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Starling MTM, Thibodeau S, de Sousa CFPM, Restini FCF, Viani GA, Gouveia AG, Mendez LC, Marta GN, Moraes FY. Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings. Cancers (Basel) 2024; 16:539. [PMID: 38339290 PMCID: PMC10854666 DOI: 10.3390/cancers16030539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care.
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Affiliation(s)
| | - Stephane Thibodeau
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
| | | | | | - Gustavo A. Viani
- Department of Medical Imagings, Ribeirão Preto Medical School, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto 14049-900, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Andre G. Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
- Division of Radiation Oncology, Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Lucas C. Mendez
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Gustavo Nader Marta
- Radiation Oncology Department, Hospital Sirio Libanês, Sao Paulo 01308-050, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Fabio Ynoe Moraes
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
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Ocanto A, Mielgo-Rubio X, Luna Tirado J, Linares Mesa N, López Valcárcel M, Pedraza S, Barragan VV, Nieto PV, Martín JZ, Couñago F. Coronavirus disease 2019 and lung cancer: where are we? EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:1082-1094. [PMID: 38023992 PMCID: PMC10651354 DOI: 10.37349/etat.2023.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/26/2023] [Indexed: 12/01/2023] Open
Abstract
Oncology patients are more susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to hospital contact and an immunological system that can be compromised by antineoplastic therapy and supportive treatments. Certain similarities have been described in the physiopathology of coronavirus disease 2019 (COVID-19) and lung cancer (LC) that may explain the higher probability of these patients of developing a more serious disease with more frequent hospitalizations and even death, especially with the addition of smoking, cardiovascular and respiratory comorbidities, old age and corticosteroids use. Pre-existing lesions and cancer therapies change the normal architecture of the lungs, so diagnostic scales such as COVID-19 Reporting and Data System (CO-RADS) are of vital importance for a correct diagnosis and patient homogenization, with a high inter-observer correlation. Moreover, anticancer treatments have required an adaptation to reduce the number of visits to the hospital [hypofractionated radiotherapy (RT), larger intervals between chemotherapy cycles, delay in follow-up tests, among others]. In a way, this has also caused a delay in the diagnosis of new cancers. On the other hand, vaccination has had a positive impact on the mortality of these patients, who maintain a similar seroprevalence to the rest of the population, with a similar impact in mortality.
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Affiliation(s)
- Abrahams Ocanto
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesiCare Madrid, 28002 Madrid, Spain
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesiCare Madrid, 28002 Madrid, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
| | - Javier Luna Tirado
- Department of Radiation Oncology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Nuria Linares Mesa
- Department of Radiation Oncology, Hospital Universitario Juan Ramón Jiménez, 21005 Huelva, Spain
| | - Marta López Valcárcel
- Department of Radiation Oncology, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Sara Pedraza
- Department of Radiation Oncology, Hospital Universitario 12 de Octubre Madrid, 28041 Madrid, Spain
| | - Victoria Vera Barragan
- Department of Radiation Oncology, Hospital Universitario de Badajoz, 06080 Badajoz, Spain
| | - Patricia Valencia Nieto
- Department of Radiation Oncology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Juan Zafra Martín
- Group of Translational Research in Cancer Immunotherapy, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga (UMA), Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario San Francisco de Asís, GenesiCare Madrid, 28002 Madrid, Spain
- Department of Radiation Oncology, Hospital Universitario Vithas La Milagrosa, GenesiCare Madrid, 28002 Madrid, Spain
- Department of Radiation Oncology, Emilio Vargas, GenesisCare Madrid, 28002 Madrid, Spain
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Puckett LL, Titi M, Kujundzic K, Dawes SL, Gore EM, Katsoulakis E, Park JH, Solanki AA, Kapoor R, Kelly M, Palta J, Chetty IJ, Jabbour SK, Liao Z, Movsas B, Thomas CR, Timmerman RD, Werner-Wasik M, Kudner R, Wilson E, Simone CB. Consensus Quality Measures and Dose Constraints for Lung Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and ASTRO Expert Panel. Pract Radiat Oncol 2023; 13:413-428. [PMID: 37075838 DOI: 10.1016/j.prro.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE For patients with lung cancer, it is critical to provide evidence-based radiation therapy to ensure high-quality care. The US Department of Veterans Affairs (VA) National Radiation Oncology Program partnered with the American Society for Radiation Oncology (ASTRO) as part of the VA Radiation Oncology Quality Surveillance to develop lung cancer quality metrics and assess quality of care as a pilot program in 2016. This article presents recently updated consensus quality measures and dose-volume histogram (DVH) constraints. METHODS AND MATERIALS A series of measures and performance standards were reviewed and developed by a Blue-Ribbon Panel of lung cancer experts in conjunction with ASTRO in 2022. As part of this initiative, quality, surveillance, and aspirational metrics were developed for (1) initial consultation and workup; (2) simulation, treatment planning, and treatment delivery; and (3) follow-up. The DVH metrics for target and organ-at-risk treatment planning dose constraints were also reviewed and defined. RESULTS Altogether, a total of 19 lung cancer quality metrics were developed. There were 121 DVH constraints developed for various fractionation regimens, including ultrahypofractionated (1, 3, 4, or 5 fractions), hypofractionated (10 and 15 fractionations), and conventional fractionation (30-35 fractions). CONCLUSIONS The devised measures will be implemented for quality surveillance for veterans both inside and outside of the VA system and will provide a resource for lung cancer-specific quality metrics. The recommended DVH constraints serve as a unique, comprehensive resource for evidence- and expert consensus-based constraints across multiple fractionation schemas.
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Affiliation(s)
- Lindsay L Puckett
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
| | - Mohammad Titi
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Elizabeth M Gore
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Evangelia Katsoulakis
- Department of Radiation Oncology, James A. Haley Veterans Affairs Healthcare System, Tampa, Florida
| | - John H Park
- Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, Missouri; Department of Radiology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University and Hines VA Medical Center, Chicago, Illinois
| | - Rishabh Kapoor
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Maria Kelly
- Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Jatinder Palta
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zhongxing Liao
- Division of Radiation Oncology, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Charles R Thomas
- Radiation Oncology, Dartmouth Cancer Institute, Hanover, New Hampshire
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sydney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | - Emily Wilson
- American Society for Radiation Oncology, Arlington, Virginia
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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4
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Trommer M, Adams A, Bürkle C, Brunner S, Grandoch A, Geffroy A, Franklin C, Gassa A, Meißner AK, Mellinghoff S, Sharma SJ, Schrittenlocher S, Witte L, Marnitz S. Impact of the COVID-19 pandemic on training conditions and education in oncologic disciplines: a survey-based analysis. Strahlenther Onkol 2023; 199:806-819. [PMID: 37540263 PMCID: PMC10449661 DOI: 10.1007/s00066-023-02121-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE The COVID-19 pandemic has led to changes in global health care. Medical societies had to update guidelines and enhance new services such as video consultations. Cancer treatment had to be modified. The aim of this study is to ensure optimal care for cancer patients with the help of high-quality training even in times of crisis. We therefore conducted a nationwide survey of physicians in training in oncological disciplines during the pandemic to assess the impact on their education. METHODS The survey was sent to tumour centres, hospitals, specialist societies, and working and junior research groups and distributed via newsletters and homepages. Interim results and a call for participation were published as a poster (DEGRO) [26] and in the German Cancer Society (DKG) journal FORUM [42]. The survey contained 53 questions on conditions of education and training and on clinical and scientific work. Statistics were carried out with LimeSurvey and SPSS (IBM Corp., Armonk, NY, USA). RESULTS Between February and November 2022, 450 participants answered the survey, with radio-oncologists being the largest group (28%). Most colleagues (63%) had access to digital training methods. Virtual sessions were rated as a good alternative, especially as multidisciplinary meetings (54%) as well as in-house and external training programs (48%, 47%). The time spent by training supervisors on education was rated as less than before the pandemic by 57%. Half of all participants perceived communication (54%), motivation (44%) and atmosphere (50%) in the team as bad. The participants felt strongly burdened by extra work (55%) and by a changed team atmosphere (49%). One third felt a change in the quality of training during the pandemic and rated it as negative (35%). According to 37% of the participants, this had little influence on their own quality of work. Additional subgroup analyses revealed significant differences in gender, specialty and education level. CONCLUSION In order to improve oncology training in times of crisis, access to digital training options and meetings should be ensured. Participants wish for regular team meetings in person to enable good team spirit, compensation for overtime work and sufficient time for training supervisors for discussion and feedback.
