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Filipas DK, Pose RM, Marks P, Tennstedt P, Beyer B, Tilki D, Isbarn H, Maurer T, Ludwig TA, Heinzer H, Steuber T. Impact of COVID-19 on the time to counseling and treatment of prostate cancer. Aging Male 2024; 27:2347465. [PMID: 38712892 DOI: 10.1080/13685538.2024.2347465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE This study investigates how the COVID-19 pandemic (CP) impacted the timeline between initial diagnosis (ID) of prostate carcinoma and subsequent therapy consultation (TC) or radical prostatectomy (RP) due to the implementation of a "minimal contact concept," which postponed clinical examinations until the day of admission. METHODS We analyzed patient data from a tertiary care center from 2018 to September 2021. The focus was on comparing the time intervals from ID to TC and from ID to RP before and during the CP. RESULTS Of 12,255 patients, 6,073 (61.6%) were treated before and 3,791 (38.4%) during the CP. The median time from ID to TC reduced from 37 days (IQR: 21 - 58d) pre-CP to 32 days (IQR: 20 - 50d) during CP (p < 0.001). Similarly, the time from ID to RP decreased from 98 days (IQR: 70 - 141d) to 75 days (IQR: 55 - 108d; p < 0.001) during the CP. There was a significant decrease in low-risk tumor cases at ID (18.9% vs. 21.4%; p = 0.003) and post-RP (4% vs. 6.7%; p < 0.001) during the CP. CONCLUSION Our findings suggest that the COVID-19 pandemic facilitated more timely treatment of prostate cancer, suggesting potential benefits for both low-risk and aggressive tumor management through expedited clinical procedures.
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Affiliation(s)
- Dejan K Filipas
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Randi M Pose
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Burkhard Beyer
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Klinik Wildetal, Urologisches Kompetenzzentrum für die Rehabilitation, Bad Wildungen, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik Isbarn
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A Ludwig
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Shah R, Loo CE, Hanna NM, Hughes S, Mafra A, Fink H, McFerran E, Garcia M, Acharya S, Langselius O, Frick C, Niyigaba J, Lasebikan N, Steinberg J, Sullivan R, Bray F, Ilbawi AM, Ginsburg O, Chiam K, Cylus J, Caruana M, David M, Hui H, Canfell K, Soerjomataram I. Global review of COVID-19 mitigation strategies and their impact on cancer service disruptions. J Cancer Policy 2024; 41:100486. [PMID: 38830535 DOI: 10.1016/j.jcpo.2024.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/15/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Abstract
During the COVID-19 pandemic, countries adopted mitigation strategies to reduce disruptions to cancer services. We reviewed their implementation across health system functions and their impact on cancer diagnosis and care during the pandemic. A systematic search was performed using terms related to cancer and COVID-19. Included studies reported on individuals with cancer or cancer care services, focusing on strategies/programs aimed to reduce delays and disruptions. Extracted data were grouped into four functions (governance, financing, service delivery, and resource generation) and sub-functions of the health system performance assessment framework. We included 30 studies from 16 countries involving 192,233 patients with cancer. Multiple mitigation approaches were implemented, predominantly affecting sub-functions of service delivery to control COVID-19 infection via the suspension of non-urgent cancer care, modified treatment guidelines, and increased telemedicine use in routine cancer care delivery. Resource generation was mainly ensured through adequate workforce supply. However, less emphasis on monitoring or assessing the effectiveness and financing of these strategies was observed. Seventeen studies suggested improved service uptake after mitigation implementation, yet the resulting impact on cancer diagnosis and care has not been established. This review emphasizes the importance of developing effective mitigation strategies across all health system (sub)functions to minimize cancer care service disruptions during crises. Deficiencies were observed in health service delivery (to ensure equity), governance (to monitor and evaluate the implementation of mitigation strategies), and financing. In the wake of future emergencies, implementation research studies that include pre-prepared protocols will be essential to assess mitigation impact across cancer care services.
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Affiliation(s)
- Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - Ching Ee Loo
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | | | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Allini Mafra
- Cancer Epidemiology and Prevention Team, Public Health Expertise, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Hanna Fink
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Montse Garcia
- Cancer Screening Unit, Institut Català d'Oncologia (ICO), Early Detection of Cancer Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | | | - Oliver Langselius
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Clara Frick
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jean Niyigaba
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Richard Sullivan
- King's College London, Institute of Cancer Policy, Guy's Hospital, London, UK
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - André Michel Ilbawi
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Karen Chiam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Jonathan Cylus
- WHO Barcelona Office for Health Systems Financing, World Health Organization Regional Office for Europe, Barcelona, Spain; London School of Hygiene and Tropical Medicine Faculty of Public Health, London, UK
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; School of Medicine & Dentistry, Griffith University, Gold Coast, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Lemanska A, Andrews C, Fisher L, Bacon S, Mehrkar A, Inglesby P, Davy S, Goldacre B, MacKenna B, Walker AJ. During the COVID-19 pandemic 20 000 prostate cancer diagnoses were missed in England. BJU Int 2024; 133:587-595. [PMID: 38414224 DOI: 10.1111/bju.16305] [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] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To investigate the effect of the COVID-19 pandemic on prostate cancer incidence, prevalence, and mortality in England. PATIENTS AND METHODS With the approval of NHS England and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models and the pre-pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals (CIs) of the predicted values were used to estimate the significance of the difference between the predicted and observed rates. RESULTS In 2020, there was a drop in recorded incidence by 4772 (31%) cases (15 550 vs 20 322; 95% CI 19 241-21 403). In 2021, the incidence started to recover, and the drop was 3148 cases (18%, 17 950 vs 21 098; 95% CI 19 740-22 456). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (95% CI 71.5-71.8) years, in 2021 it was 71.8 (95% CI 71.7-72.0) years as compared to 71.3 (95% CI 71.1-71.4) years in 2019. CONCLUSIONS Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20 000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.
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Affiliation(s)
- Agnieszka Lemanska
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Colm Andrews
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seb Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Davy
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Barclay NL, Pineda Moncusí M, Jödicke AM, Prieto-Alhambra D, Raventós B, Newby D, Delmestri A, Man WY, Chen X, Català M. The impact of the UK COVID-19 lockdown on the screening, diagnostics and incidence of breast, colorectal, lung and prostate cancer in the UK: a population-based cohort study. Front Oncol 2024; 14:1370862. [PMID: 38601756 PMCID: PMC11004443 DOI: 10.3389/fonc.2024.1370862] [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: 01/15/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The COVID-19 pandemic had collateral effects on many health systems. Cancer screening and diagnostic tests were postponed, resulting in delays in diagnosis and treatment. This study assessed the impact of the pandemic on screening, diagnostics and incidence of breast, colorectal, lung, and prostate cancer; and whether rates returned to pre-pandemic levels by December, 2021. Methods This is a cohort study of electronic health records from the United Kingdom (UK) primary care Clinical Practice Research Datalink (CPRD) GOLD database. The study included individuals registered with CPRD GOLD between January, 2017 and December, 2021, with at least 365 days of clinical history. The study focused on screening, diagnostic tests, referrals and diagnoses of first-ever breast, colorectal, lung, and prostate cancer. Incidence rates (IR) were stratified by age, sex, and region, and incidence rate ratios (IRR) were calculated to compare rates during and after lockdown with rates before lockdown. Forecasted rates were estimated using negative binomial regression models. Results Among 5,191,650 eligible participants, the first lockdown resulted in reduced screening and diagnostic tests for all cancers, which remained dramatically reduced across the whole observation period for almost all tests investigated. There were significant IRR reductions in breast (0.69 [95% CI: 0.63-0.74]), colorectal (0.74 [95% CI: 0.67-0.81]), and prostate (0.71 [95% CI: 0.66-0.78]) cancer diagnoses. IRR reductions for lung cancer were non-significant (0.92 [95% CI: 0.84-1.01]). Extrapolating to the entire UK population, an estimated 18,000 breast, 13,000 colorectal, 10,000 lung, and 21,000 prostate cancer diagnoses were missed from March, 2020 to December, 2021. Discussion The UK COVID-19 lockdown had a substantial impact on cancer screening, diagnostic tests, referrals, and diagnoses. Incidence rates remained significantly lower than pre-pandemic levels for breast and prostate cancers and associated tests by December, 2021. Delays in diagnosis are likely to have adverse consequences on cancer stage, treatment initiation, mortality rates, and years of life lost. Urgent strategies are needed to identify undiagnosed cases and address the long-term implications of delayed diagnoses.
