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Mathur P, Ramamoorthy T, Lakshminarayana SK, Nath A, Mathew S, Rajput GK. Utilization of clinical practice guidelines for cancer care in routine practice and during the coronavirus disease 2019 pandemic in India. Asia Pac J Clin Oncol 2024; 20:507-514. [PMID: 38667342 DOI: 10.1111/ajco.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/05/2024] [Indexed: 07/24/2024]
Abstract
AIM The coronavirus disease 2019 (COVID-19) pandemic affected cancer service delivery and the feasibility of following the standard treatment guidelines. The present paper describes the use of clinical care guidelines for cancer management in routine practice and the approach adopted towards cancer care during the COVID-19 pandemic in India. METHODS A web-based survey was done in 107 hospitals (including public and private health facilities) that hosted Hospital-Based Cancer Registries under the National Cancer Registry Programme. The participants comprised Principal Investigators of these registries, who were also medical, surgical, and radiation oncology clinicians. The survey was done between May 1, 2021, and July 31, 2021. Participants were provided with a web link for the survey questionnaire, confidential login, and password. RESULTS The study found high utilization of Clinical Practice Guidelines (CPGs) during practice, with eight out of ten physicians constantly to referring them. The study reported lack of knowledge, skills, and training to administer the treatment based on the guidelines followed by organizational infrastructure and affordability of treatment by the patients as the factors hampering utilization. International clinical guidelines were preferred when compared to national guidelines. The COVID-19 pandemic decreased the use of CPGs, wherein six out of ten clinicians reported their use. CONCLUSION Stakeholders who formulate clinical guidelines must consider the practical aspects and feasibility of implementing such guidelines during a pandemic and similar situations. This should be coupled with adequate changes in care practice to ensure optimal care delivery and a continuum of cancer care in routine and pandemic-imposed situations.
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Affiliation(s)
- Prashant Mathur
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Thilagavathi Ramamoorthy
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | | | - Anita Nath
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Stany Mathew
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
| | - Gurpreet Kaur Rajput
- Indian Council of Medical Research-National Centre for Disease Informatics and Research, Bengaluru, India
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Dyas AR, Bronsert MR, Stuart CM, Thomas MB, Schulick RD, Franco SR, Gleisner A, Randhawa SK, David EA, Mitchell JD, Meguid RA. Analyzing the impact of the Coronavirus disease 2019 pandemic on initial oncologic presentation and treatment of non-small cell lung cancer in the United States. J Thorac Cardiovasc Surg 2024; 168:378-390.e7. [PMID: 37981103 DOI: 10.1016/j.jtcvs.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND A significantly lower rate of non-small cell lung cancer (NSCLC) screening, greater health care avoidance, and changes to oncologic recommendations were some consequences of the Coronavirus disease 2019 (COVID-19) pandemic affecting the medical environment. We sought to determine how the health care environment during the COVID-19 pandemic affected the oncologic treatment of patients diagnosed with non-small cell lung cancer (NSCLC). METHODS This was a retrospective cohort study evaluating patients with NSCLC in the National Cancer Database (2019-2020). Patients were divided into prepandemic (2019) and pandemic (2020) cohorts, and patient, oncologic, and treatment variables were compared. Multivariable logistic regression was performed to control for the impact of demographic characteristics on oncologic variables and the impact of oncologic variables on treatment variables. RESULTS The study population comprised 250,791 patients, including 114,533 patients (45.7%) in the pandemic cohort. There were 15% fewer new NSCLC diagnoses during the pandemic compared with prepandemic. Patients diagnosed during the pandemic had more advanced clinical TNM stage on presentation (P < .0001) and were more likely to have tumors in overlapping lobes or in a main bronchus (P = .0002). They were less likely to receive cancer treatment (P < .0001) and to undergo primary resection (P < .0001) and more likely to receive adjuvant systemic therapy (P = .004) and a combination of palliative treatment regimens (P < .0001). After risk adjustment, all these differences remained statistically significant (P < .05). CONCLUSIONS The COVID-19 pandemic was associated with increased clinical stage at presentation for patients with NSCLC, which impacted subsequent treatment strategies. However, treatment differed minimally when controlling for cancer stage. Future studies will examine the impact of these differences on overall survival and cancer-free survival.
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Affiliation(s)
- Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Madeline B Thomas
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Salvador Rodriguez Franco
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Ana Gleisner
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Simran K Randhawa
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Elizabeth A David
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
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Cozma GV, Muntean C, Faur AM, Gaborean V, Petrache IA, Feier CVI. Unveiling the Effects of the COVID-19 Pandemic on Lung Cancer Surgery. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:964. [PMID: 38929581 PMCID: PMC11205397 DOI: 10.3390/medicina60060964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/23/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024]
Abstract
The aim of this study is to investigate the impact of the COVID-19 pandemic on the surgical treatment of lung cancer patients. Data from patients who underwent surgery during the pandemic were analyzed and compared to pre-pandemic and post-pandemic periods. Multiple parameters were examined, and their changes yielded significant results compared to other periods of the study. The statistical analysis revealed a significant decrease in the number of surgical interventions during the pandemic (p < 0.001), followed by a significant rebound thereafter. During this period, there was a significant increase in the T stage of cancer compared to both pre-pandemic and post-pandemic periods (p = 0.027). Additionally, the mean Charlson comorbidity index score was significantly higher during the pandemic compared to the pre-pandemic period (p = 0.042). In this crisis period, a significant decrease was recorded in both the total hospitalization duration (p = 0.015) and the pre-operative hospitalization duration (p = 0.006). These findings provide evidence of significant changes in clinical and therapeutic strategies applied to lung cancer surgery patients during the study period. The pandemic has had a substantial and complex impact, the full extent of which remains to be fully understood.
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Affiliation(s)
- Gabriel Veniamin Cozma
- Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania; (G.V.C.); (V.G.); (I.A.P.)
- Department of Surgical Semiology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania
| | - Calin Muntean
- Medical Informatics and Biostatistics, Department III-Functional Sciences, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania
| | - Alaviana Monique Faur
- Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timişoara, 300041 Timişoara, Romania;
| | - Vasile Gaborean
- Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania; (G.V.C.); (V.G.); (I.A.P.)
- Department of Surgical Semiology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania
| | - Ioan Adrian Petrache
- Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania; (G.V.C.); (V.G.); (I.A.P.)
- Department of Surgical Semiology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania
| | - Catalin Vladut Ionut Feier
- First Discipline of Surgery, Department X-Surgery, “Victor Babeş” University of Medicine and Pharmacy Timişoara, Eftimie Murgu Square No. 2, 300041 Timişoara, Romania;
- First Surgery Clinic, “Pius Brinzeu” Clinical Emergency Hospital, 300723 Timişoara, Romania
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Fujita M, Fujisawa T, Suzuki K, Nagashima K, Kasai T, Hashimoto H, Yamaguchi K, Onouchi Y, Sato D, Hata A. Impact of the coronavirus disease 2019 pandemic on primary and metastatic lung cancer treatments in Japan: A nationwide study using an interrupted time series analysis. Cancer Epidemiol 2024; 90:102549. [PMID: 38447249 DOI: 10.1016/j.canep.2024.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic prompted healthcare providers to use different approaches from the current standards of care. We aimed to identify the changes in the number of treatments for primary non-small cell lung cancer (NSCLC) and metastatic lung cancer during the pandemic. METHODS We used nationwide insurance claims data from January 2015 to January 2021, and estimated changes in the number of treatments using an interrupted time series analysis. RESULTS The number of surgical resections for primary NSCLC significantly decreased in April 2020 (-888; 95% confidence interval [CI]: -1530 to -246) and July 2020 (-1314; 95% CI: -1935 to -694), while the number of stereotactic body radiotherapies (SBRTs) increased in April 2020 (95; 95% CI: 8-182) and July 2020 (111; 95% CI: 24-198). The total number of treatments for primary NSCLC remained unchanged; however, non-significant decreases were observed in 2020. The number of surgical resections for metastatic lung cancer significantly decreased in April 2020 (-201; 95% CI: -337 to -65), but it eventually increased in July 2020 (170; 95% CI: 32-308). Additionally, the number of SBRTs significantly increased in April 2020 (37; 95% CI: 3-71) and October 2020 (57; 95% CI: 23-91). The total number of treatments for metastatic lung cancer was maintained, with an initial decrease in April 2020 followed by a subsequent increase in July and October 2020. CONCLUSION In Japan, surgical triage for primary and metastatic lung cancer are likely to have been implemented during the pandemic. Despite these proactive measures, patients with primary NSCLC may have been untreated, likely owing to their undiagnosed disease, potentially leading to a deterioration in prognosis. By contrast, patients diagnosed with cancer prior to the pandemic are presumed to have received standard management throughout the course of the pandemic.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan; Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Takehiko Fujisawa
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Kiminori Suzuki
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Hideyuki Hashimoto
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Kazuya Yamaguchi
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Daisuke Sato
- Hospital and Health Administration, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
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Stuart CM, Meguid RA, Bronsert MR, Rodriguez Franco S, Mungo B, Schulick RD, Gleisner AL, McCarter MD, Mitchell JD, Dyas AR. The United States experience with diagnosing and treating esophageal cancer during the SARS-CoV-2 pandemic: A retrospective cohort study. Int J Cancer 2024; 154:1204-1220. [PMID: 38018276 DOI: 10.1002/ijc.34805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
The downstream effects on healthcare delivery during the initial wave of the COVID-19 pandemic remain unclear. The purpose of this study was to determine how the healthcare environment surrounding the pandemic affected the oncologic care of patients diagnosed with esophageal cancer. This was a retrospective cohort study evaluating patients in the National Cancer Database (2019-2020). Patients with esophageal cancer diagnoses were divided into pre-pandemic (2019) and pandemic (2020) groups. Patient demographics, cancer-related variables, and treatment modalities were compared. Among 26,231 esophageal cancer patients, 14,024 patients (53.5%) were in the pre-pandemic cohort and 12,207 (46.5%) were in the pandemic cohort. After controlling for demographics, patients diagnosed during the pandemic were more likely to have poorly differentiated tumors (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.08-1.42), pathologic T3 disease compared to T1 (OR 1.25, 95% CI 1.02-1.53), positive lymph nodes on pathology (OR 1.36, 95% CI 1.14-1.64), and to be pathologic stage IV (OR 1.51, 95% CI 1.29-1.76). After controlling for oncologic characteristics, patients diagnosed during the pandemic were more likely to require at least two courses of systemic therapy (OR 1.78, 95% CI 1.48-2.14) and to be offered palliative care (OR 1.13, 95% CI 1.04-1.22). While these patients were offered curative therapy at lower rates, this became non-significant after risk-adjustment (p = .15). The pandemic healthcare environment was associated with significantly increased risk-adjusted rates of patients presenting with advanced esophageal cancer. While this led to significant differences in treatment, most of these differences became non-significant after controlling for oncologic factors.