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Affiliation(s)
- Maike Trommer
- Klinik und Poliklinik für Radioonkologie, Cyberknife- und Strahlentherapie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Cologne, Germany.
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany.
- Center for Molecular Medicine Cologne, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany.
| | - Anne Adams
- Institut für Medizinische Statistik und Bioinformatik, Medizinische Fakultät, Universität zu Köln, Cologne, Germany
| | - Carolin Bürkle
- Medizinische Klinik und Poliklinik III, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Stefanie Brunner
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Center for Molecular Medicine Cologne, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Andrea Grandoch
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik für Poliklinik für Mund-Kiefer- und Plastische Gesichtschirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Alexandra Geffroy
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg im Breisgau, Medizinische Fakultät, Universität Freiburg, Freiburg im Breisgau, Germany
| | - Cindy Franklin
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik und Poliklinik für Dermatologie und Venerologie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Asmae Gassa
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik und Poliklinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Herzzentrum an der Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Anna-Katharina Meißner
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Zentrum für Neurochirurgie, Klinik für Allgemeine Neurochirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Sibylle Mellinghoff
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Medizinische Klinik I, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Shachi Jenny Sharma
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Center for Molecular Medicine Cologne, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf und Halschirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Silvia Schrittenlocher
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
| | - Luisa Witte
- Urologische Klinik, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Simone Marnitz
- Klinik und Poliklinik für Radioonkologie, Cyberknife- und Strahlentherapie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO), Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Cologne, Germany
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Hallemeier CL, Moughan J, Haddock MG, Herskovic AM, Minsky BD, Suntharalingam M, Zeitzer KL, Garg MK, Greenwald BD, Komaki RU, Puckett LL, Kim H, Lloyd S, Bush DA, Kim HE, Lad TE, Meyer JE, Okawara GS, Raben A, Schefter TE, Barker JL, Falkson CI, Videtic GMM, Jacob R, Winter KA, Crane CH. Association of Radiotherapy Duration With Clinical Outcomes in Patients With Esophageal Cancer Treated in NRG Oncology Trials: A Secondary Analysis of NRG Oncology Randomized Clinical Trials. JAMA Netw Open 2023; 6:e238504. [PMID: 37083668 PMCID: PMC10122174 DOI: 10.1001/jamanetworkopen.2023.8504] [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: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 04/22/2023] Open
Abstract
Importance For many types of epithelial malignant neoplasms that are treated with definitive radiotherapy (RT), treatment prolongation and interruptions have an adverse effect on outcomes. Objective To analyze the association between RT duration and outcomes in patients with esophageal cancer who were treated with definitive chemoradiotherapy (CRT). Design, Setting, and Participants This study was an unplanned, post hoc secondary analysis of 3 prospective, multi-institutional phase 3 randomized clinical trials (Radiation Therapy Oncology Group [RTOG] 8501, RTOG 9405, and RTOG 0436) of the National Cancer Institute-sponsored NRG Oncology (formerly the National Surgical Adjuvant Breast and Bowel Project, RTOG, and Gynecologic Oncology Group). Enrolled patients with nonmetastatic esophageal cancer underwent definitive CRT in the trials between 1986 and 2013, with follow-up occurring through 2014. Data analyses were conducted between March 2022 to February 2023. Exposures Treatment groups in the trials used standard-dose RT (50 Gy) and concurrent chemotherapy. Main Outcomes and Measures The outcomes were local-regional failure (LRF), distant failure, disease-free survival (DFS), and overall survival (OS). Multivariable models were used to examine the associations between these outcomes and both RT duration and interruptions. Radiotherapy duration was analyzed as a dichotomized variable using an X-Tile software to choose a cut point and its median value as a cut point, as well as a continuous variable. Results The analysis included 509 patients (median [IQR] age, 64 [57-70] years; 418 males [82%]; and 376 White individuals [74%]). The median (IQR) follow-up was 4.01 (2.93-4.92) years for surviving patients. The median cut point of RT duration was 39 days or less in 271 patients (53%) vs more than 39 days in 238 patients (47%), and the X-Tile software cut point was 45 days or less in 446 patients (88%) vs more than 45 days in 63 patients (12%). Radiotherapy interruptions occurred in 207 patients (41%). Female (vs male) sex and other (vs White) race and ethnicity were associated with longer RT duration and RT interruptions. In the multivariable models, RT duration longer than 45 days was associated with inferior DFS (hazard ratio [HR], 1.34; 95% CI, 1.01-1.77; P = .04). The HR for OS was 1.33, but the results were not statistically significant (95% CI, 0.99-1.77; P = .05). Radiotherapy duration longer than 39 days (vs ≤39 days) was associated with a higher risk of LRF (HR, 1.32; 95% CI, 1.06-1.65; P = .01). As a continuous variable, RT duration (per 1 week increase) was associated with DFS failure (HR, 1.14; 95% CI, 1.01-1.28; P = .03). The HR for LRF 1.13, but the result was not statistically significant (95% CI, 0.99-1.28; P = .07). Conclusions and Relevance Results of this study indicated that in patients with esophageal cancer receiving definitive CRT, prolonged RT duration was associated with inferior outcomes; female patients and those with other (vs White) race and ethnicity were more likely to have longer RT duration and experience RT interruptions. Radiotherapy interruptions should be minimized to optimize outcomes.
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Affiliation(s)
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | | | - Arnold M. Herskovic
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Bruce D. Minsky
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Mohan Suntharalingam
- Department of Radiation Oncology, University of Maryland and Greenebaum Comprehensive Cancer Center, Baltimore
| | - Kenneth L. Zeitzer
- Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Madhur K. Garg
- Department of Radiation Oncology, Montefiore Medical Center–Moses Campus, Bronx, New York
| | - Bruce D. Greenwald
- Department of Gastroenterology and Hepatology, University of Maryland and Greenebaum Cancer Center, Baltimore
| | - Ritsuko U. Komaki
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Lindsay L. Puckett
- Department of Radiation Oncology, Medical College of Wisconsin and Zablocki Veterans' Administration Medical Center, Milwaukee
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah Health Science Center, Salt Lake City
| | - David A. Bush
- Department of Radiation Oncology, Loma Linda University Cancer Institute, Loma Linda, California
| | - Harold E. Kim
- Department of Radiation Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan
| | - Thomas E. Lad
- Department of Medical Oncology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Joshua E. Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Gordon S. Okawara
- Department of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Adam Raben
- Department of Radiation Oncology, Christiana Care Health Services Inc Community Clinical Oncology Program, Newark, Delaware
| | | | - Jerry L. Barker
- Department of Radiation Oncology, US Oncology Texas Oncology-Sugar Land, Fort Worth
| | - Carla I. Falkson
- Department of Medicine, Hematology/Oncology, University of Rochester, Rochester, New York
| | | | - Rojymon Jacob
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham
| | - Kathryn A. Winter
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | - Christopher H. Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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6
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Li ZHJ, Kim I, Giuliani M, Ingledew PA. Navigating Radiation Therapy During COVID-19 Using YouTube as a Source of Information. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:412-418. [PMID: 35028927 PMCID: PMC8758466 DOI: 10.1007/s13187-022-02133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic brought considerable change to the practice of radiotherapy. In the meantime, patients are increasingly turning to online resources for health information, with YouTube being one of the biggest platforms. However, little is known about what information is being disseminated to cancer patients about radiotherapy in the context of COVID-19. Therefore, this study aims to characterize and assess YouTube videos on radiotherapy during COVID-19. A YouTube search using the terms "Radiation therapy COVID-19", "Radiation therapy coronavirus", "Radiotherapy COVID-19", and "Radiotherapy coronavirus" was completed using a clear-cache web browser. The top 50 videos were collected from each search. After applying pre-determined exclusion criteria, each video was assessed for general parameters, source, and content. Two raters were used to ensure interrater reliability. One hundred five unique videos resulted from the four searches. Ninety-eight per cent were published in the last year. The median video length was 6 min and 54 s, and the median number of views was 570. Most videos were from the USA (58%). The majority of videos were published by a commercial channel (31%), non-profit organization (28%), or healthcare facility (26%). Forty-two per cent of the videos covered a topic related to radiotherapy during the pandemic. Bias was identified in 6% of videos. YouTube information on radiotherapy during COVID-19 is non-specific and can be misleading. The results of this study highlight the need for healthcare providers to proactively address patient information needs and guide them to appropriate sources of information.