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Affiliation(s)
- Nicola L. Barclay
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Marta Pineda Moncusí
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Annika M. Jödicke
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Daniel Prieto-Alhambra
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
- Department of Medical Informatics, Erasmus Medical Center University, Rotterdam, Netherlands
| | - Berta Raventós
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Danielle Newby
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Antonella Delmestri
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Wai Yi Man
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Xihang Chen
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Marti Català
- Pharmaco− and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
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Medina‐Prado L, Sala‐Miquel N, Aicart‐Ramos M, López‐Cardona J, Ponce‐Romero M, Ortíz O, Pellisé M, Aguilera L, Díez‐Redondo P, Núñez‐Rodríguez H, Seoane A, Domper‐Arnal M, Borao‐Laguna C, González‐Bernardo Ó, Suárez A, Muñoz‐Tornero M, Bustamante‐Balén M, Soutullo‐Castiñeiras C, Balleste‐Peris B, Esteban P, Jiménez‐Gómez M, Albert M, Lucas J, Valdivieso‐Cortázar E, López‐Serrano A, Solano M, Tejedor‐Tejada J, Trelles M, Zapater P, Jover R. Effect of the SARS-CoV-2 pandemic on colorectal cancer diagnosis and prognosis. Cancer Med 2024; 13:e6923. [PMID: 38491824 PMCID: PMC10943366 DOI: 10.1002/cam4.6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/23/2023] [Accepted: 12/21/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND AND STUDY AIMS Our aim was to determine the impact of the SARS-CoV-2 pandemic on the diagnosis and prognosis of colorectal cancer (CRC). PATIENTS AND METHODS This prospective cohort study included individuals diagnosed with CRC between March 13, 2019 and June 20, 2021 across 21 Spanish hospitals. Two time periods were compared: prepandemic (from March 13, 2019 to March 13, 2020) and pandemic (from March 14, 2020 to June 20, 2021, lockdown period and 1 year after lockdown). RESULTS We observed a 46.9% decrease in the number of CRC diagnoses (95% confidence interval (CI): 45.1%-48.7%) during the lockdown and 29.7% decrease (95% CI: 28.1%-31.4%) in the year after the lockdown. The proportion of patients diagnosed at stage I significantly decreased during the pandemic (21.7% vs. 19.0%; p = 0.025). Centers that applied universal preprocedure SARS-CoV-2 PCR testing experienced a higher reduction in the number of colonoscopies performed during the pandemic post-lockdown (34.0% reduction; 95% CI: 33.6%-34.4% vs. 13.7; 95% CI: 13.4%-13.9%) and in the number of CRCs diagnosed (34.1% reduction; 95% CI: 31.4%-36.8% vs. 26.7%; 95% CI: 24.6%-28.8%). Curative treatment was received by 87.5% of patients diagnosed with rectal cancer prepandemic and 80.7% of patients during the pandemic post-lockdown period (p = 0.002). CONCLUSIONS The COVID-19 pandemic has led to a decrease in the number of diagnosed CRC cases and in the proportion of stage I CRC. The reduction in the number of colonoscopies and CRC diagnoses was higher in centers that applied universal SARS-CoV-2 PCR screening before colonoscopy. In addition, the COVID-19 pandemic has affected curative treatment of rectal cancers.
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Affiliation(s)
- Lucía Medina‐Prado
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Noelia Sala‐Miquel
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | | | | | | | | | | | - Lara Aguilera
- Hospital Vall d'Hebron. Gastroenterology department vall d'Hebron Research InstituteBarcelonaSpain
| | | | | | - Agustín Seoane
- Hospital del Mar Medical Research Institute (IMIM), Gastroenterology departmentBarcelonaSpain
| | - María‐José Domper‐Arnal
- Hospital Clínico Universitario Lozano Blesa. Instituto de investigación sanitaria de Aragón (IIS Aragón)ZaragozaSpain
| | - Cristina Borao‐Laguna
- Hospital Clínico Universitario Lozano Blesa. Instituto de investigación sanitaria de Aragón (IIS Aragón)ZaragozaSpain
| | | | - Adolfo Suárez
- Hospital Universitario Central de AsturiasOviedoSpain
| | | | | | | | | | - Pilar Esteban
- Hospital Morales Meseguer. Instituto Murciano de Investigación Biosanitaria (IMIB)MuricaSpain
| | | | - Marc Albert
- Hospital Universitari de Girona Doctor Josep TruetaGironaSpain
| | - Javier Lucas
- Hospital Universitario Fundación AlcorcónAlcorconSpain
| | | | | | | | | | | | - Pedro Zapater
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
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Valencia F, Gómez HL, Neciosup SP, Limón R, Torrico MDC, Morillas L, Torres R, Sánchez C, Araya I, Gómez R, Bruges R, Vargas C, Soria T, Muñoz R, Riofrío M, Gálvez M, Ruiz R, Benites P, Cardoso F. Advanced Breast Cancer Guidelines in Latin America: Assessment, Adaptation, and Implementation of Fifth Advanced Breast Cancer Consensus Guidelines. JCO Glob Oncol 2024; 10:e2200067. [PMID: 38301184 PMCID: PMC10846768 DOI: 10.1200/go.22.00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/31/2023] [Accepted: 11/09/2023] [Indexed: 02/03/2024] Open
Abstract
PURPOSE As the fifth international consensus on advanced breast cancer (ABC5) established guidelines for the management of this disease, the aim of this article was to present the applicability of the consensus recommendations and to generate knowledge to improve access. METHODS Sixty-one recommendation statements were selected and discussed by 15 breast cancer experts from Latin America (LA). After the discussion, the level of consensus was determined through a vote. In addition to this, the level of access to each of the recommendations presented, according to the country and health system, was exposed. RESULTS Latin American experts had a high level of agreement with the ABC5 consensus recommendations (range, 83%-100%). Twelve of 61 statements are not available for all patients in LA. Among the limitations to access, the following ones are described: limited access to certain technologies (stereotactic body radiotherapy, positron emission tomography-computed tomography), the high costs of drugs that limits access to treatment with CDK4/6 inhibitors, pertuzumab, or poly(ADP-ribose) polymerase inhibitors, and the lack of molecular tests for access to therapeutic targets, as well as the difficult geography and cultural diversity of our continent. CONCLUSION Despite the great relevance of the recommendations of the ABC5 consensus guidelines, we highlight that we still need to improve access for all patients, regardless of the country or health system they are in, for which we call to action to policy makers and patient groups to improve clinical outcomes of patients with advanced breast cancer in our region.
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Affiliation(s)
| | | | | | - Ronald Limón
- OncoBolivia—Centro especializado de cáncer, Clínica de las Américas—Departamento de Oncología, Santa Cruz, Bolivia
| | | | - Lena Morillas
- Centro de Enfermedades Neoplásicas ONCOVIDA, La Paz, Bolivia
| | | | | | | | - Rodolfo Gómez
- Instituto de Cancerología de Las Américas de Medellín, Medellín, Colombia
| | | | - Carlos Vargas
- Unidad de Cáncer, Clínica de Country, Bogotá, Colombia
| | | | | | | | - Marco Gálvez
- Instituto Regional de Enfermedades Neoplasicas del Norte, Trujillo, Peru
| | | | - Pilar Benites
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
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Marty S, Lamé G, Guével E, Priou S, Chatellier G, Tournigand C, Kempf E. Impact of the Sars-Cov-2 outbreak on the initial clinical presentation of new solid cancer diagnoses: a systematic review and meta-analysis. BMC Cancer 2024; 24:143. [PMID: 38287348 PMCID: PMC10823607 DOI: 10.1186/s12885-023-11795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/25/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic might have delayed cancer diagnosis and management. The aim of this systematic review was to compare the initial tumor stage of new cancer diagnoses before and after the pandemic. METHODS We systematically reviewed articles that compared the tumor stage of new solid cancer diagnoses before and after the initial pandemic waves. We conducted a random-effects meta-analysis to compare the rate of metastatic tumors and the distribution of stages at diagnosis. Subgroup analyses were performed by primary tumor site and by country. RESULTS From 2,013 studies published between January 2020 and April 2022, we included 58 studies with 109,996 patients. The rate of metastatic tumors was higher after the COVID-19 outbreak than before (pooled OR: 1.29 (95% CI, 1.06-1.57), I2: 89% (95% CI, 86-91)). For specific cancers, common ORs reached statistical significance for breast (OR: 1.51 (95% CI 1.07-2.12)) and gynecologic (OR: 1.51 (95% CI 1.04-2.18)) cancers, but not for other cancer types. According to countries, common OR (95% CI) reached statistical significance only for Italy: 1.55 (1.01-2.39) and Spain:1.14 (1.02-1.29). Rates were comparable for stage I-II versus III-IV in studies for which that information was available, and for stages I-II versus stage III in studies that did not include metastatic patients. CONCLUSIONS Despite inter-study heterogeneity, our meta-analysis showed a higher rate of metastatic tumors at diagnosis after the pandemic. The burden of social distancing policies might explain those results, as patients may have delayed seeking care.
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Affiliation(s)
- Simon Marty
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Guillaume Lamé
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Etienne Guével
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, Paris, France
| | - Sonia Priou
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, F-75015, Paris, France
| | - Christophe Tournigand
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Emmanuelle Kempf
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France.
