities, exposing vulnerable patients with cancer to significant risks. Our study aimed to evaluate the impact of this pandemic on cancer care worldwide. METHODS We conducted a cross-sectional study using a validated web-based questionnaire of 51 items. The questionnaire obtained information on the capacity and services offered at these centers, magnitude of disruption of care, reasons for disruption, challenges faced, interventions implemented, and the estimation of patient harm during the pandemic. RESULTS A total of 356 centers from 54 countries across six continents participated between April 21 and May 8, 2020. These centers serve 716,979 new patients with cancer a year. Most of them (88.2%) reported facing challenges in delivering care during the pandemic. Although 55.34% reduced services as part of a preemptive strategy, other common reasons included an overwhelmed system (19.94%), lack of personal protective equipment (19.10%), staff shortage (17.98%), and restricted access to medications (9.83%). Missing at least one cycle of therapy by > 10% of patients was reported in 46.31% of the centers. Participants reported patient exposure to harm from interruption of cancer-specific care (36.52%) and noncancer-related care (39.04%), with some centers estimating that up to 80% of their patients were exposed to harm. CONCLUSION The detrimental impact of the COVID-19 pandemic on cancer care is widespread, with varying magnitude among centers worldwide. Additional research to assess this impact at the patient level is required.
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Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia,Abdul Rahman Jazieh, MD, MPH, National Guard Health Affairs, PO Box 22490, MC 1777, Riyadh 11426, Kingdom of Saudi Arabia; Twitter: @arjazieh, @jaziehoncology; e-mail:
| | - Hakan Akbulut
- Ankara University School of Medicine, Department of Medical Oncology, Ankara, Turkey
| | - Giuseppe Curigliano
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, and University of Milan, Milan, Italy
| | | | | | | | - Layth Mula-Hussain
- Radiation Oncology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hassan Errihani
- National Institute of Oncology, Mohammed V University, Rabat, Morocco
| | - Adnan Khattak
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Roselle B. De Guzman
- Manila Central University-Filemon D. Tanchoco Medical Foundation Hospital, Caloocan City, Philippines
| | - Clarissa Mathias
- Núcleo de Oncologia da Bahia, Grupo Oncoclínicas, Salvador, Bahia, Brazil
| | - Mohammad Omar Farouq Alkaiyat
- Department of Oncology, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Hoda Jradi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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13
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Riegel AC, Chou H, Baker J, Antone J, Potters L, Cao Y. Development and execution of a pandemic preparedness plan: Therapeutic medical physics and radiation dosimetry during the COVID-19 crisis. J Appl Clin Med Phys 2020; 21:259-265. [PMID: 32652862 PMCID: PMC7497914 DOI: 10.1002/acm2.12971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 12/30/2022] Open
Abstract
The SARS-CoV-2 coronavirus pandemic has spread around the world including the United States. New York State has been hardest hit by the virus with over 380 000 citizens with confirmed COVID-19, the illness associated with the SARS-CoV-2 virus. At our institution, the medical physics and dosimetry group developed a pandemic preparedness plan to ensure continued operation of our service. Actions taken included launching remote access to clinical systems for all dosimetrists and physicists, establishing lines of communication among staff members, and altering coverage schedules to limit on-site presence and decrease risk of infection. The preparedness plan was activated March 23, 2020, and data were collected on treatment planning and chart checking efficiency for 6 weeks. External beam patient load decreased by 25% during the COVID-19 crisis, and special procedures were almost entirely eliminated excepting urgent stereotactic radiosurgery or brachytherapy. Efficiency of treatment planning and chart checking was slightly better than a comparable 6-week interval in 2019. This is most likely due to decreased patient load: Fewer plans to generate and more physicists available for checking without special procedure coverage. Physicists and dosimetrists completed a survey about their experience during the crisis and responded positively about the preparedness plan and their altered work arrangements, though technical problems and connectivity issues made the transition to remote work difficult. Overall, the medical physics and dosimetry group successfully maintained high-quality, efficient care while minimizing risk to the staff by minimizing on-site presence. Currently, the number of COVID-19 cases in our area is decreasing, but the preparedness plan has demonstrated efficacy, and we will be ready to activate the plan should COVID-19 return or an unknown virus manifest in the future.