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Affiliation(s)
- Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Salvador Rodriguez Franco
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Benedetto Mungo
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ana L Gleisner
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Martin D McCarter
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colorado, USA
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Janczewski LM, Browner AE, Cotler JH, Palis BE, Chan K, Joung RH, Bentrem DJ, Merkow RP, Boffa DJ, Nelson H. Survival Among Patients With High-Risk Gastrointestinal Cancers During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e240160. [PMID: 38441896 PMCID: PMC10915687 DOI: 10.1001/jamanetworkopen.2024.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/30/2023] [Indexed: 03/07/2024] Open
Abstract
Importance Prior reports demonstrated that patients with cancer experienced worse outcomes from pandemic-related stressors and COVID-19 infection. Patients with certain malignant neoplasms, such as high-risk gastrointestinal (HRGI) cancers, may have been particularly affected. Objective To evaluate disruptions in care and outcomes among patients with HRGI cancers during the COVID-19 pandemic, assessing for signs of long-term changes in populations and survival. Design, Setting, and Participants This retrospective cohort study used data from the National Cancer Database to identify patients with HRGI cancer (esophageal, gastric, primary liver, or pancreatic) diagnosed between January 1, 2018, and December 31, 2020. Data were analyzed between August 23 and September 4, 2023. Main Outcome and Measures Trends in monthly new cases and proportions by stage in 2020 were compared with the prior 2 years. Kaplan-Meier curves and Cox regression were used to assess 1-year mortality in 2020 compared with 2018 to 2019. Proportional monthly trends and multivariable logistic regression were used to evaluate 30-day and 90-day mortality in 2020 compared with prior years. Results Of the 156 937 patients included in this study, 54 994 (35.0%) were aged 60 to 69 years and 100 050 (63.8%) were men. There was a substantial decrease in newly diagnosed HRGI cancers in March to May 2020, which returned to prepandemic levels by July 2020. For stage, there was a proportional decrease in the diagnosis of stage I (-3.9%) and stage II (-2.3%) disease, with an increase in stage IV disease (7.1%) during the early months of the pandemic. Despite a slight decrease in 1-year survival rates in 2020 (50.7% in 2018 and 2019 vs 47.4% in 2020), survival curves remained unchanged between years (all P > .05). After adjusting for confounders, diagnosis in 2020 was not associated with increased 1-year mortality compared with 2018 to 2019 (hazard ratio, 0.99; 95% CI, 0.97-1.01). The rates of 30-day (2.1% in 2018, 2.0% in 2019, and 2.1% in 2020) and 90-day (4.3% in 2018, 4.4% in 2019, and 4.6% in 2020) operative mortality also remained similar. Conclusions and Relevance In this retrospective cohort study, a period of underdiagnosis and increase in stage IV disease was observed for HRGI cancers during the pandemic; however, there was no change in 1-year survival or operative mortality. These results demonstrate the risks associated with gaps in care and the tremendous efforts of the cancer community to ensure quality care delivery during the pandemic. Future research should investigate long-term survival changes among all cancer types as additional follow-up data are accrued.
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Affiliation(s)
- Lauren M. Janczewski
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Bryan E. Palis
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Kelley Chan
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Rachel H. Joung
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David J. Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ryan P. Merkow
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, Illinois
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Patel VR, Gereta S, Jafri F, Mackert M, Haynes AB. Examining Public Communication About Surgical Cancer Care on Twitter. J Surg Res 2023; 291:433-441. [PMID: 37517351 DOI: 10.1016/j.jss.2023.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/12/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Social media platforms like Twitter are highly utilized for communicating about cancer care. Although surgery is the primary curative treatment for solid malignancies, little is known about online communication behaviors regarding this treatment modality. This study tracked online discussions and characterized participants to better characterize the content of public communication about surgical cancer care. METHODS Tweets referencing cancer surgery were collected from 2018 to 2021 using Twitter's Application Programming Interface. Metadata (e.g., profile biography, follower count) was used to predict user demographic information. Natural language processing was performed using Latent Dirichlet Allocation to identify common themes of conversation and mentioned cancer sites. RESULTS There were 442,840 tweets about cancer surgery by 262,168 users, including individuals (65%), influencers (1.5%), surgeons (1%), and oncologists (0.5%). Following the onset of the COVID-19 pandemic, tweets mentioning delays in care increased by 21.7% (1971-57,846 tweets). Individuals commonly mentioned surgical costs (20.3%) and postoperative recovery (21.6%). Surgeons and oncologists frequently mentioned research (52.7%), but infrequently mentioned community support (7.8%) or survivorship (9.3%). Relative to their prevalence, neurologic cancers were most discussed (231 tweets per 1000 operations) while thoracic (29 tweets per 1000 operations) and urologic cancers were least discussed (12 tweets per 1000 operations). CONCLUSIONS Twitter was utilized by patients to discuss real-time issues such as COVID-19-related surgical delays and the financial burden of cancer surgery. Further efforts to improve community outreach may be optimized by targeting greater discussion of undermentioned cancer types and encouraging clinicians to participate in discussions about community-centered themes.
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Affiliation(s)
- Vishal R Patel
- Dell Medical School, The University of Texas at Austin, Austin, Texas.
| | - Sofia Gereta
- Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Faraz Jafri
- Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Michael Mackert
- Center for Health Communication, Moody College of Communication, The University of Texas at Austin, Austin, Texas
| | - Alex B Haynes
- Dell Medical School, The University of Texas at Austin, Austin, Texas
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Janczewski LM, Cotler J, Merkow RP, Palis B, Nelson H, Mullett T, Boffa DJ. Alterations in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6:e2340148. [PMID: 37902756 PMCID: PMC10616721 DOI: 10.1001/jamanetworkopen.2023.40148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Importance The COVID-19 pandemic created challenges to the evaluation and treatment of cancer, and abrupt resource diversion toward patients with COVID-19 put cancer treatment on hold for many patients. Previous reports have shown substantial declines in cancer screening and diagnoses in 2020; however, the extent to which the delivery of cancer care was altered remains unclear. Objective To assess alterations in cancer treatment in the US during the first year of the COVID-19 pandemic. Design, Setting, and Participants This retrospective cohort study used data from the National Cancer Database (NCDB) on patients older than 18 years with newly diagnosed cancer from January 1, 2018, to December 31, 2020. Main Outcomes and Measures The main outcomes were accessibility (time to treatment, travel distance, and multi-institutional care), availability (proportional changes in cancer treatment between years), and utilization (reductions by treatment modality, hospital type) of cancer treatment in 2020 compared with 2018 to 2019. Autoregressive models forecasted expected findings for 2020 based on observations from prior years. Results Of 1 229 654 patients identified in the NCDB in 2020, 1 074 225 were treated for cancer, representing a 16.8% reduction from what was expected. Patients were predominately female (53.8%), with a median age of 66 years (IQR, 57-74 years), similar to demographics in 2018 and 2019. Median time between diagnosis and treatment was 26 days (IQR, 0-36 days) in 2020, and median travel distance for care was 11.1 miles (IQR, 5.0-25.3 miles), similar to 2018 and 2019. In 2020, fewer patients traveled longer distances (20.2% reduction of patients traveling >35 miles). The proportions of patients treated with chemotherapy (32.0%), radiation (29.5%), and surgery (57.1%) were similar to those in 2018 and 2019. Overall, 146 805 fewer patients than expected underwent surgery, 80 480 fewer received radiation, and 68 014 fewer received chemotherapy. Academic hospitals experienced the greatest reduction in cancer surgery and treatment, with a decrease of approximately 484 patients (-19.0%) per hospital compared with 99 patients (-12.6%) at community hospitals and 110 patients (-12.8%) at integrated networks. Conclusions and Relevance This study found that among patients diagnosed with cancer in 2020, access and availability of treatment remained intact; however, reductions in treated patients varied across treatment modalities and were greater at academic hospitals than at community hospitals and integrated networks compared with expected values. These results suggest the resilience of cancer service lines and frame the economic losses from reductions in cancer treatment during the pandemic.
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Affiliation(s)
- Lauren M. Janczewski
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Joseph Cotler
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Ryan P. Merkow
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Bryan Palis
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Timothy Mullett
- Department of Surgery, University of Kentucky College of Medicine, Lexington
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Low C, Tejero I, Toledano N, Mariano C, Alibhai S, Lemonde M, Haase K, Puts M. Impact of COVID-19 on older adults with cancer and their caregivers' cancer treatment experiences study: The ICE-OLD study. PLoS One 2023; 18:e0291756. [PMID: 37729131 PMCID: PMC10511107 DOI: 10.1371/journal.pone.0291756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
The COVID-19 pandemic and health services impacts related to physical distancing posed many challenges for older adults with cancer. The goal of this study was to examine the impact of the pandemic on cancer treatment plans and cancer treatment experiences of older adults (ie, aged 65 years and older) and their caregiver' experiences of caring for older adults during the pandemic to highlight gaps in care experienced. In this multi-centre qualitative study guided by an interpretive descriptive research approach we interviewed older adults diagnosed with cancer and caregivers caring for them. Participants were recruited via cancer treatment centres in the provinces of British Columbia and Ontario (Vancouver and Toronto), Canada, and through an online ad sent out through patient advocacy organization newsletters. Interviews were recorded and transcribed verbatim and data were analyzed using an interpretive thematic analysis approach. A total of 27 individuals (17 older adults, 52.9% female; 10 caregivers, 90% female) participated in interviews lasting on average 45 minutes. Older adults with cancer described many impacts and pressures created by the pandemic on their cancer experiences, though they generally felt that the pandemic did not impact treatment decisions made and access to care. We grouped our findings into two main themes with their accompanying sub-themes, related to: (1) alterations in the individual and dyadic cancer experience; and (2) navigating health and cancer systems during the pandemic. The additional stressors the pandemic placed on older adults during their treatment and decision-making process and their caregivers expose the need to create or avail additional supports for future disruptions in care.
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Affiliation(s)
- Cydney Low
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Isabel Tejero
- Geriatrics Department, Hospital del Mar, Barcelona, Spain
| | - Nelly Toledano
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Mariano
- BC Cancer Agency, Vancouver and Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Shabbir Alibhai
- Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Kidane B, Gerard IJ, Spicer J, Kim JO, Fiset PO, Wawryko P, Cecchini MJ, Inculet R, Abdulkarim B, Fortin D, Qiabi M, Qing G, Enns S, Bashir B, Tankel J, Wakeam E, Warner A, Kopek N, Yaremko BP, Rodrigues GB, Laba JM, Qu M, Malthaner RA, Palma DA. Stereotactic ablative radiotherapy before resection to avoid delay for early-stage lung cancer or oligometastases during the COVID-19 pandemic: Pathologic outcomes from the SABR-BRIDGE protocol. Cancer 2023; 129:2798-2807. [PMID: 37221679 DOI: 10.1002/cncr.34880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND During coronavirus disease 2019 (COVID-19)-related operating room closures, some multidisciplinary thoracic oncology teams adopted a paradigm of stereotactic ablative radiotherapy (SABR) as a bridge to surgery, an approach called SABR-BRIDGE. This study presents the preliminary surgical and pathological results. METHODS Eligible participants from four institutions (three in Canada and one in the United States) had early-stage presumed or biopsy-proven lung malignancy that would normally be surgically resected. SABR was delivered using standard institutional guidelines, with surgery >3 months following SABR with standardized pathologic assessment. Pathological complete response (pCR) was defined as absence of viable cancer. Major pathologic response (MPR) was defined as ≤10% viable tissue. RESULTS Seventy-two patients underwent SABR. Most common SABR regimens were 34 Gy/1 (29%, n = 21), 48 Gy/3-4 (26%, n = 19), and 50/55 Gy/5 (22%, n = 16). SABR was well-tolerated, with one grade 5 toxicity (death 10 days after SABR with COVID-19) and five grade 2-3 toxicities. Following SABR, 26 patients underwent resection thus far (13 pending surgery). Median time-to-surgery was 4.5 months post-SABR (range, 2-17.5 months). Surgery was reported as being more difficult because of SABR in 38% (n = 10) of cases. Thirteen patients (50%) had pCR and 19 (73%) had MPR. Rates of pCR trended higher in patients operated on at earlier time points (75% if within 3 months, 50% if 3-6 months, and 33% if ≥6 months; p = .069). In the exploratory best-case scenario analysis, pCR rate does not exceed 82%. CONCLUSIONS The SABR-BRIDGE approach allowed for delivery of treatment during a period of operating room closure and was well-tolerated. Even in the best-case scenario, pCR rate does not exceed 82%.