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Affiliation(s)
- Zhang Hao Jim Li
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, V6T 1Z3, Canada
| | - Inhwa Kim
- Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, B3H 4R2, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, 149 College St #504, Toronto, M5T 1P5, Canada
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Paris-Ann Ingledew
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, 2775 Laurel Street, Vancouver, V5Z 1M9, Canada.
- BC Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, V5Z 4E6, Canada.
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7
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Dimou A. Areas of Uncertainty in SARS-CoV-2 Vaccination for Cancer Patients. Vaccines (Basel) 2022; 10:vaccines10122117. [PMID: 36560527 PMCID: PMC9784623 DOI: 10.3390/vaccines10122117] [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: 08/30/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Early in the COVID-19 pandemic, it was recognized that infection with SARS-CoV-2 is associated with increased morbidity and mortality in patients with cancer; therefore, preventive vaccination in cancer survivors is expected to be particularly impactful. Heterogeneity in how a neoplastic disease diagnosis and treatment interferes with humoral and cellular immunity, however, poses a number of challenges in vaccination strategies. Herein, the available literature on the effectiveness of COVID-19 vaccines among patients with cancer is critically appraised under the lens of anti-neoplastic treatment optimization. The objective of this review is to highlight areas of uncertainty, where more research could inform future SARS-CoV-2 immunization programs and maximize benefits in the high-risk cancer survivor population, and also minimize cancer treatment deviations from standard practices.
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Affiliation(s)
- Anastasios Dimou
- Division of Medical Oncology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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8
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Kraus RD, Weil CR, Abdel-Wahab M. Benefits of Adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2200215. [PMID: 36525619 PMCID: PMC10166538 DOI: 10.1200/go.22.00215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ryan D Kraus
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
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9
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Tay SS. Perspectives on the Direction of Cancer Prehabilitation in the Pandemic and Beyond. Arch Rehabil Res Clin Transl 2022; 4:100236. [PMID: 36277731 PMCID: PMC9574864 DOI: 10.1016/j.arrct.2022.100236] [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] [Indexed: 12/14/2022] Open
Abstract
Growing attention has been placed on cancer prehabilitation in the recent years as the number of publications increase. The real-world application of prehabilitation remains heterogeneous and its implementation has been challenging during the COVID-19 pandemic. However, the pandemic has also provided impetus for change-leveraging technology and digitalization. This paper will discuss the pre-existing models of care, adaptations that had taken place in the pandemic, the model of care in the author's institution, and the future direction of cancer prehabilitation.
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Affiliation(s)
- San San Tay
- Corresponding author San San Tay, MBBS, MRCP (UK), MMED (Int Med), FAMS, Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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10
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Videtic GMM, Reddy CA, Woody NM, Stephans KL. Local Control With Single-Fraction Lung Stereotactic Body Radiotherapy is not influenced by Non-Small Cell Lung Cancer Histologic Subtype. Clin Lung Cancer 2022; 23:e428-e434. [PMID: 35750570 DOI: 10.1016/j.cllc.2022.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION/BACKGROUND For early stage medically inoperable lung cancer treated with fractionated stereotactic body radiotherapy (SBRT), higher local failure is associated with squamous carcinoma (SqC) compared to adenocarcinoma (AC). This study explored whether histology influences single-fraction SBRT local control. MATERIALS AND METHODS We surveyed our prospective data registry from 12/2009 to 12/2019 for SF-SBRT cases with biopsy-proven AC or SqC only. Outcomes of interest included local (LF), nodal (NF), distant (DF) failure rates and overall survival (OS), as well as treatment-related toxicity. RESULTS For the 10-year interval surveyed, 113 patients met study criteria. There was no association between histology and dose received (34 Gy or 30 Gy). Median follow up was 22.9 months. Patient characteristics were balanced between histologic cohorts. Median tumor size was 1.9 cm. Comparing total AC vs. SqC cohorts, 2-year LF rates (%) were 7.3 vs. 9.6, respectively (P = .9805). In %, 2-year LF, NF, DF and OS rates for AC for 30 Gy and 34 Gy, respectively, were 10.8 vs. 6.4; 10.5 vs. 16.2; 15.8 vs. 13.0; 77.9 vs.71.2 (all P = non-significant). In %, 2-year LF, NF, DF, and OS rates for SqC for 30 Gy and 34 Gy, respectively, were 11.8 vs. 8.1; 5.9 vs. 18.0; 23.5 vs. 9.7; 70.6 vs. 77.1 (all P = non-significant). When considering toxicities, there were no grade 4/5 toxicities and no significant differences in any other toxicity rate by histology or dose. CONCLUSION SF-SBRT local control was not associated with histology, unlike fractionated schedules. This novel finding adds to the evolving understanding of this treatment schedule.
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Affiliation(s)
- Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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11
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Moraes FY, Gouveia AG, Lima RP, Bratti VF, Hamamura AC, Viani GA. Radiotherapy activity in the COVID 19 pandemic: Brazil's operational national-level study. J Cancer Policy 2022; 36:100367. [PMID: 36216270 PMCID: PMC9540705 DOI: 10.1016/j.jcpo.2022.100367] [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: 06/14/2022] [Revised: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE During the COVID-19 pandemic, patients with cancer are at increased risk of not having timely diagnosis and access to cancer treatment. The present study evaluated the COVID-19 pandemic impact on radiotherapy activity in Brazil. METHODS A national-level study was performed to evaluate the RT utilization for prostate, breast, head & neck (HN), Gynecology (GYN), Gastrointestinal (GI), lung cancers, and bone/brain metastases. The data on the RT executed was extracted from the Brazilian Ministry of Health database. The NON-COVID period was considered the control group, and the comparison groups were COVID-2020 (without vaccine) and COVID-2021 (with vaccine). RESULTS We collected the data of 238,355 procedures executed on three periods. Significant difference in the RT utilization between NON-COVID and COVID-2020 were observed for prostate cancer, bone and brain metastases (-12.3 %, p = 0.02, +24 %, p = 0.02 and +14 %, p = 0.04, respectively). Comparing 2 equivalents months from NON-COVID-2019 (ref), COVID-2020, and COVID-2021, a significant increase was identified for bone and brain metastases (2020 +21 %, and 2021 +32 %), and (2020 +20 %, and 2021 +14 %). A stable drop occurred for prostate cancer (2020 -11 % and 2021 -10 %), and a variation was observed for breast (2020 +8 %, and 2021 -1 %) and lung cancer (2020 +10 %, and 2021 -3 %). For other cancers, non-significant changes were observed when comparing 2020 and 2021. CONCLUSION The RT activity was heterogeneously affected with a substantial increase for bone and brain metastases and a meaningful decline for prostate cancer. POLICY SUMMARY With a significant increase in the use of palliative radiotherapy for bone and brain metastases and a meaningful reduction in curative radiotherapy for prostate cancer, we hope these findings can help governments, RT services, medical communities, and other stakeholders develop strategies to mitigate the impact of the present and future pandemics. Finally, despite the changes imposed by the COVID pandemic, it is imperative to enhance screening, increase cancer diagnosis at an early stage, and improve access to all cancer treatments, including radiotherapy.
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Affiliation(s)
- Fabio Y Moraes
- Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Andre G Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Department - Americas Centro de Oncologia Integrado, Rio de Janeiro, RJ, Brazil
| | - Renato P Lima
- Radiation Oncology Department - Hospital Haroldo Juaçaba, Fortaleza, Ceará, Brazil
| | - Vanessa F Bratti
- Queen's University School of Medicine, Department of Public Health Sciences, Kingston, Canada
| | - Ana C Hamamura
- Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Gustavo A Viani
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Ribeirão Preto Medical School, Department of medical imagings, hematology and oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil.
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12
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Shen M, Wu X, Zhu M, Yi X. Recent advances in biological membrane-based nanomaterials for cancer therapy. Biomater Sci 2022; 10:5756-5785. [PMID: 36017968 DOI: 10.1039/d2bm01044e] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Nanomaterials have shown significant advantages in cancer theranostics, owing to their enhanced permeability and retention effect in tumors and multi-function integration capability. Biological membranes, which are collected from various cells and their secreted membrane structures, can further be applied to establish membrane-based nanomaterials with perfect biocompatibility, tumor-targeting capacity, immune-stimulatory activity and adjustable versatility for cancer therapy. In this review, according to their source, membranes are divided into four groups: (1) cell membranes; (2) secretory membranes; (3) engineered membranes; and (4) hybrid membranes. First, cell membranes can be extracted from natural cells of the body, tumor tissue cells, and bacteria. Furthermore, secretory membranes mainly refer to exosome, apoptotic body and bacterial outer membrane vesicle, and membranes with specific protein/peptide expression or therapeutic inclusions are obtained from engineered cells. Finally, a hybrid membrane will be constituted by two or more of the abovementioned membranes. These membranes can form drug-carrying nanoparticles themselves or coat multi-functional nanoparticles, further realizing efficient cancer therapy. We summarize the application of various biological membrane-based nanomaterials in cancer therapy and point out their advantages as well as the places that need to be further improved, providing systematic knowledge of this field and a strategy for further optimization.