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Affiliation(s)
- Adam C. Riegel
- Department of Radiation MedicineNorthwell HealthLake SuccessNYUSA
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA
| | - Henry Chou
- Department of Radiation MedicineNorthwell HealthLake SuccessNYUSA
| | - Jameson Baker
- Department of Radiation MedicineNorthwell HealthLake SuccessNYUSA
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA
| | - Jeffrey Antone
- Department of Radiation MedicineNorthwell HealthLake SuccessNYUSA
| | - Louis Potters
- Department of Radiation MedicineNorthwell HealthLake SuccessNYUSA
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA
| | - Yijian Cao
- Department of Radiation MedicineNorthwell HealthLake SuccessNYUSA
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA
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14
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Parashar B, Chen WC, Herman JM, Potters L. Disease Site-Specific Guidelines for Curative Radiation Treatment During 'Limited Surgery' and 'Hospital Avoidance': A Radiation Oncology Perspective From the Epicenter of COVID-19 Pandemic. Cureus 2020; 12:e8190. [PMID: 32440386 PMCID: PMC7237057 DOI: 10.7759/cureus.8190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The COVID-19 pandemic has resulted in an unprecedented situation where the standard of care (SOC) management for cancers has been altered significantly. Patients with potentially curable cancers are at risk of not receiving timely SOC multidisciplinary treatments, such as surgery, chemotherapy, radiation therapy, or combination treatments. Hospital resources are in such high demand for COVID-19 patients that procedures, such as surgery, dentistry, interventional radiology, and other ancillary services, are not available for cancer patients. Our tertiary care center is considered the center of the epicenter in the USA. As a result, all non-emergent surgeries have been suspended in order to provide hospital beds and other resources for COVID-19 patients. Additionally, ambulatory efforts to avoid treatment-related morbidity are critical for keeping patients out of emergency departments and hospitals. In this review article, we discuss evidence-based radiation therapy approaches for curable cancer patients during the COVID-19 pandemic. We focus on three scenarios of cancer care: 1) radiation therapy as an alternative to surgery when immediate surgery is not possible, 2) radiation therapy as a ‘bridge’ to surgery, and 3) radiation options definitively or postoperatively, given the risk of hospitalization with high-dose chemotherapy.
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Affiliation(s)
- Bhupesh Parashar
- Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
| | - William C Chen
- Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
| | - Joseph M Herman
- Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
| | - Louis Potters
- Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
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15
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Bjarnason TA, Rees R, Kainz J, Le LH, Stewart EE, Preston B, Elbakri I, Fife IAJ, Lee T, Gagnon IMB, Arsenault C, Therrien P, Kendall E, Tonkopi E, Cottreau M, Aldrich JE. COMP Report: A survey of radiation safety regulations for medical imaging x-ray equipment in Canada. J Appl Clin Med Phys 2020; 21:10-19. [PMID: 31539193 PMCID: PMC9195219 DOI: 10.1002/acm2.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/09/2019] [Accepted: 08/06/2019] [Indexed: 12/12/2022] Open
Abstract
X-ray regulations and room design methodology vary widely across Canada. The Canadian Organization of Medical Physicists (COMP) conducted a survey in 2016/2017 to provide a useful snapshot of existing variations in rules and methodologies for human patient medical imaging facilities. Some jurisdictions no longer have radiation safety regulatory requirements and COMP is concerned that lack of regulatory oversight might erode safe practices. Harmonized standards will facilitate oversight that will ensure continued attention is given to public safety and to control workplace exposure. COMP encourages all Canadian jurisdictions to adopt the dose limits and constraints outlined in Health Canada Safety Code 35 with the codicil that the design standards be updated to those outlined in NCRP 147 and BIR 2012.
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Affiliation(s)
- Thorarin A. Bjarnason
- Medical ImagingInterior Health AuthorityKelownaBCCanada
- RadiologyUniversity of British ColumbiaVancouverBCCanada
- PhysicsUniversity of British Columbia OkanaganKelownaBCCanada
| | - Robert Rees
- Occupational Health & SafetyYukon Workers' Compensation Health and Safety BoardWhitehorseYKCanada
| | - Judy Kainz
- Workers' Safety and Compensation Commission for Northwest Territories and NunavutYellowknifeNTCanada
| | - Lawrence H. Le
- Diagnostic ImagingAlberta Health ServicesCalgaryABCanada
- Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonABCanada
| | | | - Brent Preston
- Radiation Safety UnitGovernment of SaskatchewanSaskatoonSKCanada
| | - Idris Elbakri
- Cancer Care ManitobaWinnipegMBCanada
- Physics and AstronomyUniversity of ManitobaWinnipegMBCanada
- RadiologyUniversity of ManitobaWinnipegMBCanada
| | - Ingvar A. J. Fife
- Cancer Care ManitobaWinnipegMBCanada
- Physics and AstronomyUniversity of ManitobaWinnipegMBCanada
- RadiologyUniversity of ManitobaWinnipegMBCanada
| | - Ting‐Yim Lee
- St Joseph’s Health Care LondonLondonONCanada
- Lawson Research InstituteLondonONCanada
- Medical ImagingMedical Biophysics, OncologyRobarts Research InstituteUniversity of Western OntarioLondonONCanada
| | | | - Clément Arsenault
- Hôpital Dr Georges–L. DumontCentre d'Oncologie Dr Léon–RichardMonctonNBCanada
| | | | | | - Elena Tonkopi
- Nova Scotia Health AuthorityHalifaxNSCanada
- Diagnostic RadiologyDalhousie UniversityHalifaxNSCanada
- Radiation OncologyDalhousie UniversityHalifaxNSCanada
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