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Affiliation(s)
- Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Manitoba, Canada
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ian J Gerard
- Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Julian O Kim
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pierre O Fiset
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Paul Wawryko
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Richard Inculet
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Bassam Abdulkarim
- Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Mehdi Qiabi
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Gefei Qing
- Department of Physiology and Pathology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Enns
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bashir Bashir
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Tankel
- Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Elliot Wakeam
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Warner
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Neil Kopek
- Division of Radiation Oncology, Department of Oncology, McGill University and Cedars Cancer Center, Montreal, Quebec, Canada
| | - Brian P Yaremko
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Joanna M Laba
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Melody Qu
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Richard A Malthaner
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada
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11
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Lin YY, Hsieh MJ, Wu CY, Yang LY, Pan YB, Wu CF, Gonzalez-Rivas D, Chao YK. Comparison of active versus passive robotic-endoscope-holder-assisted unisurgeon uniportal thoracoscopic surgery in terms of surgical efficacy and patient safety. J Thorac Dis 2023; 15:3800-3810. [PMID: 37559654 PMCID: PMC10407473 DOI: 10.21037/jtd-23-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/09/2023] [Indexed: 08/11/2023]
Abstract
Background Few studies have compared robotic-arm-assisted unisurgeon uniportal surgeries with conventional human-assisted uniportal video-assisted thoracoscopic surgeries (VATSs) in terms of surgical efficacy and patient safety. In the present study, we compared the aforementioned surgeries. Methods We explored two robotic endoscope holders-a passive robotic platform (ENDOFIXexo, EA group) and a pedal-controlled active robotic platform (MTG-100, MA group)-for unisurgeon uniportal surgeries and compared the surgical outcomes with those of human-assisted uniportal surgeries (HA group) in 228 patients with a lung lesion (size, <5 cm). The primary parameters for this comparison were surgical efficacy, patient safety, and short-term patient outcomes. Results No significant differences were observed among the EA, MA, and HA groups. The success rate of robotic-arm-assisted unisurgeon uniportal wedge resection was 100%, regardless of the group. No major differences were noted in preparation time between the EA and MA groups. Segmentectomy was more favorable in the EA group than in the MA group. The rates of surgical conversion were 5% and 60% in the EA and MA groups, respectively. The EA and MA groups did not differ considerably from the HA group in terms of postoperative complications. Conclusions Unisurgeon uniportal wedge resection may be effectively performed using a robotic endoscope holder, without the need for any human assistants with an expert hand. However, the rate of surgical conversion increases with the complexity of uniportal anatomic resections. The passive platform appears to be more suitable for unisurgeon uniportal surgery than the active pedal-controlled platform given the equipment in contemporary operating rooms.
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Affiliation(s)
- Yi-Yu Lin
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Ming-Ju Hsieh
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Ching-Yang Wu
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan
| | - Ching-Feng Wu
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
- Department of Thoracic Surgery, Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospita, Coruña, Spain
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospita, Coruña, Spain
| | - Yin-Kai Chao
- College of Medicine, Chang Gung University, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan
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12
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Kato T, Katsuya R, Okado S, Sato K, Noritake O, Nakanishi K, Noguchi M, Kadomatsu Y, Ueno H, Ozeki N, Nakamura S, Fukumoto K, Chen-Yoshikawa TF. Real-world evidence of safety and influence for lung cancer surgery under COVID-19 pandemic in Japan. J Thorac Dis 2023; 15:542-551. [PMID: 36910056 PMCID: PMC9992575 DOI: 10.21037/jtd-22-1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/06/2023] [Indexed: 02/07/2023]
Abstract
Background The COVID-19 pandemic has affected the clinical practice of lung cancer surgery in Japan, but few studies have revealed the real situation of surgical practice for lung cancer in this country. This latest information will help us to decide the future direction of lung cancer surgery under pandemic circumstances. Methods We collected data from patients with primary lung cancer who underwent thoracic surgery between 2018 and 2021. To investigate the impact of the COVID-19 pandemic on lung cancer surgery, we compared between 2018-2019 (prepandemic group) and 2020-2021 (pandemic group) in the respect of patient characteristics, pathological findings, and short-term outcome after lung cancer resection by Mann-Whitney and Fisher's exact tests. Moreover, the monthly number of surgeries for lung cancer in our institution during 2020-2021 was compared with the number of newly diagnosed COVID-19 patients in Japan by Spearman correlation analysis. Results From 2018 through 2021, 936 patients with primary lung cancer underwent surgical intervention in our institute and were included in this study. The number of surgeries did not decrease in the pandemic group (n=443) compared with that in the prepandemic group (n=493). Tumor and invasive size in stage I which was measured by pathologist were significantly larger in the pandemic group than in the prepandemic group (tumor size: P=0.031, invasive size: P<0.001). In terms of postoperative short-term outcome, the median hospital stay was 6 days, 30-day mortality was 2, and morbidity was around 20% in both groups. Only one patient suffered from COVID-19 infection 5 months after right upper lobectomy. An increased ratio of newly diagnosed COVID-19 cases in Japan was negatively correlated with the number of surgeries for lung cancer in our institution in the next month (r=-0.393, P=0.007), although there was no correlation in the present or the month after next. Conclusions Even during the COVID-19 pandemic period, lung cancer surgery could be performed safely and in a sustainable manner. However, pathological findings of lung cancer tended to be progressive in early-stage lung cancer.
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Affiliation(s)
- Taketo Kato
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryotaro Katsuya
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoji Okado
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiyu Sato
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Osamu Noritake
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Nakanishi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Misa Noguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Fukumoto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Gbolahan O, Hashemi‐Sadraei N, Yash S, Williams G, Ramachandran R, Kim Y, Paluri R, Outlaw D, El‐Rayes B, Nabell L. Time to treatment initiation and its impact on real-world survival in metastatic colorectal cancer and pancreatic cancer. Cancer Med 2023; 12:3488-3498. [PMID: 35979540 PMCID: PMC9939095 DOI: 10.1002/cam4.5133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Given the dearth of data regarding the time to treatment initiation (TTI) in the palliative setting, and its impact on survival outcomes, we sought to determine TTI in a real-world cohort of metastatic colorectal cancer (mCRC) and metastatic pancreatic cancer (mPC) patients and evaluate the impact of TTI on real-world survival outcomes. METHODS We collected survival and treatment data for mCRC and mPC from the Flatiron Health electronic health records (EHR) derived database. We divided TTI into 3 categories: < 2 weeks, 2-< 4 weeks, and 4-8 weeks, from diagnosis to first-line therapy. Outcome measures were median TTI, real-world overall survival (RW-OS) based on TTI categories by Kaplan-Meier method, and impact of TTI on survival using cox proportional hazard models. RESULTS Among 7108 and 3231 patients with mCRC and mPC treated within 8 weeks of diagnosis, the median TTI were 28 days and 20 days. Median RW-OS for mCRC was 24 months; 26.9 months versus 22.6 and 18.05 months in the 4-8-week, 2-< 4 week (control) and < 2-week groups, respectively (p < 0.0001). For mPC, median RW-OS was 8 months, without significant difference in RW-OS among the groups (p = 0.05). The 4-8-week group was associated with lower hazard of death (HR 0.782, 95% CI 0.73-0.84, p < 0.0001) and the < 2-week group was associated with a higher hazard of death (HR 1.26, 95% CI 1.15-1.38, p < 0.0001) in mCRC. The 4-8-week group was associated with lower hazard of death for mPC (HR 0.88, 95% CI 0.8-0.97, p = 0.0094). CONCLUSION In a real-world cohort of patients treated within 8 weeks of diagnosis, and with the limitations of a retrospective study, later TTI did not have a negative impact on survival outcomes in mCRC and mPC.
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Affiliation(s)
- Olumide Gbolahan
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | | | - Suri Yash
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Grant Williams
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Rekha Ramachandran
- Division of Preventive MedicineUniversity of Alabama School of MedicineBirminghamAlabamaUSA
| | - Young‐il Kim
- Division of Preventive MedicineUniversity of Alabama School of MedicineBirminghamAlabamaUSA
| | - Ravikumar Paluri
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
- Wake Forest School of MedicineNorth CarolinaUnited States
| | - Darryl Outlaw
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Bassel El‐Rayes
- Emory University School of Medicine, and Winship Cancer InstituteGeorgia
| | - Lisle Nabell
- Birmingham School of Medicine and O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
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Moubarak S, Merheb D, Basbous L, Chamseddine N, Bou Zerdan M, Assi HI. COVID-19 and lung cancer: update on the latest screening, diagnosis, management and challenges. J Int Med Res 2022; 50:3000605221125047. [PMID: 36154328 PMCID: PMC9515530 DOI: 10.1177/03000605221125047] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lung cancer, considered one of the most common causes of cancer deaths worldwide,
is a complex disease with its own challenges. The coronavirus disease 2019
(COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), compounded these challenges and forced the medical healthcare
system to alter its approach to lung cancer. This narrative review aims to
identify the effect of the COVID-19 pandemic on lung cancer screening, diagnosis
and management. During this public health crisis, various medical societies have
worked on developing guidelines to protect patients with lung cancer from the
deleterious effects of SARS-CoV-2 infection, as well as from the complications
imposed by treatment delays. The different therapeutic approaches, such as
surgery, radiation oncology and immune checkpoint inhibitor therapy, along with
the latest international recommendations, will be discussed. Protecting patients
with lung cancer from COVID-19 complications, while avoiding barriers in
treatment delays, has brought unique challenges to healthcare facilities. Prompt
modifications to guidelines, and constant evaluation of their efficacy, are thus
needed.