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Affiliation(s)
- Mengling Shen
- School of Pharmacy, Jiangsu Key Laboratory of Inflammation and Molecular Drug Targets, Nantong University, Nantong, Jiangsu, 226001, China.
| | - Xiaojie Wu
- School of Pharmacy, Jiangsu Key Laboratory of Inflammation and Molecular Drug Targets, Nantong University, Nantong, Jiangsu, 226001, China.
| | - Minqian Zhu
- School of Pharmacy, Jiangsu Key Laboratory of Inflammation and Molecular Drug Targets, Nantong University, Nantong, Jiangsu, 226001, China.
| | - Xuan Yi
- School of Pharmacy, Jiangsu Key Laboratory of Inflammation and Molecular Drug Targets, Nantong University, Nantong, Jiangsu, 226001, China.
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13
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Jacqmin DJ, Crosby JSM. The impact of COVID-19 on a high-volume incident learning system: A retrospective analysis. J Appl Clin Med Phys 2022; 23:e13653. [PMID: 35616007 PMCID: PMC9278685 DOI: 10.1002/acm2.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The purpose of this work was to assess how the coronavirus disease 2019 (COVID-19) pandemic impacted our incident learning system data and communicate the impact of a major exogenous event on radiation oncology clinical practice. METHODS Trends in our electronic incident reporting system were analyzed to ascertain the impact of the COVID-19 pandemic, including any direct clinical changes. Incident reports submitted in the 18 months prior to the pandemic (September 14, 2018 to March 13, 2020) and reports submitted during the first 18 months of the pandemic (March 14, 2020 to September 13, 2021) were compared. The incident reports include several data elements that were evaluated for trends between the two time periods, and statistical analysis was performed to compare the proportions of reports. RESULTS In the 18 months prior to COVID-19, 192 reports were submitted per 1000 planning tasks (n = 832 total). In the first 18 months of the pandemic, 147 reports per 1000 planning tasks were submitted (n = 601 total), a decrease of 23.4%. Statistical analysis revealed that there were no significant changes among the data elements between the pre- and during COVID-19 time periods. An analysis of the free-text narratives in the reports found that phrases related to pretreatment imaging were common before COVID-19 but not during. Conversely, phrases related to intravenous contrast, consent for computed tomography, and adaptive radiotherapy became common during COVID-19. CONCLUSIONS The data elements captured by our incident learning system were stable after the onset of the COVID-19 pandemic, with no statistically significant findings after correction for multiple comparisons. A trend toward fewer reports submitted for low-risk issues was observed. The methods used in the work can be generalized to events with a large-scale impact on the clinic or to monitor an incident learning system to drive future improvement activities.
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Affiliation(s)
- Dustin J. Jacqmin
- Department of Human OncologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jennie S. M. Crosby
- Department of Human OncologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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14
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Kang TM, Hardcastle N, Singh AK, Slotman BJ, Videtic GMM, Stephans KL, Couñago F, Louie AV, Guckenberger M, Harden SV, Plumridge NM, Siva S. Practical considerations of single-fraction stereotactic ablative radiotherapy to the lung. Lung Cancer 2022; 170:185-193. [PMID: 35843149 DOI: 10.1016/j.lungcan.2022.06.014] [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: 05/09/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) is a well-established treatment for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and pulmonary oligometastases. The use of single-fraction SABR in this setting is supported by excellent local control and safety profiles which appear equivalent to multi-fraction SABR based on the available data. The resource efficiency and reduction in hospital outpatient visits associated with single-fraction SABR have been particularly advantageous during the COVID-19 pandemic. Despite the increased interest, single-fraction SABR in subgroups of patients remains controversial, including those with centrally located tumours, synchronous targets, proximity to dose-limiting organs at risk, and concomitant severe respiratory illness. This review provides an overview of the published randomised evidence evaluating single-fraction SABR in primary lung cancer and pulmonary oligometastases, the common clinical challenges faced, immunogenic effect of SABR, as well as technical and cost-utility considerations.
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Affiliation(s)
- Therese Mj Kang
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum, Department of Oncology, University of Melbourne, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Gregory M M Videtic
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Kevin L Stephans
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid, Spain
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Susan V Harden
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nikki M Plumridge
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum, Department of Oncology, University of Melbourne, Australia.
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15
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Bogaert B, Buisson V, Kozlakidis Z, Saintigny P. Organisation of cancer care in troubling times: A scoping review of expert guidelines and their implementation during the COVID-19 pandemic. Crit Rev Oncol Hematol 2022; 173:103656. [PMID: 35337970 PMCID: PMC8942466 DOI: 10.1016/j.critrevonc.2022.103656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
This scoping review mapped the main themes in existing expert guidelines for cancer care issued during the COVID-19 crisis from the period of March 2020-August 2021. The guidelines published during the research period principally relate to the first two waves in Europe and until the beginning of the vaccination campaign. They elaborated recommendations for cancer care reorganisation, in particular triage and quality of care issues. The article highlights the ethical, epistemological, as well as practical reasons that guidelines were not always followed to provide some lessons learned for future crises to enable better guideline development processes. We also elaborate early evidence on the impact of triage decisions and different perspectives on cancer care reorganisation from ethics and social science literature.
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Affiliation(s)
- Brenda Bogaert
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Victoria Buisson
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Zizis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - Pierre Saintigny
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.
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16
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Rodríguez De Dios N, Navarro-Martin A, Cigarral C, Chicas-Sett R, García R, Garcia V, Gonzalez JA, Gonzalo S, Murcia-Mejía M, Robaina R, Sotoca A, Vallejo C, Valtueña G, Couñago F. GOECP/SEOR radiotheraphy guidelines for non-small-cell lung cancer. World J Clin Oncol 2022; 13:237-266. [PMID: 35582651 PMCID: PMC9052073 DOI: 10.5306/wjco.v13.i4.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/27/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is a heterogeneous disease accounting for approximately 85% of all lung cancers. Only 17% of patients are diagnosed at an early stage. Treatment is multidisciplinary and radiotherapy plays a key role in all stages of the disease. More than 50% of patients with NSCLC are treated with radiotherapy (curative-intent or palliative). Technological advances-including highly conformal radiotherapy techniques, new immobilization and respiratory control systems, and precision image verification systems-allow clinicians to individualize treatment to maximize tumor control while minimizing treatment-related toxicity. Novel therapeutic regimens such as moderate hypofractionation and advanced techniques such as stereotactic body radiotherapy (SBRT) have reduced the number of radiotherapy sessions. The integration of SBRT into routine clinical practice has radically altered treatment of early-stage disease. SBRT also plays an increasingly important role in oligometastatic disease. The aim of the present guidelines is to review the role of radiotherapy in the treatment of localized, locally-advanced, and metastatic NSCLC. We review the main radiotherapy techniques and clarify the role of radiotherapy in routine clinical practice. These guidelines are based on the best available evidence. The level and grade of evidence supporting each recommendation is provided.