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
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8
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Durán-Jara E, Del Campo M, Gutiérrez V, Wichmann I, Trigo C, Ezquer M, Lobos-González L. Lactadherin immunoblockade in small extracellular vesicles inhibits sEV-mediated increase of pro-metastatic capacities. Biol Res 2024; 57:1. [PMID: 38173019 PMCID: PMC10763369 DOI: 10.1186/s40659-023-00477-8] [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: 02/01/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Tumor-derived small extracellular vesicles (sEVs) can promote tumorigenic and metastatic capacities in less aggressive recipient cells mainly through the biomolecules in their cargo. However, despite recent advances, the specific molecules orchestrating these changes are not completely defined. Lactadherin is a secreted glycoprotein typically found in the milk fat globule membrane. Its overexpression has been associated with increased tumorigenesis and metastasis in breast cancer (BC) and other tumors. However, neither its presence in sEVs secreted by BC cells, nor its role in sEV-mediated intercellular communication have been described. The present study focused on the role of lactadherin-containing sEVs from metastatic MDA-MB-231 triple-negative BC (TNBC) cells (sEV-MDA231) in the promotion of pro-metastatic capacities in non-tumorigenic and non-metastatic recipient cells in vitro, as well as their pro-metastatic role in a murine model of peritoneal carcinomatosis. RESULTS We show that lactadherin is present in sEVs secreted by BC cells and it is higher in sEV-MDA231 compared with the other BC cell-secreted sEVs measured through ELISA. Incubation of non-metastatic recipient cells with sEV-MDA231 increases their migration and, to some extent, their tumoroid formation capacity but not their anchorage-independent growth. Remarkably, lactadherin blockade in sEV-MDA231 results in a significant decrease of those sEV-mediated changes in vitro. Similarly, intraperitoneally treatment of mice with MDA-MB-231 BC cells and sEV-MDA231 greatly increase the formation of malignant ascites and tumor micronodules, effects that were significantly inhibited when lactadherin was previously blocked in those sEV-MDA231. CONCLUSIONS As to our knowledge, our study provides the first evidence on the role of lactadherin in metastatic BC cell-secreted sEVs as promoter of: (i) metastatic capacities in less aggressive recipient cells, and ii) the formation of malignant ascites and metastatic tumor nodules. These results increase our understanding on the role of lactadherin in sEVs as promoter of metastatic capacities which can be used as a therapeutic option for BC and other malignancies.
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Affiliation(s)
- Eduardo Durán-Jara
- Center for Regenerative Medicine, Institute for Sciences and Innovation in Medicine, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Matías Del Campo
- Center for Regenerative Medicine, Institute for Sciences and Innovation in Medicine, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Valentina Gutiérrez
- Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Ignacio Wichmann
- Division of Obstetrics and Gynecology, Department of Obstetrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile
- Advanced Center for Chronic Diseases (ACCDiS), Independencia, Santiago, Chile
| | - César Trigo
- Center for Regenerative Medicine, Institute for Sciences and Innovation in Medicine, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Marcelo Ezquer
- Center for Regenerative Medicine, Institute for Sciences and Innovation in Medicine, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Lorena Lobos-González
- Center for Regenerative Medicine, Institute for Sciences and Innovation in Medicine, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
- Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
- Advanced Center for Chronic Diseases (ACCDiS), Independencia, Santiago, Chile.
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9
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Iijima K, Watanabe K, Shimodaira Y. Editorial: Comparisons of COVID-19-related disturbance in diagnosis of esophagogastric cancer between the Netherlands and Japan. J Gastroenterol 2024; 59:79-80. [PMID: 37971582 DOI: 10.1007/s00535-023-02056-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Kenta Watanabe
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yosuke Shimodaira
- Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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10
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Tambuyzer T, Vanhauwaert D, Boterberg T, De Vleeschouwer S, Peacock HM, Bouchat J, Silversmit G, Verdoodt F, De Gendt C, Van Eycken L. Impact of the COVID-19 Pandemic on Incidence and Observed Survival of Malignant Brain Tumors in Belgium. Cancers (Basel) 2023; 16:63. [PMID: 38201490 PMCID: PMC10778220 DOI: 10.3390/cancers16010063] [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: 11/07/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: This study evaluates the impact of the COVID-19 pandemic on the incidence, treatment, and survival of adults diagnosed with malignant brain tumors in Belgium in 2020. (2) Methods: We examined patients aged 20 and older with malignant brain tumors (2004-2020) from the Belgian Cancer Registry database, assessing incidence, WHO performance status, vital status, and treatment data. We compared 2020 incidence rates with projected rates and age-standardized rates to 2015-2019. The Kaplan-Meier method was used to assess observed survival (OS). (3) Results: In 2020, there was an 8% drop in age-specific incidence rates, particularly for those over 50. Incidence rates plunged by 37% in April 2020 during the first COVID-19 peak but partially recovered by July. For all malignant brain tumors together, the two-year OS decreased by four percentage points (p.p.) in 2020 and three p.p. in 2019, compared to that in 2015-2018. Fewer patients (-9 p.p.) with glioblastoma underwent surgery, and the proportion of patients not receiving surgery, radiotherapy, or systemic therapy increased by six percentage points in 2020. (4) Conclusions: The COVID-19 pandemic profoundly impacted the diagnosis, treatment strategies, and survival of brain tumor patients in Belgium during 2020. These findings should guide policymakers in future outbreak responses, emphasizing the need to maintain or adapt (neuro)-oncological care pathways and promote informed decision making when care capacity is limited.
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Affiliation(s)
- Tim Tambuyzer
- Belgian Cancer Registry, 1210 Brussels, Belgium; (T.T.); (J.B.); (L.V.E.)
| | | | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Steven De Vleeschouwer
- Department of Neurosurgery, UZ Leuven, 3000 Leuven, Belgium;
- Laboratory of Experimental Neurosurgery and Neuroanatomy, Department Neurosciences, LEUVEN BRAIN INSTITUTE (LBI), KU Leuven, 3000 Leuven, Belgium
| | - Hanna M. Peacock
- Belgian Cancer Registry, 1210 Brussels, Belgium; (T.T.); (J.B.); (L.V.E.)
| | - Joanna Bouchat
- Belgian Cancer Registry, 1210 Brussels, Belgium; (T.T.); (J.B.); (L.V.E.)
| | - Geert Silversmit
- Belgian Cancer Registry, 1210 Brussels, Belgium; (T.T.); (J.B.); (L.V.E.)
| | - Freija Verdoodt
- Belgian Cancer Registry, 1210 Brussels, Belgium; (T.T.); (J.B.); (L.V.E.)
| | - Cindy De Gendt
- Belgian Cancer Registry, 1210 Brussels, Belgium; (T.T.); (J.B.); (L.V.E.)
| | - Liesbet Van Eycken
- Belgian Cancer Registry, 1210 Brussels, Belgium; (T.T.); (J.B.); (L.V.E.)
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11
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Molinier O, Guguen C, Marcq M, Chene AL, Masson P, Bigot F, Denis F, Empereur F, Saulnier P, Urban T. A Comparative Multicenter Cohort Study Evaluating the Long-Term Influence of the Strict Lockdown during the First COVID-19 Wave on Lung Cancer Patients (ARTEMISIA Trial). Cancers (Basel) 2023; 15:5729. [PMID: 38136275 PMCID: PMC10742265 DOI: 10.3390/cancers15245729] [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: 11/09/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
The consequences of the strict health restrictions during the first wave of COVID-19 on lung cancer (LC) patients are not known. This cohort study evaluated the impact of the initial lockdown on management of and long-term outcome in LC patients. This exposed-unexposed-type study included two evaluation periods of 6 months each in non-selected patients; one began on the first day of lockdown in 2020, and the other in 2019 during the same calendar period. Various indicators were compared: clinical profiles, management delays and overall survival beyond 2 years. A total of 816 patients from 7 public or private centers were enrolled. The clinical characteristics of the patients in 2020 did not differ from those in 2019, except that the population was older (p = 0.002) with more non-smokers (p = 0.006). Delays for pre-therapeutic medical management were generally reduced after the first imaging in 2020 (1.28 [1.1-1.49]). In the multivariate analysis, being part of the 2020 cohort was correlated with better prognosis (HR = 0.71 [0.5-0.84], p < 0.001). The gain observed in 2020 mainly benefited non-smoking patients, along with ECOG PS 0-2 (p = 0.01), stage 4 (p = 0.003), squamous cell carcinoma (p = 0.03) and receiving systemic therapy (p = 0.03). In conclusion, the first lockdown did not exert any deleterious impact on LC patients.