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Affiliation(s)
- Simon Moubarak
- Department of Internal Medicine, Division of Hematology and
Oncology, Naef K. Basile Cancer Institute, , American University
of Beirut Medical Center, Beirut, Lebanon
| | - Diala Merheb
- Department of Internal Medicine, , Saint George
Hospital University Medical Center, Beirut, Lebanon
| | - Lynn Basbous
- Faculty of Medicine, American University of Beirut, Beirut,
Lebanon
| | - Nathalie Chamseddine
- Department of Internal Medicine, Division of Hematology and
Oncology, Naef K. Basile Cancer Institute, , American University
of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Division of Hematology and
Oncology, Naef K. Basile Cancer Institute, , American University
of Beirut Medical Center, Beirut, Lebanon
| | - Hazem I Assi
- Department of Internal Medicine, Division of Hematology and
Oncology, Naef K. Basile Cancer Institute, , American University
of Beirut Medical Center, Beirut, Lebanon
- Hazem I Assi, Naef K. Basile Cancer
Institute, American University of Beirut Medical Center, PO Box 11-0236, Riad El
Solh, Beirut 1107 2020, Lebanon.
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15
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Luc JGY, Pizano A, Udwadia F, Gupta S, Dairywala M, Joyce C, Robinson E, Rush G, Dunning J, Myers PO, Antonoff MB, Nguyen TC. Early effect of the COVID-19 pandemic on the North American cardiothoracic surgery job market. J Thorac Dis 2022; 14:3304-3313. [PMID: 36245601 PMCID: PMC9562543 DOI: 10.21037/jtd-22-320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022]
Abstract
Background The present study aims to report the early effect of the coronavirus disease 2019 (COVID-19) pandemic on the cardiothoracic surgery job market in North America. Methods The Cardiothoracic Surgery Network (CTSNet) job market database was queried, and patterns from January to May for 2019 versus January to May 2020 were compared for trends in job postings and job seekers. Results Our study is comprised of 395 cardiothoracic surgery job postings, of which 98% were positions located in North America and 63% were academic. The negative impact of the pandemic on the cardiothoracic surgery job market was greatest in the cardiothoracic/cardiovascular combined subspecialty, followed by congenital and adult cardiac surgery, whereas general thoracic surgery experienced an increase in proportion of jobs available. Despite an increase in views per job posted in 2020 vs. 2019 (532 vs. 290), employer views of job seeker curriculum vitae declined over the same time period in 2020 (January, 380 views/month to May, 3 views/month) compared to 2019 (January, 100 views/month to May, 54 views/month). Conclusions An analysis of job postings from CTSNet suggests a decline in job availability in the North American cardiothoracic surgical job market following declaration of the pandemic with acknowledgement that there is month to month variability and a supply-demand mismatch. The COVID-19 pandemic has had an unprecedented impact on our field, and the ultimate consequences remain unknown.
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Affiliation(s)
- Jessica G. Y. Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alejandro Pizano
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
| | - Farhad Udwadia
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed Dairywala
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, TX, USA
| | | | | | - Grahame Rush
- The Cardiothoracic Surgery Network, Chicago, IL, USA
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Patrick O. Myers
- Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tom C. Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, CA, USA
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16
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Abstract
BACKGROUND During the coronavirus disease 2019 pandemic, national guidelines recommended that elective surgery for esophageal cancer be deferred by 3 months when hospital resources are limited. The impact of this delay on patient outcomes is unknown. We sought to evaluate the survival of patients with stage I and II/III esophageal cancer who undergo early vs delayed treatment. STUDY DESIGN Using the National Cancer Database from 2010 to 2017, multivariable Cox proportional hazards modeling and propensity score-matched analysis were employed to compare survival of patients with stage I esophageal cancer who received early (0 to 4 weeks after diagnosis) vs delayed esophagectomy (12 to 16 weeks) and of patients with stage II/III esophageal cancer who-after receiving timely chemoradiation (0 to 4 weeks after diagnosis)-underwent early (9 to 17 weeks) vs delayed esophagectomy (21 to 29 weeks). RESULTS For stage I esophageal cancer, 226 (41.7%) patients underwent early esophagectomy, and 316 (58.3%) patients underwent delayed esophagectomy. Propensity score matching created 2 groups of 134 patients with early or delayed esophagectomy, whose 5-year survival was comparable (hazard ratio [HR] 65.0% [95% confidence interval (CI) 55.2% to 73.2%] vs HR 65.1% [95% CI 55.6% to 73.1%], p = 0.50). For stage II/III esophageal cancer, 1,236 (86.1%) patients underwent early esophagectomy, and 200 (13.9%) underwent delayed esophagectomy. Propensity score matching created 2 groups of 130 patients; the early esophagectomy group had improved 5-year survival compared with the delayed esophagectomy group (HR 41.6% [95% CI 32.1% to 50.8%] vs HR 22.9% [95% CI 14.9% to 31.8%], p = 0.006). CONCLUSIONS Early esophagectomy was associated with similar survival compared with delayed esophagectomy for patients with stage I esophageal cancer. For patients with stage II/III esophageal cancer, early esophagectomy was associated with improved survival relative to delayed esophagectomy.
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17
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Chikwe J. Editor’s Choice: Strengths, Challenges, and Opportunities. Ann Thorac Surg 2022; 113:1761-1766. [DOI: 10.1016/j.athoracsur.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Indexed: 11/01/2022]
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18
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Noll J, Reichert M, Dietrich M, Riedel JG, Hecker M, Padberg W, Weigand MA, Hecker A. When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA. Langenbecks Arch Surg 2022; 407:1315-1332. [PMID: 35307746 PMCID: PMC8934603 DOI: 10.1007/s00423-022-02495-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially "Long Covid") in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.
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Affiliation(s)
- J Noll
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Dietrich
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - J G Riedel
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Hecker
- Medical Clinic II, University Hospital of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M A Weigand
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.
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Nguyen DM, Kodia K, Szewczyk J, Alnajar A, Stephens-McDonnough JA, Villamizar NR. Effect of COVID-19 on the delivery of care for thoracic surgical patients. JTCVS OPEN 2022; 10:456-468. [PMID: 35194585 PMCID: PMC8849839 DOI: 10.1016/j.xjon.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/02/2021] [Indexed: 12/01/2022]
Abstract
Objective In this study we aimed to determine the effect of the COVID-19 pandemic on the delivery of care for thoracic surgical patients at an urban medical center. Methods A retrospective analysis of all thoracic surgical cases from May 1, 2019, to December 31, 2020, was conducted. Demographic characteristics, preoperative surgical indications, procedures, final pathologic diagnoses, and perioperative outcomes were recorded. A census of operative cases, relevant ancillary services, and outpatient thoracic clinics were obtained from our institutional database. Results Six hundred nineteen cases were included in this study (329 pre-COVID-19 and 290 COVID-19, representing an 11.8% reduction). There were no differences in type of thoracic procedures or perioperative outcomes among the 2 cohorts. Prolonged reduction of thoracic surgical cases (50% of baseline) during the first half of the COVID-19 period was followed by a resurgence of surgical volumes to 110% of baseline in the second half. A similar incidence of cases were performed for oncologic indications during the first half whereas more benign cases were performed in the second half, coinciding with the launch of our robotic foregut surgery program. After undergoing surgery during the pandemic, none of our patients reported COVID-19 symptoms within 14 days of discharge. Conclusions During the initial surge of COVID-19, while there was temporary closure of operative services, our health care system continued to provide safe care for thoracic surgery patients, particularly those with oncologic indications. Since phased reopening, we have experienced a rebound of surgical volume and case mix, ultimately mitigating the initial negative effect of the pandemic on delivery of thoracic surgical care.
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Raveglia F, Orlandi R, Li H, Cerfolio R, Tam JKC, Scarci M. Editorial: Rethink Thoracic Surgery as a Whole After the Pandemic. How to Optimize Resources and Deliver Excellent Patient Care. Front Surg 2022; 9:920626. [PMID: 35706849 PMCID: PMC9191574 DOI: 10.3389/fsurg.2022.920626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Riccardo Orlandi
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Robert Cerfolio
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - John Kit Chung Tam
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore, Singapore
| | - Marco Scarci
- Department of Thoracic Surgery, Hammersmith Hospital, London, UK
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21
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Zhang J, Han Y, Zhang Y, Dong D, Cao Y, Chen X, Li H. Considerations for the Surgical Management of Thoracic Cancers During the COVID-19 Pandemic: Rational Strategies for Thoracic Surgeons. Front Surg 2022; 9:742007. [PMID: 35615657 PMCID: PMC9124784 DOI: 10.3389/fsurg.2022.742007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/23/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The novel Coronavirus Disease 2019 (COVID-19) has resulted in a global health crisis since first case was identified in December 2019. As the pandemic continues to strain global public health systems, elective surgeries for thoracic cancer, such as early-stage lung cancer and esophageal cancer (EC), have been postponed due to a shortage of medical resources and the risk of nosocomial transmission. This review is aimed to discuss the influence of COVID-19 on thoracic surgical practice, prevention of nosocomial transmission during the pandemic, and propose modifications to the standard practices in the surgical management of different thoracic cancer. Methods A literature search of PubMed, Medline, and Google Scholar was performed for articles focusing on COVID-19, early-stage lung cancer, and EC prior to 1 July 2021. The evidence from articles was combined with our data and experience. Results We review the challenges in the management of different thoracic cancer from the perspectives of thoracic surgeons and propose rational strategies for the diagnosis and treatment of early-stage lung cancer and EC during the COVID-19 pandemic. Conclusions During the COVID-19 pandemic, the optimization of hospital systems and medical resources is to fight against COVID-19. Indolent early lung cancers, such as pure ground-glass nodules/opacities (GGOs), can be postponed with a lower risk of progression, while selective surgeries of more biologically aggressive tumors should be prioritized. As for EC, we recommend immediate or prioritized surgeries for patients with stage Ib or more advanced stage and patients after neoadjuvant therapy. Routine COVID-19 screening should be performed preoperatively before thoracic surgeries. Prevention of nosocomial transmission by providing appropriate personal protective equipment (PPE), such as N-95 respirator masks with eye protection to healthcare workers, is necessary.
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Affiliation(s)
| | | | | | | | | | | | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Overview of Cardiothoracic Surgeon Compensation: Practice Setting, Productivity, and Payment Structures. Ann Thorac Surg 2022; 114:2383-2390. [PMID: 35337788 DOI: 10.1016/j.athoracsur.2022.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/29/2021] [Accepted: 02/01/2022] [Indexed: 11/20/2022]
Abstract
The Centers for Medicare and Medicaid Services recently proposed a substantial cut to reimbursement for surgical services, punctuating a steady decline in reimbursement for clinical services provided by cardiothoracic surgeons during the last several decades. Meanwhile, the costs of practicing cardiothoracic surgery continue to increase. In an effort to defect against diminishing control over patient care and further negative changes affecting reimbursement, cardiothoracic surgeons must be able to convincingly demonstrate their value to patients and the health care system. However, the overall contribution of a cardiothoracic surgeon can be difficult to measure objectively and varies widely according to a host of factors, including practice setting, experience, subspecialization, and the local market. To address these challenges, The Society of Thoracic Surgeons Workforce on Practice Management has commissioned a Writing Task Force to raise awareness, to concentrate knowledge, and to organize information related to compensation as a comprehensive resource for cardiothoracic surgeons. The purpose of this initial report is to provide an overview of the major factors having an impact on compensation for cardiothoracic surgeons.