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Affiliation(s)
- Núria Rodríguez De Dios
- Department of Radiation Oncology, Hospital del Mar, Barcelona 08003, Spain
- Radiation Oncology Research Group, Hospital Del Mar Medical Research Institution, Barcelona 08003, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona 08003, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Thoracic Malignancies Unit, Hospital Duran i Reynals. ICO, L´Hospitalet de L, Lobregat 08908, Spain
| | - Cristina Cigarral
- Department of Radiation Oncology, Hospital Clínico de Salamanca, Salamanca 37007, Spain
| | - Rodolfo Chicas-Sett
- Department of Radiation Oncology, ASCIRES Grupo Biomédico, Valencia 46004, Spain
| | - Rafael García
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Virginia Garcia
- Department of Radiation Oncology, Hospital Universitario Arnau de Vilanova, Lleida 25198, Spain
| | | | - Susana Gonzalo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
| | - Mauricio Murcia-Mejía
- Department of Radiation Oncology, Hospital Universitario Sant Joan de Reus, Reus 43204, Tarragona, Spain
| | - Rogelio Robaina
- Department of Radiation Oncology, Hospital Universitario Arnau de Vilanova, Lleida 25198, Spain
| | - Amalia Sotoca
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Carmen Vallejo
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - German Valtueña
- Department of Radiation Oncology, Hospital Clínico Universitario Lozano Blesa, Zaragoza 50009, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
- Department of Clinical, Universidad Europea, Madrid 28670, Spain
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17
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Fernández C, Navarro-Martin A, Bobo A, Cabrera-Rodriguez J, Calvo P, Chicas-Sett R, Luna J, Rodríguez de Dios N, Couñago F. Single-fraction stereotactic ablative body radiation therapy for primary and metastasic lung tumor: A new paradigm? World J Clin Oncol 2022; 13:101-115. [PMID: 35316929 PMCID: PMC8894272 DOI: 10.5306/wjco.v13.i2.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/07/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
Stereotactic ablative body radiotherapy (SABR) is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer (NSCLC) and pulmonary metastasis. Several fractionation schemes have proven to be safe and effective, including the single fraction (SF) scheme. SF is an option cost-effectiveness, more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments. The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm, recommending this option to minimize patients’ visits to hospital. SF SABR already has a long experience, strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases, making it a valid treatment option; although its use in central locations, synchronous and recurrencies tumors requires more prospective safety and efficacy studies. The SABR radiobiology study, together with the combination with systemic therapies, (targeted therapies and immunotherapy) is a direction of research in both advanced disease and early stages whose future includes SF.
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Affiliation(s)
- Castalia Fernández
- Department of Radiation Oncology, GenesisCare Madrid, Madrid 28043, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Institut Catalá d’Oncologia, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Andrea Bobo
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | | | - Patricia Calvo
- Department of Radiation Oncology, Hospitalario Clínico Universitario de Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Rodolfo Chicas-Sett
- Department of Radiation Oncology, ASCIRES Grupo Biomédico, Valencia 46004, Spain
| | - Javier Luna
- Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid 28040, Spain
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28223, Spain
- Department of Medicine, School of Biomedical Sciences, Universidad Europea, Madrid 28223, Spain
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18
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Nieder C, Haukland EC, Mannsåker B. Shortened Palliative Radiotherapy Results in a Lower Rate of Treatment During the Last Month of Life. Cureus 2022; 14:e21617. [PMID: 35233303 PMCID: PMC8881233 DOI: 10.7759/cureus.21617] [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] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Palliative radiotherapy (PRT) during the last month of life (PRT30) should be avoided because relevant clinical benefits are unlikely to occur. While traditional short-course fractionation regimens are suitable for most patients, a minority may derive gains from higher doses of PRT. Compared to older regimens such as 13 fractions of 3 Gy, more hypofractionated, non-ablative concepts with reduced overall treatment time are not well studied. Methods Retrospective analysis (2017-2020) of 107 patients treated to metastatic lesions (one or two target volumes per patient) with traditional >2 weeks regimens or newer ≤2 weeks regimens, e.g. seven fractions of 5 Gy or five fractions of 6 Gy. Results Failure to complete radiotherapy was registered in 8% of patients (traditional fractionation) and 1%, respectively (p=0.12). Moderate rates of PRT30 were observed (11% and 6%, respectively, p=0.44). PRT30 was more likely in patients irradiated for brain or lymph node metastases. Utilization of newer ≤2 weeks regimens was highest in 2020, presumably as a result of the coronavirus disease 2019 (COVID-19) pandemic. Conclusion The implementation of newer fractionation regimens for selected patients has resulted in acceptable rates of non-completion and PRT30. Optimal selection criteria remain to be determined. Established, guideline-endorsed short-course regimens such as five fractions of 4 Gy and 8-Gy single fractions continue to represent important PRT approaches.
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The Impact of the COVID-19 Pandemic on Cancer Patient's Management-Lithuanian Cancer Center Experience. Healthcare (Basel) 2021; 9:healthcare9111522. [PMID: 34828568 PMCID: PMC8623620 DOI: 10.3390/healthcare9111522] [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: 09/09/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 12/31/2022] Open
Abstract
The pandemic spread of the COVID-19 virus significantly affected daily life, but the highest pressure was piled on the health care system. Our aim was to evaluate an impact of COVID-19 pandemic management measures on cancer services at the National Cancer Institute (NCI) of Lithuania. We assessed the time period from 1 February 2020 to 31 December 2020 and compared it to the same period of 2019. Data for our analysis were extracted from the NCI Hospital Information System (HIS) and the National Health Insurance Fund (NHIF). Contingency table analysis and ANOVA were performed. The COVID-19 pandemic negatively affected the cancer services provided by NCI. Reductions in diagnostic radiology (−16%) and endoscopy (−29%) procedures were accompanied by a decreased number of patients with ongoing medical (−30%), radiation (−6%) or surgical (−10%) treatment. The changes in the number of newly diagnosed cancer patients were dependent on tumor type and disease stage, showing a rise in advanced disease at diagnosis already during the early period of the first lockdown. The extent of out-patient consultations (−14%) and disease follow-up visits (−16%) was also affected by the pandemic, and only referrals to psychological/psychiatric counselling were increased. Additionally, the COVID-19 pandemic had an impact on the structure of cancer services by fostering the application of modified systemic anticancer therapy or hypofractionated radiotherapy. The most dramatic drop occurred in the number of patients participating in cancer prevention programs; the loss was 25% for colon cancer and 62% for breast cancer screening. Marked restriction in access to preventive cancer screening and overall reduction of the whole spectrum of cancer services may negatively affect cancer survival measures in the nearest future.
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Videtic GMM, Reddy CA, Woody NM, Stephans KL. Ten-Year Experience in Implementing Single-Fraction Lung SBRT for Medically Inoperable Early-Stage Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 111:436-442. [PMID: 34048817 DOI: 10.1016/j.ijrobp.2021.05.116] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To review 10 years of using single-fraction lung stereotactic body radiation therapy (SF-SBRT) for medically inoperable peripheral early-stage lung cancer. METHODS AND MATERIALS An institutional review board-approved prospective lung SBRT data registry was surveyed until the end of December 2019 for all patients receiving SF-SBRT with minimum 6-month follow-up. Doses used were either 34 Gy or 30 Gy. Outcomes of interest included rates of local failure and overall survival (OS), as well as treatment-related toxicity graded per Common Terminology Criteria for Adverse Events version 3.0. RESULTS A total of 229 patients met the study criteria. Patient characteristics included female sex (55%); median age, 74.6 years (range, 47-94); and median Karnofsky Performance Status 80 (range, 50-100). Tumor characteristics included median diameter, 1.6 cm (range, 0.7-4.1); median positron emission tomography standardized uptake value maximum 6.1 (range, 0.8-24.3); and 63.6% of patients biopsied. SF-SBRT dose was 34 Gy in 72.1% cases and 30 Gy in 27.9%, with patient and tumor characteristics balanced between cohorts. Overall median follow-up times for 30 Gy and 34 Gy were 36.7 and 17.2 months, respectively (P < .0001). At analysis, 55.9% patients were alive. Two (0.9%) patients developed grade 3 toxicities, and none had grade 4/5 toxicities. Grades 1 to 2 pneumonitis and chest wall toxicity were seen in 7% and 12.7% patients, respectively. Median overall survival was 44.1 months. Rates of 2-year local, nodal, and distant failure were 7.3%, 9.4%, and 12.2%, respectively. There were no significant differences in outcomes by dose. CONCLUSIONS This is the largest institutional series to date reporting on SF-SBRT outcomes for medically inoperable peripheral early-stage lung cancer and the first to report on a decade's experience in implementing this schedule. Outcomes from this analysis are comparable to published results from 2 randomized trials and validate the use of this schedule in routine practice. In the absence of phase 3 trials, this study should encourage increased use of SF-SBRT for inoperable tumors.