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Affiliation(s)
- Olivier Molinier
- Respiratory Medicine Department, Hospital Center, 194 Avenue Rubillard, CEDEX 9, 72037 Le Mans, France
| | - Camille Guguen
- Respiratory Medicine Department, Hospital Center, 194 Avenue Rubillard, CEDEX 9, 72037 Le Mans, France
| | - Marie Marcq
- Respiratory Medicine Department, Hospital Center, 85925 La Roche-sur-Yon, France
| | - Anne-Laure Chene
- Respiratory Medicine Department, Thorax Institute, University Hospital Center, University of Nantes, 44093 Nantes, France
| | - Philippe Masson
- Respiratory Medicine Department, Hospital Center, 49300 Cholet, France
| | - Frédéric Bigot
- Oncology Department, Western Cancer Institute Paul Papin, 49105 Angers, France;
| | - Fabrice Denis
- Oncology Department, Clinique Victor Hugo, 72000 Le Mans, France;
| | | | - Philippe Saulnier
- Biostatistics Department, National Institute of Health and Medical Research, University of Angers, 49100 Angers, France
| | - Thierry Urban
- Respiratory Medicine Department, University Hospital Center, 49100 Angers, France;
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12
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Bernal Lara P, Savedoff WD, García Agudelo MF, Bernal C, Goyeneche L, Sorio R, Pérez-Cuevas R, da Rocha MG, Shibata LG, San Roman Vucetich C, Bauhoff S. Disruption Of Non-COVID-19 Health Care In Latin America During The Pandemic: Effects On Health, Lessons For Policy. Health Aff (Millwood) 2023; 42:1657-1666. [PMID: 38048496 DOI: 10.1377/hlthaff.2023.00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
COVID-19 had severe direct and indirect effects on health and well-being in Latin America. To understand the extent to which disruptions among non-COVID-19-related health services affected population health, we used administrative data from the period 2015-21 to examine public hospital discharges and mortality for conditions amenable to health care in four Latin American countries: Brazil, Ecuador, Mexico, and Peru. Between March 2020 and December 2021, hospitalization rates for these conditions declined by 28 percent and mortality rates increased by 15 percent relative to prepandemic years. Noncommunicable diseases accounted for 89 percent of this rise in mortality. The poorest states in each country experienced relatively larger increases in mortality. Our results, which focus on the health effects of service disruption, suggest that maintaining health care services in this region during the pandemic could have avoided at least 96,000 deaths. Policies should focus on maintaining essential health care services during emergencies, particularly for patients with noncommunicable diseases, and on minimizing negative consequences by ensuring coordinated and continuous care; leveraging alternative modalities of care, such as telemedicine; broadening the role of nonphysician health care workers; and expanding options for medication delivery.
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Affiliation(s)
- Pedro Bernal Lara
- Pedro Bernal Lara , Inter-American Development Bank, Washington, D.C
| | | | | | - Carolina Bernal
- Carolina Bernal, Inter-American Development Bank, Bogota, Colombia
| | - Laura Goyeneche
- Laura Goyeneche, Inter-American Development Bank, Washington, D.C
| | - Rita Sorio
- Rita Sorio, Inter-American Development Bank, Lima, Peru
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13
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Herrera CA, Juárez-Ramírez C, Reyes-Morales H, Bedregal P, Reartes-Peñafiel DL, Díaz-Portillo SP, Klazinga N, Kringos DS, Veillard J. COVID-19 Disruption To Routine Health Care Services: How 8 Latin American And Caribbean Countries Responded. Health Aff (Millwood) 2023; 42:1667-1674. [PMID: 38048493 DOI: 10.1377/hlthaff.2023.00694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Latin America and the Caribbean was one of the regions hardest hit globally by SARS-CoV-2. This qualitative exploratory study examined how the COVID-19 pandemic disrupted the delivery of routine health services from the perspective of health care system decision makers and managers. Between May and December 2022, we conducted forty-two semistructured interviews with decision makers from ministries of health and health care managers with responsibilities during the COVID-19 pandemic in eight countries in Latin America and the Caribbean. On the basis of these interviews, we identified themes in three domains: impacts on the provision of routine health services, including postponed and forgone primary care and hospital services; barriers to maintaining routine health services due to preexisting structural health care system weaknesses and difficulties attributed to the pandemic; and innovative strategies to sustain and recover services such as public-private financing and coordination, telemedicine, and new roles for primary care. In the short term, policy efforts should focus on recovering postponed services, including those for noncommunicable diseases. Medium- and long-term health care system reforms should strengthen primary care and address structural issues, such as fragmentation, to promote more resilient health care systems.
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Affiliation(s)
| | - Clara Juárez-Ramírez
- Clara Juárez-Ramírez , National Institute of Public Health of Mexico, Mexico City, Mexico
| | - Hortensia Reyes-Morales
- Hortensia Reyes-Morales, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Paula Bedregal
- Paula Bedregal, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Sandra P Díaz-Portillo
- Sandra P. Díaz-Portillo, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Niek Klazinga
- Niek Klazinga, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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14
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Amato O, Guarneri V, Girardi F. Epidemiology trends and progress in breast cancer survival: earlier diagnosis, new therapeutics. Curr Opin Oncol 2023; 35:612-619. [PMID: 37681462 PMCID: PMC10566595 DOI: 10.1097/cco.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW In this review we will critically appraise the latest evidence on breast cancer (BC) survival trends and discuss how these may reflect breakthroughs in early diagnosis and treatment approaches. We will address the wide global inequalities in BC survival and review the ongoing initiatives aimed at improving cancer control worldwide. RECENT FINDINGS BC outcomes have improved in high-income countries during the last decades, following the implementation of strategies for early detection and optimal multimodality treatment. Novel therapeutics, such as anti-HER2 targeted treatments, have also contributed to the progress in BC survival. However, BC mortality is still high in low-income countries, due to the lack of optimal healthcare infrastructures. In the context of marked inequities in BC management across world regions, international collaborations such as the Global Breast Cancer Initiative and the Global Initiative for Cancer Registry Development work to foster capacity-building in developing countries, tackle the burden of BC and deliver the Sustainable Development Goals by 2030. SUMMARY Collection of robust, high-quality data from population-based cancer registries is crucial to drive and refine public health interventions. Population-based data are also the litmus paper to evaluate the real-world impact of clinical advances and monitor progress.
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Affiliation(s)
- Ottavia Amato
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
| | - Valentina Guarneri
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
| | - Fabio Girardi
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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15
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Li S, Dong R, Kang Z, Li H, Wu X, Li T. Exosomes: Another intercellular lipometabolic communication mediators in digestive system neoplasms? Cytokine Growth Factor Rev 2023; 73:93-100. [PMID: 37541791 DOI: 10.1016/j.cytogfr.2023.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 08/06/2023]
Abstract
Neoplasms are one of the most concerned public health problems worldwide. Digestive system neoplasms, with a high morbidity and mortality, is one of the most common malignant tumors in human being. It is found that exosomes act as an intercellular communication media to carry the metabolic and genetic information of parental cells to target cells. Likely, exosomes participate in lipid metabolism and regulates multiple processes in digestive system neoplasms, including the information transmission among cancer cells, the formation of neoplastic microenvironment, and the neoplastic biological behaviors like metastasis, invasion, and the chemotherapy resistance. In this review, we firstly introduce the main mechanisms whereas exosomes act as intercellular lipometabolic communication mediator in digestive system neoplasms. Thereafter we introduce the relationship between exosomes lipid metabolism and various type of digestive system neoplasms, including gastric cancer, hepatocellular carcinoma, pancreatic cancer, and colorectal cancer. Eventually, we summarized and prospected the development and implication of exosomes in digestive system neoplasms. The further research of exosomes as intercellular lipid metabolism mediator will contribute to accurate and efficient diagnosis and treatment of digestive system neoplasms.
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Affiliation(s)
- Shaodong Li
- Department of General Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China; Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China
| | - Ruizhi Dong
- Department of Colorectal & Anal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China
| | - Zhenhua Kang
- Department of Colorectal & Anal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China
| | - Hucheng Li
- Department of Hepato-Pancreato-Biliary Center, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.
| | - Xueliang Wu
- Department of General Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China; Tumor Research Institute, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China.
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China.
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16
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Veettil SK, Schwerer L, Kategeaw W, Toth D, Samore MH, Hutubessy R, Chaiyakunapruk N. Scoping review of modelling studies assessing the impact of disruptions to essential health services during COVID-19. BMJ Open 2023; 13:e071799. [PMID: 37751952 PMCID: PMC10533712 DOI: 10.1136/bmjopen-2023-071799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Studies assessing the indirect impact of COVID-19 using mathematical models have increased in recent years. This scoping review aims to identify modelling studies assessing the potential impact of disruptions to essential health services caused by COVID-19 and to summarise the characteristics of disruption and the models used to assess the disruptions. METHODS Eligible studies were included if they used any models to assess the impact of COVID-19 disruptions on any health services. Articles published from January 2020 to December 2022 were identified from PubMed, Embase and CINAHL, using detailed searches with key concepts including COVID-19, modelling and healthcare disruptions. Two reviewers independently extracted the data in four domains. A descriptive analysis of the included studies was performed under the format of a narrative report. RESULTS This scoping review has identified a total of 52 modelling studies that employed several models (n=116) to assess the potential impact of disruptions to essential health services. The majority of the models were simulation models (n=86; 74.1%). Studies covered a wide range of health conditions from infectious diseases to non-communicable diseases. COVID-19 has been reported to disrupt supply of health services, demand for health services and social change affecting factors that influence health. The most common outcomes reported in the studies were clinical outcomes such as mortality and morbidity. Twenty-five studies modelled various mitigation strategies; maintaining critical services by ensuring resources and access to services are found to be a priority for reducing the overall impact. CONCLUSION A number of models were used to assess the potential impact of disruptions to essential health services on various outcomes. There is a need for collaboration among stakeholders to enhance the usefulness of any modelling. Future studies should consider disparity issues for more comprehensive findings that could ultimately facilitate policy decision-making to maximise benefits to all.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Luke Schwerer
- USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Warittakorn Kategeaw
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Damon Toth
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Matthew H Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
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Nascimento de Lima P, van den Puttelaar R, Hahn AI, Harlass M, Collier N, Ozik J, Zauber AG, Lansdorp-Vogelaar I, Rutter CM. Projected long-term effects of colorectal cancer screening disruptions following the COVID-19 pandemic. eLife 2023; 12:e85264. [PMID: 37129468 PMCID: PMC10154022 DOI: 10.7554/elife.85264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
The aftermath of the initial phase of the COVID-19 pandemic may contribute to the widening of disparities in colorectal cancer (CRC) outcomes due to differential disruptions to CRC screening. This comparative microsimulation analysis uses two CISNET CRC models to simulate the impact of ongoing screening disruptions induced by the COVID-19 pandemic on long-term CRC outcomes. We evaluate three channels through which screening was disrupted: delays in screening, regimen switching, and screening discontinuation. The impact of these disruptions on long-term CRC outcomes was measured by the number of life-years lost due to CRC screening disruptions compared to a scenario without any disruptions. While short-term delays in screening of 3-18 months are predicted to result in minor life-years loss, discontinuing screening could result in much more significant reductions in the expected benefits of screening. These results demonstrate that unequal recovery of screening following the pandemic can widen disparities in CRC outcomes and emphasize the importance of ensuring equitable recovery to screening following the pandemic.