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23
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Safety and Feasibility of Lung Cancer Surgery under the COVID-19 Circumstance. Cancers (Basel) 2022; 14:cancers14051334. [PMID: 35267642 PMCID: PMC8909353 DOI: 10.3390/cancers14051334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The global coronavirus disease 2019 (COVID-19) pandemic has drastically changed the current practice of medicine worldwide. As more clinical data is collected and processed, we are beginning to have an understanding of which patients are more at risk for severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Preliminary data has shown that patients with lung cancer are disproportionally affected by the current COVID-19 pandemic. Furthermore, studies have shown that lung cancer patients are also significantly more likely to be admitted to the ICU and need mechanical ventilation. A specific subset of patients that are even more at risk for severe COVID-19 are those that require lung cancer surgery. To minimize the risk of SARS-CoV-2 infections in patients undergoing surgery, new treatment guidelines and preventive measures are necessary. In this review, we summarize the latest evidence regarding recommendations for patients undergoing lung cancer surgery in the COVID-19 era. Abstract The current coronavirus disease 2019 (COVID-19) pandemic has forced healthcare providers worldwide to adapt their practices. Our understanding of the effects of COVID-19 has increased exponentially since the beginning of the pandemic. Data from large-scale, international registries has provided more insight regarding risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and has allowed us to delineate specific subgroups of patients that have higher risks for severe complications. One particular subset of patients that have significantly higher risks of SARS-CoV-2 infection with higher morbidity and mortality rates are those that require surgical treatment for lung cancer. Earlier studies have shown that COVID-19 infections in patients that underwent lung cancer surgery is associated with higher rates of respiratory failure and mortality. However, deferral of cancer treatments is associated with increased mortality as well. This creates difficult situations in which healthcare providers are forced to weigh the benefits of surgical treatment against the possibility of SARS-CoV-2 infections. A number of oncological and surgical organizations have proposed treatment guidelines and recommendations for patients planned for lung cancer surgery. In this review, we summarize the latest data and recommendations for patients undergoing lung cancer surgery in the COVID-19 circumstance.
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24
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Villena-Vargas J, Lutton EM, Mynard N, Nasar A, Voza F, Chow O, Lee B, Harrison S, Stiles BM, Port JL, Altorki NK. Safety of Lung Cancer Surgery During COVID-19 in a Pandemic Epicenter. J Thorac Cardiovasc Surg 2022; 164:378-385. [PMID: 35459540 PMCID: PMC8885108 DOI: 10.1016/j.jtcvs.2021.11.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/20/2021] [Accepted: 11/01/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jonathan Villena-Vargas
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Evan M Lutton
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Nathan Mynard
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Abu Nasar
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Francesca Voza
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Oliver Chow
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Benjamin Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY
| | - Nasser K Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY.
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25
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Wei TJ, Hsiung PY, Liu JH, Lin TC, Kuo FT, Wu CY. Use of Electronic Auscultation in Full Personal Protective Equipment to Detect Ventilation Status in Selective Lung Ventilation: A Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:851395. [PMID: 35265648 PMCID: PMC8899469 DOI: 10.3389/fmed.2022.851395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/31/2022] [Indexed: 01/25/2023] Open
Abstract
Chest auscultation is the first procedure performed to detect endotracheal tube malpositioning but conventional stethoscopes do not conform to the personal protective equipment (PPE) protocol during the COVID-19 pandemic. This double-blinded randomized controlled trial evaluated the feasibility of using ear-contactless electronic stethoscope to identify endobronchial blocker established selective lung ventilation, simulating endobronchial intubation during thoracic surgery with full PPE. Conventional and electronic auscultation was performed without and with full PPE, respectively, of 50 patients with selective lung ventilation. The rates of correct ventilation status detection were 86 and 88% in the conventional and electronic auscultation groups (p = 1.00). Electronic auscultation revealed a positive predictive value of 87% (95% CI 77 to 93%), and a negative predictive value of 91% (95% CI 58 to 99%), comparable to the results for conventional auscultation. For detection of the true unilateral lung ventilation, the F1 score and the phi were 0.904 and 0.654, respectively for conventional auscultation; were 0.919 and 0.706, respectively for electronic auscultation. Furthermore, the user experience questionnaire revealed that the majority of participant anesthesiologists (90.5%) rated the audio quality of electronic lung sounds as comparable or superior to that of conventional acoustic lung sounds. In conclusion, electronic auscultation assessments of ventilation status as examined during thoracic surgery in full PPE were comparable in accuracy to corresponding conventional auscultation assessments made without PPE. Users reported satisfactory experience with the electronic stethoscope.
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Affiliation(s)
| | | | | | | | | | - Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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26
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Major Pulmonary Resection for Non-Small Cell Lung Carcinoma during the COVID-19 Pandemic—Single Israeli Center Cross-Sectional Study. J Clin Med 2022; 11:jcm11041102. [PMID: 35207376 PMCID: PMC8876835 DOI: 10.3390/jcm11041102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The highly contagious COVID-19 has created unprecedented challenges in providing care to patients with resectable non-small cell lung carcinoma (NSCLC). Surgical management now needs to consider the risks of malignant disease progression by delaying surgery, and those of COVID-19 transmission to patients and operating room staff. The goal of our study was to describe our experience in providing both emergent and elective surgical procedures for patients with NSCLC during the COVID-19 pandemic in Israel, and to present our point of view regarding the safety of performing lung cancer surgery. Methods: This observational cross-sectional study included all consecutive patients with NSCLC who operated at Tel Aviv Medical Center, a large university-affiliated hospital, from February 2020 through December 2020, during the COVID-19 pandemic in Israel. The patients’ demographics, COVID-19 preoperative screening results, type and side of surgery, pathology results, morbidity and mortality rates, postoperative complications, including pulmonary complications management, and hospital stay were evaluated. Results: Included in the study were 113 patients, 68 males (60.2%) and 45 females (39.8%), with a median age of 68.2 years (range, 41–89). Of these 113 patients, 83 (73.5%) underwent video-assisted thoracic surgeries (VATS), and 30 (26.5%) underwent thoracotomies. Fifty-five patients (48.7%) were preoperatively screened for COVID-19 and received negative results. Fifty-six postoperative complications were reported in 35 patients (30.9%). A prolonged air leak was detected in 11 patients (9.7%), atrial fibrillation in 11 patients (9.7%), empyema in 5 patients (4.4%), pneumonia in 9 patients (7.9%) and lobar atelectasis in 7 patients (6.2%). Three patients (2.7%) with postoperative pulmonary complications required mechanical ventilation, and two of them (1.6%) underwent tracheostomy. Two patients (1.6%) were postoperatively diagnosed as positive for COVID-19. Conclusions: Our data demonstrate the feasibility and efficacy of implementing precautionary strategies to ensure the safety of lung cancer patients undergoing pulmonary resection during the COVID-19 pandemic. The strategy was equally effective in protecting the surgical staff and healthcare providers, and we recommend performing lung cancer surgery during the pandemic era.
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27
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Banfill K, Croxford W, Fornacon-Wood I, Wicks K, Ahmad S, Britten A, Carson C, Dorey N, Hatton M, Hiley C, Thippu Jayaprakash K, Jegannathen A, Koh P, Panakis N, Peedell C, Pope A, Powell C, Stilwell C, Thomas B, Toy E, Wood V, Yahya S, Zhou SY, Price G, Faivre-Finn C. Changes in the Management of Patients having Radical Radiotherapy for Lung Cancer during the First Wave of the COVID-19 Pandemic in the UK. Clin Oncol (R Coll Radiol) 2022; 34:19-27. [PMID: 34763964 PMCID: PMC8552552 DOI: 10.1016/j.clon.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/15/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022]
Abstract
AIMS In response to the COVID-19 pandemic, guidelines on reduced fractionation for patients treated with curative-intent radiotherapy were published, aimed at reducing the number of hospital attendances and potential exposure of vulnerable patients to minimise the risk of COVID-19 infection. We describe the changes that took place in the management of patients with stage I-III lung cancer from April to October 2020. MATERIALS AND METHODS Lung Radiotherapy during the COVID-19 Pandemic (COVID-RT Lung) is a prospective multicentre UK cohort study. The inclusion criteria were: patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between 2nd April and 2nd October 2020. Patients who had had a change in their management and those who continued with standard management were included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment were collected and reported as counts and percentages. Patient characteristics associated with a change in treatment were analysed using multivariable binary logistic regression. RESULTS In total, 1553 patients were included (median age 72 years, 49% female); 93 (12%) had a change to their diagnostic investigation and 528 (34%) had a change to their treatment from their centre's standard of care as a result of the COVID-19 pandemic. Age ≥70 years, male gender and stage III disease were associated with a change in treatment on multivariable analysis. Patients who had their treatment changed had a median of 15 fractions of radiotherapy compared with a median of 20 fractions in those who did not have their treatment changed. Low rates of COVID-19 infection were seen during or after radiotherapy, with only 21 patients (1.4%) developing the disease. CONCLUSIONS The COVID-19 pandemic resulted in changes to patient treatment in line with national recommendations. The main change was an increase in hypofractionation. Further work is ongoing to analyse the impact of these changes on patient outcomes.
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Affiliation(s)
- K Banfill
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - W Croxford
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - K Wicks
- The University of Manchester, Manchester, UK
| | - S Ahmad
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Britten
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C Carson
- The Northern Ireland Cancer Centre, Belfast, UK
| | - N Dorey
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - C Hiley
- University College London Hospitals, London, UK
| | - K Thippu Jayaprakash
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Jegannathen
- University Hospitals North Midlands, Stoke-on-Trent, UK
| | - P Koh
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - N Panakis
- Oxford Universities NHS Trust, Oxford, UK
| | - C Peedell
- The James Cook University Hospital, Middlesbrough, UK
| | - A Pope
- Clatterbridge Cancer Centre, Bebington, UK
| | - C Powell
- Velindre Cancer Centre, Cardiff, UK
| | | | - B Thomas
- Swansea Bay University Hospital, Swansea, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - V Wood
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - S Yahya
- University Hospitals Birmingham, Birmingham, UK
| | - S Y Zhou
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - G Price
- The University of Manchester, Manchester, UK
| | - C Faivre-Finn
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
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28
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Pozzi N, Zuckerman A, Son J, Geraci TC, Chang SH, Cerfolio RJ. Managing Scarcity: Innovation and Resilience During the COVID-19 Pandemic. Front Surg 2021; 8:769962. [PMID: 34722628 PMCID: PMC8551480 DOI: 10.3389/fsurg.2021.769962] [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: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 01/30/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic remains a disruptive force upon the health care system, with particular import for thoracic surgery given the pulmonary pathophysiology and disease implications of the virus. The rapid and severe onset of disease required expedient innovation and change in patient management and novel approaches to care delivery and nimbleness of workforce. In this review, we detail our approaches to patients with COVID-19, including those that required surgical intervention, our expedited and novel approach to bronchoscopy and tracheostomy, and our expansion of telehealth. The pandemic has created a unique opportunity to reflect on our delivery of care in thoracic surgery and apply lessons learned during this time to "rethink" how to optimize resources and deliver excellent and cutting-edge patient care.