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Affiliation(s)
- Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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21
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Tsao MN, Louie AV. Radical Radiation for Large-Volume Locally Advanced Non-Small Cell Lung Cancer: Constrained by Constraints! Int J Radiat Oncol Biol Phys 2021; 110:261-263. [PMID: 33989567 DOI: 10.1016/j.ijrobp.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- May N Tsao
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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22
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Magrini SM, Guerini AE, Borghetti P, Volpi G, Triggiani L, Costa L, Pegurri L, Spiazzi L, Buglione M. Universal testing for COVID-19 in patients undergoing cancer treatment during the second outbreak in Brescia. TUMORI JOURNAL 2021; 108:278-282. [PMID: 34405756 DOI: 10.1177/03008916211034917] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) has been overwhelming on patients with cancer, who may be at higher risk of developing severe disease. During the second COVID-19 outbreak in Italy, we planned universal microbiologic screening for patients scheduled for antineoplastic treatment. METHODS All patients with planned active treatment at Brescia University Radiation Oncology Department were screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA with repeated nasopharyngeal swabs (NPS) from October 31, 2020. Treatment continuation, suspension, or delay was modulated for patients testing positive according to clinical presentation. RESULTS From October 31, 2020, to February 6, 2021, 636 patients were enrolled and 1243 NPS were performed, of which 28 (2.25%) were positive. The infection rate was 2.52%; 81.3% of the patients with a positive NPS were asymptomatic, 2 had mild disease, and 1 severe disease that led to death. All patients already on treatment with mild or asymptomatic COVID-19 carried on the therapy with no or minimal delay. Median delay for patients with infection detected before treatment start was 16.5 days. CONCLUSIONS Detected incidence of COVID-19 was lower during the second outbreak in our patients (2.52% vs 3.23%), despite the extensive testing schedule, and substantiates the high rate of asymptomatic infections and the low mortality among patients with COVID-19 (6.3% vs 38.5% during the first outbreak). Universal SARS-CoV-2 screening for all patients with planned treatment might allow early identification of patients with COVID-19, resulting in timely management that could improve clinical outcomes and prevent spread of the infection.
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Affiliation(s)
- Stefano M Magrini
- Department of Radiation Oncology, Università degli Studi di Brescia, Brescia University, Brescia, Italy
| | - Andrea E Guerini
- Department of Radiation Oncology, Università degli Studi di Brescia, Brescia University, Brescia, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giulia Volpi
- Department of Radiation Oncology, Università degli Studi di Brescia, Brescia University, Brescia, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, Università degli Studi di Brescia, Brescia University, Brescia, Italy
| | - Loredana Costa
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ludovica Pegurri
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Luigi Spiazzi
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Michela Buglione
- Department of Radiation Oncology, Università degli Studi di Brescia, Brescia University, Brescia, Italy
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Samper Ots PM, Zapatero Ortuño J, Pedraza Fernández S, Mayrata Canellas E, González San Segundo C, Campo Vargas M, Caballero B, Ramos Albiac M, Vázquez Masedo G, Álvarez B, Rodríguez Villalba S, Muñoz Miguelañez T, Diezhandino Garcia P, Sancho G, Guzmán Gómez L, Tripero J, Rico Oses MR, Ibañez Villoslada C, Soler Rodríguez AMS, Chust ML, Fondevilla Soler A, Lozano Martin EM, Morillo Macias V, Fuentes Sánchez C, Torrado Moya L, Fernández López J, Solé JM, Guijarro Verdú M, Mira Flores M, Wals A, Expósito Hernández J. Impact of covid-19 on patients in radiotherapy oncology departaments in Spain. Radiother Oncol 2021; 161:148-151. [PMID: 34118358 PMCID: PMC8189749 DOI: 10.1016/j.radonc.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
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24
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Salama JK, Giuliani ME, Robinson CG, Daly ME. Single-fraction SBRT for Early Stage NSCLC-A Viable Option in "These Uncertain Times"? Int J Radiat Oncol Biol Phys 2021; 109:1-4. [PMID: 33308692 DOI: 10.1016/j.ijrobp.2020.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Joseph K Salama
- Department of Radiation Oncology, Duke University, Durham, North Carolina.
| | - Meredith E Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, California
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Megan E Daly
- University of California Davis Comprehensive Cancer, Department of Radiation Oncology, Center, Sacramento, California
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25
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A Comparison of Hypofractionated and Twice-Daily Thoracic Irradiation in Limited-Stage Small-Cell Lung Cancer: An Overlap-Weighted Analysis. Cancers (Basel) 2021; 13:cancers13122895. [PMID: 34207857 PMCID: PMC8229231 DOI: 10.3390/cancers13122895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Despite evidence for the superiority of twice-daily (BID) radiotherapy schedules, their utilization in practice remains logistically challenging. Hypofractionation (HFRT) is a commonly implemented alternative. We aim to compare the outcomes and toxicities in limited-stage small-cell lung cancer (LS-SCLC) patients treated with hypofractionated versus BID schedules. A bi-institutional retrospective cohort review was conducted of LS-SCLC patients treated with BID (45 Gy/30 fractions) or HFRT (40 Gy/15 fractions) schedules from 2007 to 2019. Overlap weighting using propensity scores was performed to balance observed covariates between the two radiotherapy schedule groups. Effect estimates of radiotherapy schedule on overall survival (OS), locoregional recurrence (LRR) risk, thoracic response, any ≥grade 3 (including lung, and esophageal) toxicity were determined using multivariable regression modelling. A total of 173 patients were included in the overlap-weighted analysis, with 110 patients having received BID treatment, and 63 treated by HFRT. The median follow-up was 20.4 months. Multivariable regression modelling did not reveal any significant differences in OS (hazard ratio [HR] 1.67, p = 0.38), LRR risk (HR 1.48, p = 0.38), thoracic response (odds ratio [OR] 0.23, p = 0.21), any ≥grade 3+ toxicity (OR 1.67, p = 0.33), ≥grade 3 pneumonitis (OR 1.14, p = 0.84), or ≥grade 3 esophagitis (OR 1.41, p = 0.62). HFRT, in comparison to BID radiotherapy schedules, does not appear to result in significantly different survival, locoregional control, or toxicity outcomes.
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Chuong MD, Kotecha R, Mehta MP, Adamson S, Romaguera T, Hall MD, Alvarez D, Gutierrez AN, Mishra V, De Zarraga F, Mittauer KE. Case report of visual biofeedback-driven, magnetic resonance-guided single-fraction SABR in breath hold for early stage non-small-cell lung cancer. Med Dosim 2021; 46:247-252. [PMID: 33648822 DOI: 10.1016/j.meddos.2021.01.003] [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: 01/08/2021] [Revised: 01/14/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
Stereotactic ablative body radiation therapy (SABR) is a well-established alternative to surgery for early stage non-small-cell lung cancer (NSCLC). While SABR is typically delivered in 3 to 5 fractions, randomized trials have shown single-fraction SABR to be a reasonable alternative. We present the case of a 66-year-old male with history of cholangiocarcinoma who was subsequently diagnosed with peripheral early stage NSCLC and treated in mid-inspiration breath hold (BH) to 34 Gy in 1 fraction on a magnetic resonance (MR)-guided linear accelerator, with treatment delivery completed in 17 minutes. Visual biofeedback was utilized to maximize patient compliance with appropriate depth of inspiration BH and improve overall treatment delivery time efficiency. The benefits of single- vs multifraction SABR and unique advantages of MR guidance that are particularly well-suited for single-fraction SABR are reviewed.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Sonia Adamson
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA
| | - Tino Romaguera
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Diane Alvarez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Vivek Mishra
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Fernando De Zarraga
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL 33176, USA
| | - Kathryn E Mittauer
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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Kearney M, Coffey M, Rossi M, Tsang Y. Future-proof Radiation therapist (RTT) practice in a pandemic - Lessons learnt from COVID-19. Tech Innov Patient Support Radiat Oncol 2021; 17:18-24. [PMID: 33564723 PMCID: PMC7862908 DOI: 10.1016/j.tipsro.2021.02.001] [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: 11/24/2020] [Revised: 01/05/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022] Open
Abstract
RT is an essential service that must continue despite the challenges posed by COVID-19. Our study suggests changes were implemented into RTT practice in response to COVID-19. Proactive measures are needed to protect both RTTs and patients in future Covid surges.
Background and Purpose The European SocieTy for Radiotherapy and Oncology Radiation Therapist Committee (ESTRO RTTC) published a guidance document and infographic providing recommendations to minimise risk of COVID-19 transmission in radiotherapy (RT) departments. The purpose of this study was to investigate the changes embedded in RT practice in the COVID-19 era and to recommend proactive measures to protect RT practice in future pandemics. Materials and Methods The study was initiated by the ESTRO Radiation Oncology Safety and Quality Committee (ROSQC). A survey consisting of multiple choice, open ended and Likert scale questions was created to analyse the extent of changes embedded in RT practice in response to the COVID-19 pandemic under the four domains: patient care, RTT workflow, remote working and RT practice. This online survey was distributed globally in May 2020. Results 229 respondents across 27 countries completed the survey. 60% of respondents reported continuing/commencing RT in COVID-19 patients. Routine testing of patients and RTTs was not common. Split teams' procedures, hot linacs and separate entrances were implemented by 50% of respondents. Remote working was implemented for RT team members where face to face patient contact was not essential. Lack of staff, connectivity issues and lack of confirmed positive cases in the department were the main reasons cited for not implementing recommended measures. Conclusion It is suggested that RT departments have responded to the COVID-19 pandemic and implemented certain changes in RT practice. RT departments should act now to implement recommended proactive measures to protect patients and RTTs – frontline healthcare workers.