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Affiliation(s)
| | | | - Anne I Hahn
- Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | | | | | | | - Ann G Zauber
- Memorial Sloan Kettering Cancer CenterNew YorkUnited States
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18
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Kodama M, Miyamori D, Kanno K, Ito M. The impact of early‐stage COVID‐19 pandemic on the diagnosis and treatment of gastric cancer: A cross‐sectional study using a large‐scale cancer registry in Hiroshima, Japan. DEN OPEN 2023; 3:e180. [PMID: 36381640 PMCID: PMC9637546 DOI: 10.1002/deo2.180] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 11/09/2022]
Abstract
Background After the confirmation of coronavirus infection in Japan, a behavioral change caused people and physicians to refrain from visiting hospitals or undergoing examinations. This study aimed to assess how the trend of diagnosis in gastric cancers changed, and how it affected the therapeutic strategies and the interval from diagnosis to treatment during the COVID‐19 pandemic. Methods We use 15 cancer‐designated hospitals’ registries in Hiroshima, Japan. The target period was March to December 2020, and the same period in 2019 was set as the control period. The monthly mean of diagnoses and the interval from diagnosis to treatment were compared overall and separately by age, treatment procedure, diagnostic process, and clinical stage. Result In 2020, the monthly mean (standard deviation [SD]) of patients was 192.2 (29.9), a significant 20.1% decrease from 240.7 (20.7) in 2019 due to older age and curative treatment groups. By reason for performing endoscopy, the change rate in cancer screening, endoscopic follow‐up, and symptomatic status were ‐27.0%, ‐18.0%, and ‐17.3%, respectively. Meanwhile, the interval (days) from diagnosis to treatment (SD) was 37.8 (26.5) in 2020, significantly shorter than 46 (31.5) in 2019. Conclusion From 2019 to 2020, we observed a significant decrease in the diagnosis of curable early‐stage gastric cancer and treatments, although the interval from diagnosis to treatment decreased. This study suggests that cancer screening played a significant role in the decline in cancer diagnosis that occurred during the COVID‐19 pandemic. Even under COVID‐19 pandemic conditions, there should be an awareness of cancer screening and endoscopic follow‐up.
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Affiliation(s)
- Masanobu Kodama
- Graduate School of Public Health Hiroshima University Hiroshima Japan
- Department of General Internal Medicine Hiroshima University Hospital Hiroshima Japan
| | - Daisuke Miyamori
- Department of General Internal Medicine Hiroshima University Hospital Hiroshima Japan
| | - Keishi Kanno
- Department of General Internal Medicine Hiroshima University Hospital Hiroshima Japan
| | - Masanori Ito
- Department of General Internal Medicine Hiroshima University Hospital Hiroshima Japan
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El-Tawab SS, Fox J, Trent S, Kehoe S. Cervical cancer during the covid pandemic: Are patients presenting with more advanced or larger tumours? Eur J Obstet Gynecol Reprod Biol 2023; 283:95-99. [PMID: 36822124 DOI: 10.1016/j.ejogrb.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVES Concerns were raised by clinicians at the Oxford Gynaecological Cancer MDT that there was an increasing number of women presenting with large cervical tumours requiring chemo-radiotherapy, possibly due to delays associated with the COVID pandemic. This audit was undertaken to assess whether this was a real event. STUDY DESIGN This retrospective cohort study collated the data from the central pathology service covering Oxfordshire, in the Oxford Gynaecological cancer centre. The control population consisted of patients treated during the 2 years pre-pandemic (1st Jan 2018-31 Dec 2019) and the study group the 2-year pandemic period (1st Jan 2020 until 31st December 2021). A total of 153 patients (74 control and 79 study) were diagnosed of cervical cancer during the study period. Variables included in the analysis were age, pathway of referral and diagnosis (cytology or clinical), FIGO stage, tumour histology, tumour size (using maximum diameter on MRI) and treatment. Student's t-test was used for continuous and discrete variables, respectively. The X2 test was used for the statistical analysis of proportions. RESULTS There was no statistically significant differences was noted in the referral pathways during both periods. Statistically significant stage migration from FIGO stage II to III was detected (p < 0.05), though no statistically significant change in tumour size. However, the pattern of tumour volume on case-to-case comparison elicited more cases with larger volumes during the pandemic periods. CONCLUSIONS Referral pathways of diagnosed cancer cervix was not affected during the pandemic in Oxfordshire. Therapeutic treatment numbers were unchanged - but some changes in tumour volume were likely the reason for the impression more such cases. Whether the stage shift noted here is representative of the wider population requires further studies.
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Affiliation(s)
- Sally S El-Tawab
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford University Hospitals Foundation Trust, Headington, Oxford OX3 7DL, United Kingdom; Elshatby Maternity University Hospital, Gynaecology Oncology Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Julia Fox
- Consultant Biomedical Scientist, Cellular Pathology Department, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Headington, Oxford OX3 9DU, United Kingdom.
| | - Sally Trent
- Clinical Oncology Department, Churchill Hospital, Oxford University Hospitals Foundation Trust, Headington, Oxford OX3 7DL, United Kingdom.
| | - Sean Kehoe
- Oxford Gynaecological Cancer Centre, Churchill Hospital, Oxford University Hospitals Foundation Trust, Headington, Oxford OX3 7DL, United Kingdom; Nuffield Department of Women's & Reproductive Health, The Women's Centre, John Radcliffe Hospital, Oxford OX3 9 DU, United Kingdom.
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20
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Impact of COVID-19 on Uro-Oncological Patients: A Comprehensive Review of the Literature. Microorganisms 2023; 11:microorganisms11010176. [PMID: 36677468 PMCID: PMC9865028 DOI: 10.3390/microorganisms11010176] [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: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Background: The aim of this paper is to discuss the impact of COVID-19 on patients with urological malignancies (prostate cancer, bladder and upper tract urothelial cancer, kidney cancer, penile and testicular cancer) and to review the available recommendations reported in the literature. Methods: A review was performed, through the PubMed database, regarding available recommendations reported in the literature, to identify studies examining the impact of COVID-19 on treatment and clinical outcomes (including upstaging, recurrence, and mortality) for uro-oncological patients. Results: The COVID-19 pandemic dramatically changed the urological guidelines and patients' access to screening programs and follow-up visits. Great efforts were undertaken to guarantee treatments to high-risk patients although follow up was not always possible due to recurrent surges, and patients with lower risk cancers had to wait for therapies. Conclusions: Physically and mentally, uro-oncological patients paid a heavy price during the COVID-19 pandemic. Long term data on the "costs" of clinical decisions made during the COVID-19 pandemic are still to be revealed and analyzed.
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21
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Wang X, Zhang C, Song H, Yuan J, Zhang L, He J. CircCCDC66: Emerging roles and potential clinical values in malignant tumors. Front Oncol 2023; 12:1061007. [PMID: 36698408 PMCID: PMC9869039 DOI: 10.3389/fonc.2022.1061007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Circular RNAs (circRNAs) are endogenous non-coding RNAs (ncRNAs) with a closed-loop structure. In recent years, circRNAs have become the focus of much research into RNA. CircCCDC66 has been identified as a novel oncogenic circRNA and is up-regulated in a variety of malignant tumors including thyroid cancer, non-small cell carcinoma, gastric cancer, colorectal cancer, renal cancer, cervical cancer, glioma, and osteosarcoma. It mediates cancer progression by regulating epigenetic modifications, variable splicing, transcription, and protein translation. The oncogenicity of circCCDC66 suppresses or promotes the expression of related genes mainly through direct or indirect pathways. This finding suggests that circCCDC66 is a biomarker for cancer diagnosis, prognosis assessment and treatment. However, there is no review on the relationship between circCCDC66 and cancers. Thus, the expression, biological functions, and regulatory mechanisms of circCCDC66 in malignant tumor and non-tumor diseases are summarized. The clinical value and prognostic significance of circCCDC66 are also evaluated, which can provide insights helpful to those exploring new strategies for the early diagnosis and targeted treatment of malignancies.