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Affiliation(s)
- Natalie Pozzi
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Aaron Zuckerman
- Department of General Surgery, NYU Langone Health-Brooklyn, Brooklyn, NY, United States
| | - Joohee Son
- Department of General Surgery, NYU Langone Health-Brooklyn, Brooklyn, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
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29
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Invited Commentary. J Am Coll Surg 2021; 232:605-606. [PMID: 33771318 PMCID: PMC7985434 DOI: 10.1016/j.jamcollsurg.2020.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
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30
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Fraser R, Steven M, McCall P, Shelley B. Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:405-413. [PMID: 34276253 PMCID: PMC8275630 DOI: 10.1007/s40140-021-00467-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review explores recent international guidance on the anesthetic management of patients undergoing thoracic surgery during the COVID-19 pandemic: those with suspected or confirmed COVID-19 requiring urgent thoracic surgery and those presenting for elective procedures. RECENT FINDINGS A significant mortality risk is associated with patients with COVID-19 undergoing thoracic surgery; therefore, where possible, it should be avoided. Thoracic surgery also carries a significant risk of viral transmission to healthcare workers due to the necessarily high frequency of intraoperative aerosol-generating procedures involved, such as lung isolation, one-lung ventilation, and flexible bronchoscopy. SUMMARY Guidelines recommend appropriate personal protective equipment and numerous procedural modifications to prevent viral transmission to staff and other patients. With appropriate disease mitigation strategies in place, elective thoracic surgery, in particular for lung cancer, has been able to continue safely in many centres.
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Affiliation(s)
- R. Fraser
- Cardiothoracic Anaesthesia, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY UK
| | - M. Steven
- Cardiothoracic Anaesthesia, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY UK
| | - P. McCall
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, UK
- Critical Care and Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
| | - B. Shelley
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Glasgow, UK
- Critical Care and Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
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31
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Luc JGY, Nguyen TC, Ad N. Impact of the Coronavirus Disease 2019 Pandemic on Cardiac Surgical Education in North America. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:350-357. [PMID: 34167378 DOI: 10.1177/15569845211011459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We report the impact of the coronavirus disease 2019 (COVID-19) pandemic on cardiac surgery trainee education in North America. METHODS A survey was sent to participating academic adult cardiac surgery centers in North America. Data regarding the effect of COVID-19 on cardiac surgery training were analyzed. RESULTS Responses were received from 53 academic institutions with diverse geographic distribution. Cardiac surgery trainee re-deployment to alternative clinical duties peaked at the height of the pandemic. We stratified institutions based on high (n = 20) and low burden (n = 33) of patients hospitalized with COVID-19. The majority of institutions have converted didactics (high burden 90% vs low burden 73%) and interviews for jobs/fellowships (high burden 75% vs low burden 73%) from in-person to virtual. Institutions were mixed in preference for administration of the licensing examination, with the most common preference for examinations to be held remotely on normal timeline (high burden 45% vs low burden 30%) or in person with more than 3-month delay (high burden 20% vs low burden 33%). Despite the challenges experienced during the COVID-19 pandemic on trainee clinical experience, re-deployment, and decreased operative volume, institutions expected their trainees to graduate on schedule (high burden 95% vs low burden 91%). CONCLUSIONS Our study demonstrates that actions taken during the COVID-19 pandemic has led to disruptions in cardiac surgery training with transition of didactics and interviews virtually and re-deployment to alternative duties. Despite this, institutions remain optimistic that their trainees will graduate on schedule.
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Affiliation(s)
- Jessica G Y Luc
- 8166 Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, TX, USA
| | - Niv Ad
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Adventist White Oak Medical Center, Silver Spring, MD, USA
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Thoracic Surgery in the COVID-19 Pandemic: A Novel Approach to Reach Guideline Consensus. J Clin Med 2021; 10:jcm10132769. [PMID: 34202563 PMCID: PMC8269029 DOI: 10.3390/jcm10132769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 01/16/2023] Open
Abstract
The COVID-19 pandemic challenges international and national healthcare systems. In the field of thoracic surgery, procedures may be deferred due to mandatory constraints of the access to diagnostics, staff and follow-up facilities. There is a lack of prospective data on the management of benign and malignant thoracic conditions in the pandemic. Therefore, we derived recommendations from 14 thoracic societies to address key questions on the topic of COVID-19 in the field of thoracic surgery. Respective recommendations were extracted and the degree of consensus among different organizations was calculated. A high degree of consensus was found to temporarily suspend non-critical elective procedures or procedures for benign conditions and to prioritize patients with symptomatic or advanced cancer. Prior to hospitalization, patients should be screened for respiratory symptoms indicating possible COVID-19 infection and most societies recommended to screen all patients for COVID-19 prior to admission. There was a weak consensus on the usage of serology tests and CT scans for COVID-19 diagnostics. Nearly all societies suggested to postpone elective procedures in patients with suspected or confirmed COVID-19 and recommended constant reevaluation of these patients. Additionally, we summarized recommendations focusing on precautions in the theater and the management of chest drains. This study provides a novel approach to informed guidance for thoracic surgeons during the COVID-19 pandemic in the absence of scientific evidence-based data.
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Raveglia F, Orlandi R, Rimessi A, Minervini F, Cioffi U, De Simone M, Guttadauro A, Scarci M. Standardization of Procedures to Contain Cost and Reduce Variability of Care After the Pandemic. Front Surg 2021; 8:695341. [PMID: 34250010 PMCID: PMC8264450 DOI: 10.3389/fsurg.2021.695341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our private and professional routine. In particular, the lockdowns have severely affected the entire healthcare system and hospital activities, forcing it to rethink the protocols in force. We suggest that this scenario, in spite of the new challenges involving so far complex healthcare providers, may lead to the unique opportunity to rethink pathways and management of patients. Indeed, having to resume institutional activity after a long interruption that has completely canceled the previously existing schemes, healthcare providers have the unique opportunity to overcome obsolete and “we have always done in this way” model on the wave of the general desire to resume a normal life. Furthermore, the pandemic has highlighted some flaws in our health system, highlighting those critical issues that most need to be addressed. This article is a review of pre-pandemic literature addressing the use of Lean Six Sigma (LSS) and standardization processes in thoracic surgery to improve efficiency. Our goal is to identify the main issues that could be successfully improved along the entire pathway of a patient from the first referral to diagnosis, hospitalization, and surgical operation up to convalescence. Furthermore, we aim to identify the standardization processes that have been implemented to achieve significant improvements in patient outcomes while reducing costs. The methods and goals that could be used in the near future to modernize our healthcare systems are drawn up from a careful reading and interpretation in light of the pandemic of the most significant review articles in the literature.
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Affiliation(s)
- Federico Raveglia
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Riccardo Orlandi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Arianna Rimessi
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
| | - Fabrizio Minervini
- Thoracic Surgery, Lucerne Cantonal Hospital, University of Lucerne, Lucerne, Switzerland
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | | | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Marco Scarci
- Thoracic Surgery, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST)-Monza, Monza, Italy
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Martínez-Hernández NJ, Caballero Silva U, Cabañero Sánchez A, Campo-Cañaveral de la Cruz JL, Obeso Carillo A, Jarabo Sarceda JR, Sevilla López S, Cilleruelo Ramos Á, Recuero Díaz JL, Call S, Couñago F, Hernando Trancho F. Effect of COVID-19 on Thoracic Oncology Surgery in Spain: A Spanish Thoracic Surgery Society (SECT) Survey. Cancers (Basel) 2021; 13:2897. [PMID: 34207878 PMCID: PMC8226458 DOI: 10.3390/cancers13122897] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 01/02/2023] Open
Abstract
After the first wave of COVID-19, the Spanish Society of Thoracic Surgeons (SECT) surveyed its members to assess the impact of the pandemic on thoracic oncology surgery in Spain. In May 2020, all SECT members were invited to complete an online, 40-item, multiple choice questionnaire. The questionnaire was developed by the SECT Scientific Committee and sent via email. The overall response rate was 19.2%. The respondents answered at least 91.5% of the items, with only one exception (a question about residents). Most respondents (89.3%) worked in public hospitals. The reported impact of the pandemic on routine clinical activity was considered extreme or severe by 75.5% of respondents (25.5% and 50%, respectively). Multidisciplinary tumour boards were held either with fewer members attending or through electronic platforms (44.6% and 35.9%, respectively). Surgical activity decreased by 95.7%, with 41.5% of centers performing surgery only on oncological patients and 11.7% only in emergencies. Nearly 60% of respondents reported modifying standard protocols for early-stage cancer and in the preoperative workup. Most centers (≈80%) reported using full personal protective equipment when operating on COVID-19 positive patients. The COVID-19 pandemic severely affected thoracic oncology surgery in Spain. The lack of common protocols led to a variable care delivery to lung cancer patients.
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Affiliation(s)
| | - Usue Caballero Silva
- Thoracic Surgery, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (U.C.S.); (A.C.S.)
| | | | | | - Andrés Obeso Carillo
- Thoracic Surgery, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | | | | | | | - José Luis Recuero Díaz
- Thoracic Surgery, Instituto de Investigación Sanitaria de Aragón, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Sergi Call
- Thoracic Surgery, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain;
| | - Felipe Couñago
- Radiation Oncology, Hospital Universitario Quirónsalud, 28223 Pozuelo de Alarcón, Spain;
- Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Radiation Oncology, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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35
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Scarci M, Raveglia F, Bortolotti L, Benvenuti M, Merlo L, Petrella L, Cardillo G, Rocco G. COVID-19 After Lung Resection in Northern Italy. Semin Thorac Cardiovasc Surg 2021; 34:726-732. [PMID: 33989754 PMCID: PMC8111882 DOI: 10.1053/j.semtcvs.2021.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/16/2022]
Abstract
We reviewed surgical cases from 4 Thoracic Surgery departments in the Lombardia region of Italy, the area mostly affected by Coronavirus pandemic in Europe, with the aim to describe the impact of COVID-19 on the treatment of thoracic surgical patients. Clinical, radiological and laboratory data from patients who underwent lung resection from December 2019 to March 2020 were retrospectively collected until June 2020. Univariable Cox regression models were estimated to evaluate potential prognostic factors for developing COVID-19 and to investigate postoperative mortality among patients who developed symptomatic COVID-19 infection. We examined data from 107 patients. (74 lobectomies, 32 wedge/segmentectomies and 1 pneumonectomy). Twelve patients developed COVID-19 (Group 1), whereas 95 patients were not infected (Group 2). In Group 1, 6 patients (50%) died from complications related to infection; in Group 2, one patient (1%) died because of non-COVID-19-related causes. Median days from surgery to first symptoms, CT confirmation, clinical confirmation and PCR positivity was 48.1, 54.3, 55.1, and 55.2 respectively. At univariable analysis, DLCO/VA% (P = 0.008), duration of the surgery (P = 0.009), smoking history (pack/year) (P < 0.001), BMI (P< 0.001) and number of segments resected (P = 0.010) were associated with COVID-19 onset. Moreover, CCI (P < 0.001), DLCO/VA% (P = 0.002), cigarette pack/year (P < 0.001), BMI (P < 0.001) and COVID-19 (P < 0.001) were associated with death. Patients who undergo lung resection and then develop symptomatic COVID-19 infection are at higher risk of developing severe respiratory complications and postoperative death. Insidious symptoms’ onset may lead to a delay in diagnosis. We suggest two mitigating strategies: (1) Improve symptoms surveillance and isolation during recovery period, (2) Be aware of a potential greater risk of developing symptomatic COVID-19 and death correlated with elevated CCI, BMI, smoking history, DLCO/VA%, number of resected segments and duration of surgery.