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Affiliation(s)
- Maeve Kearney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
| | - Mary Coffey
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College, Dublin 2, Ireland
| | - Maddalena Rossi
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Yat Tsang
- Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
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28
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Nieder C, Haukland EC, Mannsaker B, Yobuta R. Palliative Radiotherapy During the Last Month of Life: Have COVID-19 Recommendations Led to Reduced Utilization? In Vivo 2021; 35:649-652. [PMID: 33402522 DOI: 10.21873/invivo.12304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM The study aimed to evaluate practice changes in the time period of the early wave of the COVID-19 pandemic. PATIENTS AND METHODS This was a retrospective single institution study. We defined palliative radiotherapy (PRT) initiated before Saturday, March 14th as pre-COVID and PRT initiated later as during-COVID (through June 30th). RESULTS National COVID-19 recommendations led to a significant decrease in PRT with 10 or more fractions, while re-irradiation and radiotherapy during the final 30 days of life were equally common before and after these recommendations had been issued in March 2020. CONCLUSION Rapid adoption of modified PRT regimens was feasible. However, the challenge of overtreatment in the final phase of the disease, due to inaccurate survival prediction, persisted.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Ellinor C Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Bard Mannsaker
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Rosalba Yobuta
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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Murakami N, Nakamura S, Kashihara T, Inaba K, Kaneda T, Takahashi K, Okuma K, Igaki H, Itami J. Increased number of prostate cancer patients selecting high dose-rate interstitial brachytherapy during the COVID-19 pandemic. Radiother Oncol 2021; 154:274-275. [PMID: 33227353 PMCID: PMC7679657 DOI: 10.1016/j.radonc.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Satoshi Nakamura
- Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoya Kaneda
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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30
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Fadavi P, Houshyari M, Yousefi Kashi AS, Jarrahi AM, Roshanmehr F, Broomand MA, Sandoughdaran S, Taghizadeh-Hesary F. Review on the Oncology Practice in the Midst of COVID-19 Crisis: The Challenges and Solutions. Asian Pac J Cancer Prev 2021; 22:19-24. [PMID: 33507674 PMCID: PMC8184167 DOI: 10.31557/apjcp.2021.22.1.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
As of late 2019, the outbreak of novel coronavirus disease (COVID-19) –that started in China– has rapidly afflicted all over the world. The COVID-19 pandemic has challenged health-care facilities to provide optimal care. In this context, cancer care requires special attention because of its peculiar status by including patients who are commonly immunocompromised and treatments that are often highly toxic. In this review article, we have classified the main impacts of the COVID-19 pandemic on oncology practices –followed by their solutions– into ten categories, including impacts on (1) health care providers, (2) medical equipment, (3) access to medications, (4) treatment approaches, (5) patients’ referral, (6) patients’ accommodation, (7) patients’ psychological health, (8) cancer research, (9) tumor board meetings, and (10) economic income of cancer centers. The effective identification and management of all these challenges will improve the standards of cancer care over the viral pandemic and can be a practical paradigm for possible future crises.
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Affiliation(s)
- Pedram Fadavi
- Department of Radiation Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Houshyari
- Department of Clinical Oncology, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Shahram Yousefi Kashi
- Department of Clinical Oncology, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Cancer Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mosavi Jarrahi
- Cancer Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnaz Roshanmehr
- Faculty of Science and Engineering, Waseda University, Tokyo, Japan.,Kagawa Nutrition University, Saitama, Japan
| | - Mohammad Ali Broomand
- Department of Clinical Oncology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saleh Sandoughdaran
- Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gupta K, Gandhi S, Mebane A, Singh A, Vishnuvardhan N, Patel E. Cancer patients and COVID-19: Mortality, serious complications, biomarkers, and ways forward. Cancer Treat Res Commun 2020; 26:100285. [PMID: 33360669 PMCID: PMC7832265 DOI: 10.1016/j.ctarc.2020.100285] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has particularly serious consequences for cancer patients, as they are at high risk for severe complications and mortality due to the virus since cancer patients are immunocompromised. Preliminary evidence suggests that patients with hematological, and metastatic malignancies are particularly susceptible to developing severe COVID-19 illness, which leads to poor prognosis. Biomarkers including C-reactive protein and interleukin-6 may be predictors of outcome and, therefore, crucial in assessing COVID-19 illness severity in cancer patients. A patient-specific risk and benefit inventory should be completed, and expert guidelines consulted when deciding to continue or postpone therapeutic interventions. This review presents preliminary evidence of COVID-19 infection and its impact on cancer, as well as discussion of general guidelines for the treatment and management of cancer patients with COVID-19.
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Affiliation(s)
- Kush Gupta
- Kasturba Medical College, Light House Hill Road, Mangalore, KA 575001, India.
| | - Shipra Gandhi
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA.
| | - Alexander Mebane
- Heart, Vascular & Leg Center, 5020 Commerce Dr, Bakersfield, CA, 93309, USA.
| | - Angelica Singh
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
| | - Nivetha Vishnuvardhan
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
| | - Eshan Patel
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
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Madan A, Siglin J, Khan A. Comprehensive review of implications of COVID-19 on clinical outcomes of cancer patients and management of solid tumors during the pandemic. Cancer Med 2020; 9:9205-9218. [PMID: 33078903 PMCID: PMC7774721 DOI: 10.1002/cam4.3534] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease-2019 (COVID-19) has emerged as a novel infection which has spread rapidly across the globe and currently presents a grave threat to the health of vulnerable patient populations like those with malignancy, elderly, and immunocompromised. Healthcare systems across the world are grappling with the detrimental impact of this pandemic while learning about this novel disease and concurrently developing vaccines, strategies to mitigate its spread, and treat those infected. Cancer patients today face with a unique situation. They are susceptible to severe clinically adverse events and higher mortality from COVID-19 infection as well as morbidity and mortality from their underlying malignancy. Conclusion: Our review suggests increased risk of mortality and serious clinical events from COVID-19 infection in cancer patients. However, risk of adverse events does not seem to be increased by cancer therapies. True impact of COVID-19 on cancer patients will unravel over the next few months. We have also reviewed clinical features of COVID-19, recent recommendations from various medical, surgical, and radiation oncology societies for major solid tumor types like lung, breast, colorectal, and prostate cancer during the duration of this pandemic.
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Affiliation(s)
- Ankit Madan
- Department of Internal MedicineSOVAH Cancer CenterDanvilleVAUSA
| | - Joshua Siglin
- Department of Radiation oncologyDuke UniversityRaleighNCUSA
| | - Aleem Khan
- Department of PsychiatrySalem VA medical CenterUniversity of Virginia School of MedicineSalemVAUSA
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Abstract
The Covid-19 epidemic has placed considerable strain on healthcare systems in all countries. The impacts are multiple for patients treated for cancer.The objective of this manuscript is to summarize the epidemiological data available on patients with lung cancer developing a Covid infection, in particular the risk factors for aggravation and mortality, to describe the different strategies to improve the management of these patients and to summarize the existing recommendations in this area.The largest cohort on this subject, Teravolt, which included 1012 patients, found a hospitalization rate of 72 %, an aggravation rate of 56 % and a mortality of 32 %. In multivariate analysis, age ≥65 years (OR 1.53 CI 1.11-2.1), active smoking (OR 2 CI 1.3-3), metastatic status (OR 1.9 CI 1, 3-2.7), an ECOG PS ≥2 (OR 3.7 CI 2.7-5), taking corticosteroids before COVID infection (OR 1.8 CI 1.2-2.7), are associated with a higher risk of mortality but not treatments with chemotherapy or targeted therapies. Interestingly, treatment with immunotherapy appears to decrease the risk of mortality (OR 0.6 CI 0.97)Several screening strategies for asymptomatic forms have been reported in the literature and seem useful for diagnosing asymptomatic forms in patients undergoing systemic treatment or radiotherapy. Finally, national and international recommendations converge on many points, in particular for the need to protect patients and their families from Covid by assessing the benefit / risk of treatment on a case-by-case basis.© 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- C. Chouaid
- Service de Pneumologie, CHI Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, équipe CEpiA, Créteil, France
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Brunello A, Galiano A, Finotto S, Monfardini S, Colloca G, Balducci L, Zagonel V. Older cancer patients and COVID-19 outbreak: Practical considerations and recommendations. Cancer Med 2020; 9:9193-9204. [PMID: 33219746 PMCID: PMC7774711 DOI: 10.1002/cam4.3517] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Since the COVID-19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high-quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early-stage and advanced-stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated.