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Affiliation(s)
- Xiaoxiao Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Chao Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Huangqin Song
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Junlong Yuan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Lei Zhang
- Department of Hepatobiliary Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China,Hepatic Surgery Center, Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiefeng He
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China,Department of Hepatobiliary Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China,*Correspondence: Jiefeng He,
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22
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Honorato M, Calderón O, Rojas V, Fasce G, Bartolotti C, Caglevic C. Considerations and analysis of the implementation of oncogeriatrics in Chile and its importance: Review of current literature. FRONTIERS IN AGING 2023; 4:1141792. [PMID: 37033403 PMCID: PMC10077059 DOI: 10.3389/fragi.2023.1141792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/24/2023] [Indexed: 04/11/2023]
Abstract
The Chilean census of 2017 reported that 11.4% of the local population are 65 years or older, and according to the National Institute of Statistics (INE) the current expectancy of life in Chile is 76 years for men and 81 years for women respectively. Cancer in Chile is a major public health problem. Aging is a significant risk factor for cancer development which added to the improved life expectancy, it increases the incidence of cancer. In 2040, new cancer cases will increase from 19.3 to 30.2 million worldwide. Older people are a heterogeneous group requiring specialized and individualized management. Chronological age does not necessarily correlate with physiological age. More than half of the geriatric patients with cancer have at least one comorbidity which is relevant when defining a cancer treatment. Likewise, polypharmacy is frequent and is an important issue to consider in people with cancer due to the risk associated with drug interactions. Oncogeriatric assessment consists of a comprehensive multidimensional evaluation, including functional and biopsychosocial issues, addressing aspects of the neoplastic disease such as the risk of toxicities due to systemic therapy and life expectancy. This tool has proven to be helpful in the diagnosis of conditions that are not evident in a routine oncological evaluation, such as geriatric syndromes, frailty, functional dependence, and cognitive impairment among others, which have an impact when deciding on therapy, predicting risks of treatment toxicity and mortality. In this article we aim to describe the current situation of Oncogeriatrics and to provide epidemiological information about cancer in the elderly population in Chile attempting to highlight the importance of the Oncogeriatrics units, within cancer departments, for a better decision taking in the elderly cancer patient.
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Affiliation(s)
| | - Oscar Calderón
- Geriatrics Department, Clínica Alemana de Santiago, Santiago, Chile
- Geriatrics, Complejo Asistencial Dr Sótero del Río, Santiago, Chile
| | - Verónica Rojas
- Geriatrics Department, Clínica Alemana de Santiago, Santiago, Chile
| | - Gerardo Fasce
- Geriatrics Service, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
- Geriatrics Service, Department of Medicine, Clínica Las Condes, Santiago, Chile
| | - Constanza Bartolotti
- Geriatrics, Internal Medicine Department, Universidad de la Frontera, Temuco, Chile
- Geriatrics, Centro Comunitario Kiműnche, Temuco, Chile
| | - Christian Caglevic
- Cancer Research Department, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- *Correspondence: Christian Caglevic,
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23
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de Lima PN, van den Puttelaar R, Hahn AI, Harlass M, Collier N, Ozik J, Zauber AG, Lansdorp-Vogelaar I, Rutter CM. Unequal Recovery in Colorectal Cancer Screening Following the COVID-19 Pandemic: A Comparative Microsimulation Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.12.23.22283887. [PMID: 36597528 PMCID: PMC9810216 DOI: 10.1101/2022.12.23.22283887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aftermath of the initial phase of the COVID-19 pandemic may contribute to the widening of disparities in access to colorectal cancer (CRC) screening due to differential disruptions to CRC screening. This comparative microsimulation analysis uses two CISNET CRC models to simulate the impact of ongoing screening disruptions induced by the COVID-19 pandemic on long-term CRC outcomes. We evaluate three channels through which screening was disrupted: delays in screening, regimen switching, and screening discontinuation. The impact of these disruptions on long-term colorectal cancer (CRC) outcomes was measured by the number of Life-years lost due to CRC screening disruptions compared to a scenario without any disruptions. While short-term delays in screening of 3-18 months are predicted to result in minor life-years loss, discontinuing screening could result in much more significant reductions in the expected benefits of screening. These results demonstrate that unequal recovery of screening following the pandemic can widen disparities in colorectal cancer outcomes and emphasize the importance of ensuring equitable recovery to screening following the pandemic.
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Affiliation(s)
| | - Rosita van den Puttelaar
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Anne I. Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Matthias Harlass
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, USA
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, USA
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Carolyn M. Rutter
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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24
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Lash RS, Hong AS, Bell JF, Reed SC, Pettit N. Recognizing the emergency department’s role in oncologic care: a review of the literature on unplanned acute care. EMERGENCY CANCER CARE 2022; 1:6. [PMID: 35844666 PMCID: PMC9200439 DOI: 10.1186/s44201-022-00007-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The global prevalence of cancer is rapidly increasing and will increase the acute care needs of patients with cancer, including emergency department (ED) care. Patients with cancer present to the ED across the cancer care continuum from diagnosis through treatment, survivorship, and end-of-life. This article describes the characteristics and determinants of ED visits, as well as challenges in the effort to define preventable ED visits in this population.
Findings
The most recent population-based estimates suggest 4% of all ED visits are cancer-related and roughly two thirds of these ED visits result in hospitalization—a 4-fold higher ED hospitalization rate than the general population. Approximately 44% of cancer patients visit the ED within 1 year of diagnosis, and more often have repeat ED visits within a short time frame, though there is substantial variability across cancer types. Similar patterns of cancer-related ED use are observed internationally across a range of different national payment and health system settings. ED use for patients with cancer likely reflects a complex interaction of individual and contextual factors—including provider behavior, health system characteristics, and health policies—that warrants greater attention in the literature.
Conclusions
Given the amount and complexity of cancer care delivered in the emergency setting, future research is recommended to examine specific symptoms associated with cancer-related ED visits, the contextual determinants of ED use, and definitions of preventable ED use specific to patients with cancer.
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25
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Colorectal cancer trends in Chile: A Latin-American country with marked socioeconomic inequities. PLoS One 2022; 17:e0271929. [DOI: 10.1371/journal.pone.0271929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/05/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction
Colorectal cancer (CRC) is the third most frequent malignant disease in the world. In some countries with established screening programs, its incidence and mortality have decreased, and survival has improved.
Aims
To obtain reliable data about the epidemiology of CRC in Chile, we analyzed the trends in the last ten years and the influence of observable factors on survival, including a nationwide health program for CRC treatment access (GES program).
Methods
Publicly available data published by the Ministry of Health and National Institute of Statistics were used. Data were obtained from registries of mortality and hospital discharges, making follow-up of the individuals possible. Crude and age-standardized incidence and mortality rates were calculated, and individual survival was studied by constructing Kaplan–Meier curves. Finally, a Cox statistical model was established to estimate the impact of the observable factors.
Results
We found 37,217 newly identified CRC patients between 2008 and 2019 in Chile, corresponding to 103,239 hospital discharges. In the same period, 24,217 people died of CRC. A nearly linear, steady increase in crude incidence, mortality and prevalence was observed. CRC incidence was the lowest in the North of the country, increasing toward the South and reaching a maximum value of 34.6/100,000 inhabitants/year in terms of crude incidence and 20.7/100,000 inhabitants/year in terms of crude mortality in the XII region in 2018. We found that older patients had lower survival rates, as well as men compared to women. Survival was significantly better for patients with private insurance than those under the public insurance system, and the treating hospital also played a significant role in the survival of patients. Patients in the capital region survived longer than those in almost every other part of the country. We found no significant effect on survival associated with the GES program.
Conclusions
We found important inequalities in the survival probabilities for CRC patients in Chile. Survival depends mainly on the type of insurance, access to more complex hospitals, and geographical location; all three factors correlated with socioeconomic status of the population. Our work emphasized the need to create specific programs addressing primary causes to decrease the differences in CRC survival.