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Affiliation(s)
| | | | | | | | - Luca Merlo
- Department of Statistical Sciences, Sapienza University of Rome, Italy
| | - Lea Petrella
- MEMOTEF Department, Sapienza University of Rome, Italy
| | | | - Gaetano Rocco
- Thoracic Surgery, Memorial Sloan Kettering, Cornell University, New York
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36
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Heiden BT, Eaton DB, Engelhardt KE, Chang SH, Yan Y, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non-Small Cell Lung Cancer. JAMA Netw Open 2021; 4:e2111613. [PMID: 34042991 PMCID: PMC8160592 DOI: 10.1001/jamanetworkopen.2021.11613] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The association between delayed surgical treatment and oncologic outcomes in patients with non-small cell lung cancer (NSCLC) is poorly understood given that prior studies have used imprecise definitions for the date of cancer diagnosis. OBJECTIVE To use a uniform method to quantify surgical treatment delay and to examine its association with several oncologic outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using a novel data set from the Veterans Health Administration (VHA) system. Included patients had clinical stage I NSCLC and were undergoing resection from 2006 to 2016 within the VHA system. Time to surgical treatment (TTS) was defined as the time between preoperative diagnostic computed tomography imaging and surgical treatment. We evaluated the association between TTS and several delay-associated outcomes using restricted cubic spline functions. Data analyses were performed in November 2021. EXPOSURE Wait time between cancer diagnosis and surgical treatment (ie, TTS). MAIN OUTCOMES AND MEASURES Several delay-associated oncologic outcomes, including pathologic upstaging, resection with positive margins, and recurrence, were assessed. We also assessed overall survival. RESULTS Among 9904 patients who underwent surgical treatment for clinical stage I NSCLC, 9539 (96.3%) were men, 4972 individuals (50.5%) were currently smoking, and the mean (SD) age was 67.7 (7.9) years. The mean (SD) TTS was 70.1 (38.6) days. TTS was not associated with increased risk of pathologic upstaging or positive margins. Recurrence was detected in 4158 patients (42.0%) with median (interquartile range) follow-up of 6.15 (2.51-11.51) years. Factors associated with increased risk of recurrence included younger age (hazard ratio [HR] for every 1-year increase in age, 0.992; 95% CI, 0.987-0.997; P = .003), higher Charlson Comorbidity Index score (HR for every 1-unit increase in composite score, 1.055; 95% CI, 1.037-1.073; P < .001), segmentectomy (HR vs lobectomy, 1.352; 95% CI, 1.179-1.551; P < .001) or wedge resection (HR vs lobectomy, 1.282; 95% CI, 1.179-1.394; P < .001), larger tumor size (eg, 31-40 mm vs <10 mm; HR, 1.209; 95% CI, 1.051-1.390; P = .008), higher tumor grade (eg, II vs I; HR, 1.210; 95% CI, 1.085-1.349; P < .001), lower number of lymph nodes examined (eg, ≥10 vs <10; HR, 0.866; 95% CI, 0.803-0.933; P < .001), higher pathologic stage (III vs I; HR, 1.571; 95% CI, 1.351-1.837; P < .001), and longer TTS, with increasing risk after 12 weeks. For each week of surgical delay beyond 12 weeks, the hazard for recurrence increased by 0.4% (HR, 1.004; 95% CI, 1.001-1.006; P = .002). Factors associated with delayed surgical treatment included African American race (odds ratio [OR] vs White race, 1.267; 95% CI, 1.112-1.444; P < .001), higher area deprivation index [ADI] score (OR for every 1 unit increase in ADI score, 1.005; 95% CI, 1.002-1.007; P = .002), lower hospital case load (OR for every 1-unit increase in case load, 0.998; 95% CI, 0.998-0.999; P = .001), and year of diagnosis, with less recent procedures more likely to have delay (OR for each additional year, 0.900; 95% CI, 0.884-0.915; P < .001). Patients with surgical treatment within 12 weeks of diagnosis had significantly better overall survival than those with procedures delayed more than 12 weeks (HR, 1.132; 95% CI, 1.064-1.204; P < .001). CONCLUSIONS AND RELEVANCE Using a more precise definition for TTS, this study found that surgical procedures delayed more than 12 weeks were associated with increased risk of recurrence and worse survival. These findings suggest that patients with clinical stage I NSCLC should undergo expeditious treatment within that time frame.
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Affiliation(s)
- Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | | | - Kathryn E. Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Su-Hsin Chang
- VA St Louis Health Care System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Yan Yan
- VA St Louis Health Care System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
- VA St Louis Health Care System, St Louis, Missouri
| | - Ruben G. Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
- VA St Louis Health Care System, St Louis, Missouri
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
- VA St Louis Health Care System, St Louis, Missouri
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37
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The management of postoperative COVID-19 pneumonia in a case with right pneumonectomy. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:275-278. [PMID: 34104525 PMCID: PMC8167471 DOI: 10.5606/tgkdc.dergisi.2021.20074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
A 61-year-old male patient was hospitalized for the evaluation of a lung mass. The patient underwent right pneumonectomy. Although reverse-transcription polymerase chain reaction tests were negative for COVID-19, the diagnosis was supported by thoracic computed tomography. The patient responded to COVID-19 treatment, as evidenced by thoracic computed tomography. This case report highlights the importance of prompt diagnosis and treatment of COVID-19 in a patient who underwent pneumonectomy, which has high mortality and morbidity rates.
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38
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Boisen ML, Fernando RJ, Kolarczyk L, Teeter E, Schisler T, La Colla L, Melnyk V, Robles C, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights From 2020. J Cardiothorac Vasc Anesth 2021; 35:2855-2868. [PMID: 34053812 DOI: 10.1053/j.jvca.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022]
Abstract
Selected highlights in thoracic anesthesia in 2020 include updates in the preoperative assessment and prehabilitation of patients undergoing thoracic surgery; updates in one-lung ventilation (OLV) pertaining to the devices used for OLV; the use of dexmedetomidine for lung protection during OLV and protective ventilation, recommendations for the care of thoracic surgical patients with coronavirus disease 2019; a review of recent meta-analyses comparing truncal blocks with paravertebral and thoracic epidural blocks; and a review of outcomes after initiating the enhanced recovery after surgery guidelines for lung and esophageal surgery.
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Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Luca La Colla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vladyslav Melnyk
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Constantin Robles
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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Wang A, Chang SH, Kim EJ, Bessich JL, Sabari JK, Cooper B, Geraci TC, Cerfolio RJ. Dynamic Management of Lung Cancer Care During Surging COVID-19. Front Surg 2021; 8:663364. [PMID: 33898509 PMCID: PMC8059638 DOI: 10.3389/fsurg.2021.663364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
Management of patients with lung cancer continues to be challenging during the COVID-19 pandemic, due to the increased risk of complications in this subset of patients. During the COVID-19 surge in New York City, New York University Langone Health adopted triage strategies to help with care for lung cancer patients, with good surgical outcomes and no transmission of COVID-19 to patients or healthcare workers. Here, we will review current recommendations regarding screening and management of lung cancer patients during both a non-surge phase and surge phase of COVID-19.
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Affiliation(s)
- Annie Wang
- Department of Surgery, New York University Langone Health, New York, NY, United States
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Eric J Kim
- New York University Grossman School of Medicine, New York, NY, United States
| | - Jamie L Bessich
- Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Joshua K Sabari
- Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Benjamin Cooper
- Department of Radiation Oncology, New York University Langone Health, New York, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, United States
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40
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Elective lung resection after treatment for COVID-19 pneumonia. Gen Thorac Cardiovasc Surg 2021; 69:1159-1162. [PMID: 33811611 PMCID: PMC8019292 DOI: 10.1007/s11748-021-01630-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022]
Abstract
A 65-year-old man with coronavirus disease 2019 (COVID-19) was admitted to our hospital. Computed tomography detected bilateral pneumonia with a lung nodule suspicious for lung cancer. Lobectomy was performed 3 months after the treatment for COVID-19 without any complications. The surgical specimen revealed fibrosis below the pleura with a small collection of lymphocytes and intravascular hemorrhagic thrombosis, and no residual RNA was detected. This is the first report describing a surgical specimen after recovery from COVID-19 pneumonia, and suggests that elective thoracic surgery can be performed safely, depending on the patient’s respiratory function, without infectious risk.
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41
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Perri JL, Nguyen TC. Commentary: Cardiac Surgery Cannot Wait in the Wings - The Show Must Go On. Semin Thorac Cardiovasc Surg 2021; 34:189-190. [PMID: 33662554 PMCID: PMC7919517 DOI: 10.1053/j.semtcvs.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer L Perri
- Division of Adult Cardiothoracic Surgery, UCSF Health, San Francisco, California.
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, UCSF Health, San Francisco, California
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42
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Khalifeh YI, Tfayli AH. Managing Lung Cancer during Coronavirus Disease 2019 Pandemic. Turk Thorac J 2021; 22:163-168. [PMID: 33871341 PMCID: PMC8051296 DOI: 10.5152/turkthoracj.2021.20110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/19/2020] [Indexed: 01/19/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as a pandemic by the World Health Organization. As this disease continues to spread worldwide, it has posed enormous challenges on the healthcare of several diseases, especially cancer, because hospital facilities have invested health resources for patients with COVID-19. Indeed, patients with lung cancer are particularly vulnerable because of their poor baseline lung function and cancer-related treatment. In addition, once infected, they are at an increased risk of pulmonary complications from COVID-19. Oncologists are thus facing a challenge as how to balance the treatment plans to control the disease while protecting the patients with lung cancer from COVID-19. In fact, it is crucial to provide individualized treatment recommendations to limit the risks during these difficult times. This review highlights the key challenges that oncologists face when diagnosing COVID-19 among patients with lung cancer and examines the current recommendations from available literature, clinical expertise, and expert opinions regarding managing lung cancer in the era of COVID-19. It also explores the treatment approach recommended for patients with lung cancer while avoiding putting them at excessive risk of contracting COVID-19 infection.
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Affiliation(s)
- Yara Ibrahim Khalifeh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Hussein Tfayli
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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43
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Inanc Y, Olgac G, Balci MK, Kutlu CA. COVID-19 pneumonia following double-sleeve lobectomy for lung cancer. Gen Thorac Cardiovasc Surg 2021; 69:577-579. [PMID: 32997235 PMCID: PMC7524866 DOI: 10.1007/s11748-020-01500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
Here, we report a 54-year-old man who underwent double-sleeve left upper lobectomy for lung cancer and his postoperative course was complicated with COVID-19 pneumonia. Five days after his discharge from hospital, he was re-admitted with mild fever and bilateral multiple ground glass opacities on his chest CT. PCR testing confirmed COVID-19 infection and he was treated according to policies established by our nation's health authority. He is still receiving adjuvant chemotherapy and remains well at 3 months after the operation.