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Affiliation(s)
- Antonella Brunello
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Antonella Galiano
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | - Silvia Finotto
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
| | | | - Giuseppe Colloca
- Dipartimento di Diagnostica per ImmaginiRadioterapia Oncologica ed EmatologiaIstituto di RadiologiaFondazione Policlinico A. Gemelli IRCCS ‐ Università Cattolica Sacro CuoreRomaItaly
| | - Lodovico Balducci
- Moffitt Cancer CenterUniversity of South Florida College of MedicineTampaFloridaUSA
| | - Vittorina Zagonel
- Oncology 1 UnitDepartment of OncologyIstituto Oncologico Veneto IOV ‐ IRCCSPadovaItaly
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Back to (new) normality-A CODRAL/AIRO-L survey on cancer radiotherapy in Lombardy during Italian COVID-19 phase 2. Med Oncol 2020; 37:108. [PMID: 33150476 PMCID: PMC7641253 DOI: 10.1007/s12032-020-01434-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Abstract
Background Italy experienced one of the world’s severest COVID-19 outbreak, with Lombardy being the most afflicted region. However, the imposed safety measures allowed to flatten the epidemic curve and hence to ease the restrictions and inaugurate, on the 4th of May 2020, the Italian phase (P) 2 of the pandemic. The present survey study, endorsed by CODRAL and AIRO-L, aimed to assess how radiotherapy (RT) departments in Lombardy have dealt with the recovery. Materials and methods A questionnaire dealing with the management of pandemic was developed online and sent to all CODRAL Directors on the 10th of June 2020. Answers were collected in full anonymity one week after. Results All the 33 contacted RT facilities (100%) responded to the survey. Despite the scale of the pandemic, during P1 14 (42.4%) centres managed to safely continue the activity (≤ 10% reduction). During P2, 10 (30.3%) centres fully recovered and 14 (42.4%) reported an increase. Nonetheless, 6 (18.2%) declared no changes and, interestingly, 3 (9.1%) reduced activities. Overall, 21 centres (63.6%) reported suspected or positive cases within healthcare workforce since the beginning of the pandemic. Staff units were quarantined in 19 (57.6%) and 6 (18.2%) centres throughout P1 and P2, respectively. In the two phases, about two thirds centres registered positive or suspected cases amongst patients. Conclusion The study revealed a particular attention to anti-contagion measures and a return to normal or even higher clinical workload in most RT centres in Lombardy, necessary to carry out current and previously deferred treatments. Electronic supplementary material The online version of this article (10.1007/s12032-020-01434-1) contains supplementary material, which is available to authorized users.
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The Role of Telehealth During the COVID-19 Pandemic Across the Interdisciplinary Cancer Team: Implications for Practice. Semin Oncol Nurs 2020; 36:151090. [PMID: 33218886 PMCID: PMC7561334 DOI: 10.1016/j.soncn.2020.151090] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective This literature review aims to explore the role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer care team. Data Sources Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, and gray literature were searched using Google Scholar up until September 2020. Conclusion Although the safe and effective delivery of cancer care via telehealth requires education and training for health care professionals and patients, telehealth has provided a timely solution to the barriers caused by the COVID-19 pandemic on the delivery of interdisciplinary cancer services. Globally, evidence has shown that telehealth in cancer care can leverage an innovative response during the COVID-19 pandemic but may provide a long-lasting solution to enable patients to be treated appropriately in their home environment. Telehealth reduces the travel burden on patients for consultation, affords a timely solution to discuss distressing side effects, initiate interventions, and enable possible treatment additions and/or changes. Implications for Nursing Practice Global public health disasters pose significant and unique challenges to the provision of necessary services for people affected by cancer. Oncology nurses can provide a central contribution in the delivery of telehealth through transformational leadership across all domains and settings in cancer care. Oncology nurses provide the “hub of cancer care” safely embedded in the interdisciplinary team. Telehealth provides a solution to the current global health crisis but could also benefit the future provision of services and broad reach clinical trials.
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Onesti CE, Rugo HS, Generali D, Peeters M, Zaman K, Wildiers H, Harbeck N, Martin M, Cristofanilli M, Cortes J, Tjan-Heijnen V, Hurvitz SA, Berchem G, Tagliamento M, Campone M, Bartsch R, De Placido S, Puglisi F, Rottey S, Müller V, Ruhstaller T, Machiels JP, Conte P, Awada A, Jerusalem G. Oncological care organisation during COVID-19 outbreak. ESMO Open 2020; 5:S2059-7029(20)32664-8. [PMID: 32847836 PMCID: PMC7451457 DOI: 10.1136/esmoopen-2020-000853] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background COVID-19 appeared in late 2019, causing a pandemic spread. This led to a reorganisation of oncology care in order to reduce the risk of spreading infection between patients and healthcare staff. Here we analysed measures taken in major oncological units in Europe and the USA. Methods A 46-item survey was sent by email to representatives of 30 oncological centres in 12 of the most affected countries. The survey inquired about preventive measures established to reduce virus spread, patient education and processes employed for risk reduction in each oncological unit. Results Investigators from 21 centres in 10 countries answered the survey between 10 April and 6 May 2020. A triage for patients with cancer before hospital or clinic visits was conducted by 90.5% of centres before consultations, 95.2% before day care admissions and in 100% of the cases before overnight hospitalisation by means of phone calls, interactive online platforms, swab test and/or chest CT scan. Permission for caregivers to attend clinic visits was limited in many centres, with some exceptions (ie, for non-autonomous patients, in the case of a new diagnosis, when bad news was expected and for terminally ill patients). With a variable delay period, the use of personal protective equipment was unanimously mandatory, and in many centres, only targeted clinical and instrumental examinations were performed. Telemedicine was implemented in 76.2% of the centres. Separated pathways for COVID-19-positive and COVID-19-negative patients were organised, with separate inpatient units and day care areas. Self-isolation was required for COVID-19-positive or symptomatic staff, while return to work policies required a negative swab test in 76.2% of the centres. Conclusion Many pragmatic measures have been quickly implemented to deal with the health emergency linked to COVID-19, although the relative efficacy of each intervention should be further analysed in large observational studies.
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Affiliation(s)
- Concetta Elisa Onesti
- Department of Medical Oncology, CHU de Liège, Liege, Belgium .,Laboratory of Human Genetics, GIGA Research Institute and University of Liège, Liège, Belgium
| | - Hope S Rugo
- Department of Medicine and Division of Oncology, University of California San Francisco, Comprehensive Cancer Center, San Francisco, California, USA
| | - Daniele Generali
- UO Patologia Mammaria e Ricerca Traslazionale, Breast Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy.,University of Trieste, Trieste, Italy
| | - Marc Peeters
- Oncology Department, University Hospital Antwerp (UZA), Antwerp, Belgium
| | - Khalil Zaman
- Oncology Department, CHUV - Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Nadia Harbeck
- Breast Center, Dept. OB&GYN and CCLMU, Ludwig Maximilians University Hospital, Munich, Germany
| | - Miguel Martin
- Departamento de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Massimo Cristofanilli
- Feinberg School of Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Javier Cortes
- Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,IOB Institute of Oncology, Madrid, Spain
| | - Vivianne Tjan-Heijnen
- Medical Oncology Department, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Sara A Hurvitz
- Los Angeles/Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| | - Guy Berchem
- Hemato-Oncology Department, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Mario Campone
- Institut de Cancérologie de l'Ouest, Centre René Gauducheau, Saint Herblain, France
| | - Rupert Bartsch
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sabino De Placido
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | | | - Volkmar Müller
- Ginecology Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ruhstaller
- Medical Oncology Department, Breast Center of Eastern Switzerland, St Gallen, Switzerland
| | | | - PierFranco Conte
- Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy.,Division of Medical Oncology, University of Padova, Padova, Italy
| | - Ahmad Awada
- Medical Oncology Department, Institut Jules Bordet, Bruxelles, Belgium.,Medical Oncology Department, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, CHU de Liège, Liege, Belgium.,Université de Liège, Liege, Belgium
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