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26
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Alfaro T, Martinez-Folgar K, Vives A, Bilal U. Excess Mortality during the COVID-19 Pandemic in Cities of Chile: Magnitude, Inequalities, and Urban Determinants. J Urban Health 2022; 99:922-935. [PMID: 35688966 PMCID: PMC9187147 DOI: 10.1007/s11524-022-00658-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
We estimated excess mortality in Chilean cities during the COVID-19 pandemic and its association with city-level factors. We used mortality, and social and built environment data from the SALURBAL study for 21 Chilean cities, composed of 81 municipalities or "comunas", grouped in 4 macroregions. We estimated excess mortality by comparing deaths from January 2020 up to June 2021 vs 2016-2019, using a generalized additive model. We estimated a total of 21,699 (95%CI 21,693 to 21,704) excess deaths across the 21 cities. Overall relative excess mortality was highest in the Metropolitan (Santiago) and the North regions (28.9% and 22.2%, respectively), followed by the South and Center regions (17.6% and 14.1%). At the city-level, the highest relative excess mortality was found in the Northern cities of Calama and Iquique (around 40%). Cities with higher residential overcrowding had higher excess mortality. In Santiago, capital of Chile, municipalities with higher educational attainment had lower relative excess mortality. These results provide insight into the heterogeneous impact of COVID-19 in Chile, which has served as a magnifier of preexisting urban health inequalities, exhibiting different impacts between and within cities. Delving into these findings could help prioritize strategies addressed to prevent deaths in more vulnerable communities.
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Affiliation(s)
- Tania Alfaro
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Independencia 939, Santiago, Chile.
| | - Kevin Martinez-Folgar
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Alejandra Vives
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, CEDEUS, Santiago, Chile
| | - Usama Bilal
- Urban Health Collaborative; and Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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27
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de Brito BB, Marques HS, Silva FAFD, Cordeiro Santos ML, Araújo GRL, Valente LDA, Freire de Melo F. Influence of the COVID-19 pandemic in the gastrointestinal oncology setting: An overview. World J Gastrointest Pathophysiol 2022; 13:157-169. [PMID: 36187602 PMCID: PMC9516457 DOI: 10.4291/wjgp.v13.i5.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 02/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been impacting healthcare in various ways worldwide and cancer patients are greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. The reorganization of the health facilities in order to supply the high demand resulting from the aforementioned infection as well as the social isolation measures led to impairments for the diagnosis and follow-up of patients with gastrointestinal cancers, which has had an impact on the prognosis of the oncologic patients. In that context, health authorities and organizations have elaborated new guidelines with specific recommendations for the management of individuals with gastrointestinal neoplasms during the pandemic. Of note, oncologic populations seem to be more susceptible to unfavorable outcomes when exposed to SARS-CoV-2 infection and some interactions involving virus, tumor, host immune system and anticancer therapies are probably related to the poorer prognosis observed in those COVID-19 patients. Moreover, vaccination stands out as the main prevention method against severe SARS-CoV-2 infection and some particularities have been observed regarding the seroconversion of vaccinated oncologic patients including those with gastrointestinal malignancies. In this minireview, we gather updated information regarding the influence of the pandemic in the diagnosis of gastrointestinal neoplasms, new recommendations for the management of gastrointestinal cancer patients, the occurrence of SARS-CoV-2 infection in those individuals and the scenario of the vaccination against the virus in that population.
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Affiliation(s)
- Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45055-380, Bahia, Brazil
| | | | - Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Glauber Rocha Lima Araújo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lara de Araujo Valente
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45055-380, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Brazil
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Allahqoli L, Mazidimoradi A, Salehiniya H, Alkatout I. Impact of COVID-19 on cancer screening: a global perspective. Curr Opin Support Palliat Care 2022; 16:102-109. [PMID: 35862881 PMCID: PMC9451605 DOI: 10.1097/spc.0000000000000602] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Cancer screening disruption due to COVID-19 may have a significant impact on patients, healthcare practitioners, and healthcare systems. In this present review, we aim to offer a comprehensive view of the effect of the COVID-19 pandemic on cancer screening programs worldwide. RECENT FINDINGS The present review comprised 33 publications. During the COVID-19 pandemic, the rates of cancer screening investigations were drastically reduced worldwide. Screening rates plummeted for all types of cancer, all ages, and racial/ethnic groups. Reductions in screening percentages were higher in several underserved racial groups. Cancer screening was suspended for at least 30 days in 13 countries. SUMMARY Screenings for all types of cancer fell sharply. In the chain of cancer management, delays in any step are liable to change the outcome of the next step. Further long-term research will be needed to fully comprehend the impact of the pandemic on cancer services and patient outcomes.
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Affiliation(s)
| | | | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Kiel, Germany
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29
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Zheng X, Ding S, Wu M, Sun C, Wu Y, Wang S, Du Y, Yang L, Xue L, Wang B, Wang C, Cui W, Xie Y. Dynamic monitoring revealed a slightly prolonged waiting time for total gastrectomy during the COVID-19 pandemic without increasing the short-term complications. Front Oncol 2022; 12:944602. [PMID: 36119493 PMCID: PMC9471957 DOI: 10.3389/fonc.2022.944602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/17/2022] [Indexed: 01/08/2023] Open
Abstract
We aimed to determine the pattern of delay and its effect on the short-term outcomes of total gastrectomy before and during the coronavirus disease 2019 (COVID-19) pandemic. Overlaid line graphs were used to visualize the dynamic changes in the severity of the pandemic, number of gastric cancer patients, and waiting time for a total gastrectomy. We observed a slightly longer waiting time during the pandemic (median: 28.00 days, interquartile range: 22.00–34.75) than before the pandemic (median: 25.00 days, interquartile range: 18.00–34.00; p = 0.0071). Moreover, we study the effect of delayed surgery (waiting time > 30 days) on short-term outcomes using postoperative complications, extreme value of laboratory results, and postoperative stay. In patients who had longer waiting times, we did not observe worse short-term complication rates (grade II–IV: 15% vs. 19%, p = 0.27; grade III–IV: 7.3% vs. 9.2%, p = 0.51, the short waiting group vs. the prolonged waiting group) or a higher risk of a longer POD (univariable: OR 1.09, 95% CI 0.80–1.49, p = 0.59; multivariable: OR 1.10, 95% CI 0.78–1.55, p = 0.59). Patients in the short waiting group, rather than in the delayed surgery group, had an increased risk of bleeding in analyses of laboratory results (plasma prothrombin activity, hemoglobin, and hematocrit). A slightly prolonged preoperative waiting time during COVID-19 pandemic might not influence the short-term outcomes of patients who underwent total gastrectomy.
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Affiliation(s)
- Xiaohao Zheng
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shikang Ding
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Gastrointestinal Surgery, Yun Cheng Center Hospital, Yuncheng, China
| | - Chunyang Sun
- Department of General Surgery, The Central Hospital of Jia Mu Si City, Jiamusi, China
| | - Yunzi Wu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shenghui Wang
- Department of General Surgery, Civil Aviation General Hospital, Beijing, China
| | - Yongxing Du
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Chengfeng Wang, ; Wei Cui, ; Yibin Xie,
| | - Wei Cui
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Chengfeng Wang, ; Wei Cui, ; Yibin Xie,
| | - Yibin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China
- *Correspondence: Chengfeng Wang, ; Wei Cui, ; Yibin Xie,
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30
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Mena G, Aburto JM. Unequal impact of the COVID-19 pandemic in 2020 on life expectancy across urban areas in Chile: a cross-sectional demographic study. BMJ Open 2022; 12:e059201. [PMID: 35985781 PMCID: PMC9395593 DOI: 10.1136/bmjopen-2021-059201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To quantify the impact of the COVID-19 pandemic on life expectancy in Chile categorised by rural and urban areas, and to correlate life expectancy changes with socioeconomic factors at the municipal level. DESIGN Retrospective cross-sectional demographic analysis using aggregated national all-cause death data stratified by year, sex and municipality during the period 2010-2020. SETTING AND POPULATION Chilean population by age, sex and municipality from 2002 to 2020. MAIN OUTCOME MEASURES Stratified mortality rates using a Bayesian methodology. These were based on vital and demographic statistics from the national institute of statistics and department of vital statistics of ministry of health. With this, we assessed the unequal impact of the pandemic in 2020 on life expectancy across Chilean municipalities for males and females and analysed previous mortality trends since 2010. RESULTS Life expectancy declined for both males and females in 2020 compared with 2019. Urban areas were the most affected, with males losing 1.89 years and females 1.33 years. The strength of the decline in life expectancy correlated positively with indicators of social deprivation and poverty. Also, inequality in life expectancy between municipalities increased, largely due to excess mortality among the working-age population in socially disadvantaged municipalities. CONCLUSIONS Not only do people in poorer areas live shorter lives, they also have been substantially more affected by the COVID-19 pandemic, leading to increased population health inequalities. Quantifying the impact of the COVID-19 pandemic on life expectancy provides a more comprehensive picture of the toll.