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Affiliation(s)
- Yusuf Inanc
- Department of Thoracic Surgery, Bahcesehir University School of Medicine, Merdivenköy, 23 Nisan Sok. No:17, Kadıköy, 34732, Istanbul, Turkey.
| | - Guven Olgac
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Research and Teaching Hospital, Istanbul, Turkey
| | | | - Cemal Asim Kutlu
- Department of Thoracic Surgery, Bahcesehir University School of Medicine, Merdivenköy, 23 Nisan Sok. No:17, Kadıköy, 34732, Istanbul, Turkey
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44
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Zhang JT, Zhong WZ, Wu YL. Cancer treatment in the coronavirus disease pandemic. Lung Cancer 2020; 152:98-103. [PMID: 33373838 PMCID: PMC7832712 DOI: 10.1016/j.lungcan.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022]
Abstract
COVID-19 patients with cancer had increased risk of death and severe outcomes compared to those without cancer. There is no conclusive evidence indicating that antineoplastic treatment aggravates COVID-19 disease There was no significant difference in COVID-19 severity regardless of PD-1 blockade exposure.
Half a year after its emergence, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has resulted in a pandemic, with cases continuing to increase in nearly every country. Surges in coronavirus disease of 2019 (COVID-19) cases have clearly had profound effects on current cancer treatment paradigms. Considering the effect of antineoplastic treatment and the immunosuppressive properties of cancer itself, cancer patients are deemed to be more vulnerable to SARS-CoV-2. Hence, the specific risk of SARS-CoV-2 must be carefully weighed against the benefit of antineoplastic treatment for cancer patients in the COVID-19 era. In this review, we discuss the current evidence in this important field, and in particular, the effect of SARS-CoV-2 on antineoplastic treatment.
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Affiliation(s)
- Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, South China University of Technology & Guangdong Academy of Medical Sciences, Guangdong Key Laboratory of Lung Cancer Translational Medicine, Guangzhou, 510080, China.
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45
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Bertolaccini L, Iacono GL, Mazzella A, Prisciandaro E, Sedda G, Spaggiari L. A methodological evaluation of the published consensus statements, recommendations and guidelines about surgical management in the course of coronavirus disease pandemic. Asian Cardiovasc Thorac Ann 2020; 29:361-368. [PMID: 33287545 PMCID: PMC8165737 DOI: 10.1177/0218492320980937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background A project to benchmark the consensus statements, guidelines, and
recommendations on surgical management in the course of the COVID-19
pandemic was developed to assess the methodology used. Standard and
practical approaches for COVID-19 management in surgical patients to date
are not accessible, despite the magnitude of the pandemic. A plethora of
consensus statements, guidelines, and recommendations on surgical management
in the course of COVID-19 epidemic have been rapidly published in the last
three months. Methods Each manuscript was scored on a seven-point scale in the different items and
domains with the Appraisal of Guidelines for Research and Evaluation II. Results Nine guidelines that met the inclusion criteria were assessed. Transnational
cooperation produced only one guideline. Multivariable analysis showed that
improved scores of stakeholders’ involvement were related to internationally
developed guidelines. Clarity of presentation was related to the
contribution of scientific societies due to greater rigor of development.
The rigor of development produced guidelines with a high overall value.
Higher healthcare expenses did not produce superior guidelines. Conclusions Evaluated by the Appraisal of Guidelines for Research and Evaluation II, the
methodological characteristic of consensus statements, guidelines, and
recommendations on surgical management during COVID-19 pandemic was
relatively low. International development should be recommended as a model
for the development of best methodological quality guidelines.
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Affiliation(s)
- Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giorgio Lo Iacono
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Antonio Mazzella
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Prisciandaro
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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46
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Fiorelli S, Menna C, Piccioni F, Ibrahim M, Rendina EA, Rocco M, Massullo D. The Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak. J Cardiothorac Vasc Anesth 2020; 34:3203-3210. [PMID: 32631666 PMCID: PMC7276138 DOI: 10.1053/j.jvca.2020.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Cecilia Menna
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Piccioni
- Department of Critical Care and Supportive Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mohsen Ibrahim
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
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47
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Gundavda MK, Gundavda KK. Cancer or COVID-19? A Review of Guidelines for Safe Cancer Care in the Wake of the Pandemic. ACTA ACUST UNITED AC 2020; 2:2691-2701. [PMID: 33251481 PMCID: PMC7679239 DOI: 10.1007/s42399-020-00632-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
In the wake of the COVID-19 pandemic, due to reasons beyond control, health care workers have struggled to deliver treatment for the patients with cancer. The concern for otherwise healthy patients with curable cancers that require timely intervention or therapy is the risk of contracting COVID-19 may outweigh the benefits of cancer treatment. Lack of international guidelines leaves health care providers with a case-to-case approach for delivering optimal cancer care in the wake of the pandemic. Transition to telemedicine has somewhat bridged the gap for in-office visits, but there is a continuing challenge of delays in cancer screening or significant decline of new diagnoses of cancers due to the pandemic. We aim to propose a balance in risk from treatment delay versus risks from COVID-19 with emphasis on treatment modality (surgery, radiation, and systemic therapy) as well as supportive care for cancer patients, and therefore have reviewed the publications and recommendations from international societies and study groups available as of October 2020.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Andheri West, Mumbai, Maharashtra 400053 India
| | - Kaival K Gundavda
- Department of Surgical Oncology, Tata Memorial hospital, 93, Ground floor, Main Building, Mumbai, Maharashrta 400012 India
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48
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Goldstein BA, Cerullo M, Krishnamoorthy V, Blitz J, Mureebe L, Webster W, Dunston F, Stirling A, Gagnon J, Scales CD. Development and Performance of a Clinical Decision Support Tool to Inform Resource Utilization for Elective Operations. JAMA Netw Open 2020; 3:e2023547. [PMID: 33136133 PMCID: PMC7607444 DOI: 10.1001/jamanetworkopen.2020.23547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Hospitals ceased most elective procedures during the height of coronavirus disease 2019 (COVID-19) infections. As hospitals begin to recommence elective procedures, it is necessary to have a means to assess how resource intensive a given case may be. OBJECTIVE To evaluate the development and performance of a clinical decision support tool to inform resource utilization for elective procedures. DESIGN, SETTING, AND PARTICIPANTS In this prognostic study, predictive modeling was used on retrospective electronic health records data from a large academic health system comprising 1 tertiary care hospital and 2 community hospitals of patients undergoing scheduled elective procedures from January 1, 2017, to March 1, 2020. Electronic health records data on case type, patient demographic characteristics, service utilization history, comorbidities, and medications were and abstracted and analyzed. Data were analyzed from April to June 2020. MAIN OUTCOMES AND MEASURES Predicitons of hospital length of stay, intensive care unit length of stay, need for mechanical ventilation, and need to be discharged to a skilled nursing facility. These predictions were generated using the random forests algorithm. Predicted probabilities were turned into risk classifications designed to give assessments of resource utilization risk. RESULTS Data from the electronic health records of 42 199 patients from 3 hospitals were abstracted for analysis. The median length of stay was 2.3 days (range, 1.3-4.2 days), 6416 patients (15.2%) were admitted to the intensive care unit, 1624 (3.8%) received mechanical ventilation, and 2843 (6.7%) were discharged to a skilled nursing facility. Predictive performance was strong with an area under the receiver operator characteristic ranging from 0.76 to 0.93. Sensitivity of the high-risk and medium-risk groupings was set at 95%. The negative predictive value of the low-risk grouping was 99%. We integrated the models into a daily refreshing Tableau dashboard to guide decision-making. CONCLUSIONS AND RELEVANCE The clinical decision support tool is currently being used by surgical leadership to inform case scheduling. This work shows the importance of a learning health care environment in surgical care, using quantitative modeling to guide decision-making.
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Affiliation(s)
- Benjamin A. Goldstein
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Surgical Center for Outcomes Research, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Marcelo Cerullo
- Department of Surgery, Duke University, Durham, North Carolina
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Critical Care and Perioperative Population Health Research Unit, Duke University, Durham, North Carolina
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Leila Mureebe
- Department of Surgery, Duke University, Durham, North Carolina
| | - Wendy Webster
- Department of Surgery, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
- Department of Head & Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina
| | - Felicia Dunston
- Duke Health Technology Solutions, Duke University Health System, Durham, North Carolina
| | - Andrew Stirling
- Duke Health Technology Solutions, Duke University Health System, Durham, North Carolina
| | - Jennifer Gagnon
- Duke Health Technology Solutions, Duke University Health System, Durham, North Carolina
| | - Charles D. Scales
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Surgical Center for Outcomes Research, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
- Department of Surgery, Duke University, Durham, North Carolina
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49
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Fligor SC, Tsikis ST, Wang S, Ore AS, Allar BG, Whitlock AE, Calvillo-Ortiz R, Arndt K, Callery MP, Gangadharan SP. Time to surgery in thoracic cancers and prioritization during COVID-19: a systematic review. J Thorac Dis 2020; 12:6640-6654. [PMID: 33282365 PMCID: PMC7711379 DOI: 10.21037/jtd-20-2400] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has overwhelmed hospital resources worldwide, requiring widespread cancellation of non-emergency operations, including lung and esophageal cancer operations. In the United States, while hospitals begin to increase surgical volume and tackle the backlog of cases, the specter of a “second wave,” with a potential vaccine months to years away, highlights the ongoing need to triage cases based upon the risk of surgical delay. We synthesize the available literature on time to surgery and its impact on outcomes along with a critical appraisal of the released triage guidelines in the United States. Methods We performed a systematic literature review using PubMed according to preferred reporting items for systematic reviews and meta-analyses guidelines evaluating relevant literature from the past 15 years. Results Out of 679 screened abstracts, 12 studies investigating time to surgery in lung cancer were included. In stage I–II lung cancer, delayed resection beyond 6 to 8 weeks is consistently associated with lower survival. No identified evidence justifies a 2 cm cutoff for immediate versus delayed surgery. For stage IIIa lung cancer, time to surgery greater than 6 weeks after neoadjuvant therapy is similarly associated with worse survival. For esophageal cancer, 254 abstracts were screened and 23 studies were included. Minimal literature addresses primary esophagectomy, but time to surgery over 8 weeks is associated with lower survival. In the neoadjuvant setting, longer time to surgery is associated with increased pathologic complete response, but also decreased survival. The optimal window for esophagectomy following neoadjuvant therapy is 6 to 8 weeks. Conclusions In the setting of the COVID-19 pandemic, timely resection of lung and esophageal cancer should be prioritized whenever possible based upon local resources and disease-burden.
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Affiliation(s)
- Scott C Fligor
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Savas T Tsikis
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sophie Wang
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ana Sofia Ore
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashlyn E Whitlock
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rodrigo Calvillo-Ortiz
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kevin Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark P Callery
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sidhu P Gangadharan
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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50
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Depypere LP, Daddi N, Gooseman MR, Batirel HF, Brunelli A. The impact of coronavirus disease 2019 on the practice of thoracic oncology surgery: a survey of members of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2020; 58:752-762. [PMID: 32862224 PMCID: PMC7499623 DOI: 10.1093/ejcts/ezaa284] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Lieven P Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Niccolò Daddi
- Department of Thoracic Surgery, Bologna University School of Medicine, Bologna, Italy
| | - Michael R Gooseman
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Hasan F Batirel
- Department of Thoracic Surgery, Marmara University School of Medicine, Istanbul, Turkey
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