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Affiliation(s)
- Gonzalo Mena
- Department of Statistics, Oxford University, Oxford, UK
| | - José Manuel Aburto
- Leverhulme Centre for Demographic Science and Nuffield College, University of Oxford, Oxford, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Inderdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
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Elek P, Csanádi M, Fadgyas-Freyler P, Gervai N, Oross-Bécsi R, Szécsényi-Nagy B, Tatár M, Váradi B, Zemplényi A. Heterogeneous impact of the COVID-19 pandemic on lung, colorectal and breast cancer incidence in Hungary: results from time series and panel data models. BMJ Open 2022; 12:e061941. [PMID: 35981776 PMCID: PMC9393855 DOI: 10.1136/bmjopen-2022-061941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE During the COVID-19 pandemic, health system resources were reallocated to provide care for patients with COVID-19, limiting access for others. Patients themselves also constrained their visits to healthcare providers. In this study, we analysed the heterogeneous effects of the pandemic on the new diagnoses of lung, colorectal and breast cancer in Hungary. DESIGN Time series and panel models of quarterly administrative data, disaggregated by gender, age group and district of residence. PARTICIPANTS Data for the whole population of Hungary between the first quarter of 2017 and the second quarter of 2021. MAIN OUTCOME MEASURES Number of patients newly diagnosed with lung, colorectal and breast cancer, defined as those who were hospitalised with the appropriate primary International Classification of Diseases Tenth Revision diagnosis code but had not had hospital encounters with such a code within the previous 5 years. RESULTS The incidence of lung, colorectal and breast cancer decreased by 14.4% (95% CI 10.8% to 17.8%), 19.9% (95% CI 12.2% to 26.9%) and 15.5% (95% CI 2.5% to 27.0%), respectively, during the examined period of the pandemic, with different time patterns across cancer types. The incidence decreased more among people at least 65 years old than among the younger (p<0.05 for lung cancer and p<0.1 for colorectal cancer). At the district level, both the previously negative income gap in lung cancer incidence and the previously positive income gap in breast cancer incidence significantly narrowed during the pandemic (p<0.05). CONCLUSIONS The decline in new cancer diagnoses, caused by a combination of supply-side and demand-side factors, suggests that some cancer cases have remained hidden. It calls for action by policy makers to engage individuals with high risk of cancer more in accessing healthcare services, to diagnose the disease early and to prepare for effective management of patient pathways from diagnosis to survival or end-of-life care.
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Affiliation(s)
- Peter Elek
- Institute of Economics, Centre for Economic and Regional Studies, Budapest, Hungary
- Institute of Economics, Corvinus University of Budapest, Budapest, Hungary
| | | | | | | | | | - Balázs Szécsényi-Nagy
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
- Community Health Centre, Gyál, Hungary
| | - Manna Tatár
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Balázs Váradi
- Budapest Institute for Policy Analysis, Budapest, Hungary
- Department of Economics, Eötvös Loránd Tudományegyetem, Budapest, Hungary
| | - Antal Zemplényi
- Centre for Health Technology Assessment and Pharmacoeconomic Research, Pécsi Tudományegyetem, Pécs, Hungary
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Luciani S, Agurto I, Caixeta R, Hennis A. Prioritizing noncommunicable diseases in the Americas region in the era of COVID-19. Rev Panam Salud Publica 2022; 46:e83. [PMID: 35875322 PMCID: PMC9299393 DOI: 10.26633/rpsp.2022.83] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/24/2022] [Indexed: 01/14/2023] Open
Abstract
This article describes the situation of noncommunicable diseases (NCDs) in the Americas, implementation of NCD interventions according to key progress indicators, the impact of COVID-19 on NCD services, and ways to reprioritize NCDs following COVID-19. Information was retrieved from institutional data and through a supplementary scoping review of published articles related to NCDs and COVID-19 in the Americas published April 2020–November 2021. While NCDs account for 80.7% of all deaths in the Americas, implementation of a key set of NCD interventions has been limited, with only three countries reporting implementation of 12 or more of the 19 NCD indicators. By mid-May 2022, the Americas had reported about 29.9% of all COVID-19 cases in the world (154 million of 515 million) and 43.5% all COVID-19 deaths (2.7 million of 6.2 million). This pandemic has hampered progress on NCDs and significantly disrupted services for people who require ongoing care. Adaptive strategies, such as telehealth and mobile pharmacies, have been used to mitigate service disruptions. However, NCD prevention and management must be an integral part of recovering from the COVID-19 pandemic. This will require scaled up efforts to establish/re-establish and enforce policies on NCD risk factors, especially for tobacco control and obesity prevention, as well as greater investment in primary care and expansion of telemedicine and digital health solutions for continuous care for people with NCDs. Lastly, limited data are available on the impact of COVID-19 on NCDs, and hence NCD data and surveillance need to be strengthened.
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Affiliation(s)
- Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Irene Agurto
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Roberta Caixeta
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
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Streamlining breast cancer and colorectal cancer biosimilar regulations to improve treatment access in Latin America: an expert panel perspective. Lancet Oncol 2022; 23:e348-e358. [DOI: 10.1016/s1470-2045(22)00121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022]
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Stilidi IS, Zaridze DG, Maksimovich DM, Dzitiev DM. The decrease in the incidence of malignant tumors as a consequence of the epidemic of COVID-19. Public Health 2022. [DOI: 10.21045/2782-1676-2021-2-1-5-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2020 we observed a sudden decline in cancer incidence in Russia in comparison with 2019. The age-standardized rates (ASR) per 100,000 population of cancers that were on increase before 2019 dropped abruptly including cancers of the colorectum, prostate, breast, thyroid, kidney, while for those cancers that steadily decreased including cancers of the lung and stomach, the decrease has speeded up.The difference between predicted and actual number of cases registered in 2020 was 98 142 for all cancers, 24 172 for skin cancer (excluding melanoma), 13202 – for prostate cancer 11 660 – for breast cancer, 9570 – for colorectal cancer, 7235 – for lung cancer, 5450 – for kidney cancer, 3506 for gastric cancer, 2744 for urinary bladder cancer, 2436 – thyroid cancer and 2080 for melanoma.The observed decrease in cancer incidence in 2020 reflects the decrease in the detection rate of cancer. Following arguments might explain this decrease. First the individuals with complains or symptoms who in normal situation would seek medical advice might have barriers for consulting doctor due to isolation and lockdowns. For the same reason the coverage of the population by the check-up programs temporarily decreased including screening for breast, cervix, colorectal and prostate cancer. Regrettably there are no data on the population coverage of these screening programs either before (in 2019) or at the time of COVID epidemic (in 2020).For most of these tumors the effective screening tests are available that if applied correctly with quality control contribute to early diagnosis and consequently to the improvement of survival and decrease in mortality.The decrease in the detection rate of cancer in 2020 and 2021 (still to be seen) will result in the shift of the stage of cancer at diagnosis from early to late stages. The proportion of cancer patients diagnosed at the stages III–IV will increase and will be followed by increase in mortality from cancer.The decrease in cancer detection rate is observed in many counties. The Covid‑19 pandemic affected cancer control in Europe. In one third of the countries in Europe the pressure on the health system created by the Covid –19 pandemic caused interruptions in cancer care.To handle effectively the problem of the underdiagnosis of cancer during the Covid‑19 pandemic we have to address population using all available ways of communication and explain that the decrease in detection rate of cancer will be followed by shifting the stage of detected cancer from early to late stages and this will affect its curability. People should be advised to see doctor immediately for any health problems. To make this advice effective the accessibility of cancer diagnostic and treatment facilities need to return to pre-pandemic level.Screening programs should be restored. However, they need to be adjusted to the WHO guidelines and the existing international experience. WHO guidelines recommend screening for colorectal, breast and cervical cancer. Cervical cancer screening – preferably using HPV testing that is much more sensitive than cytological testing and could be carried out twice in the life at age 35 and 45 years.The evidence-based cancer control program will not only help us to overcome the consequences of the pandemic and returning to the pre-pandemic state but also will promote further decline of cancer mortality.
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Affiliation(s)
- I. S. Stilidi
- N. N. Blokhin National Medical Research Center of Oncology
| | - D. G. Zaridze
- N. N. Blokhin National Medical Research Center of Oncology
| | | | - D. M. Dzitiev
- N. N. Blokhin National Medical Research Center of Oncology
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Duarte MB, Argenton JL, Carvalheira JB. Impact of COVID-19 in Cervical and Breast Cancer Screening and Systemic Treatment in São Paulo, Brazil: An Interrupted Time Series Analysis. JCO Glob Oncol 2022; 8:e2100371. [PMID: 35696624 PMCID: PMC9225667 DOI: 10.1200/go.21.00371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE COVID-19 caused a disruption in cancer management around the world, resulting in an estimated excess burden secondary to screening disruption and excess lag time for treatment initiation. METHODS We gathered information from primary reimbursement data sets of the public health system of São Paulo, Brazil, from April 2020 to November 2021, and compared these data with those of the pre–COVID-19 period. We used an interrupted time series model to estimate the effect of the COVID-19 pandemic on the rate of key procedures of breast and cervical cancer health care chain. RESULTS We estimated that 1,149,727, 2,693, and 713,616 pap smears, conizations, and mammograms, respectively, were missed or delayed during the COVID-19 pandemic, compared with those in the years immediately before the COVID-19 stay-at-home restrictions. Specifically, we observed an acute decrease of procedures after the COVID-19 stay-at-home restrictions, with a trend to recovery in the long term. Regarding the systemic treatment analysis, we observed a 25% reduction in the rate of initiation of adjuvant systemic treatment for early breast cancer (stage I/II). However, we did not find a clear effect on the other settings of systemic treatment for breast cancer. We estimated an excess of 156 patients starting palliative care for cervical cancer after the COVID-19 stay-at-home restrictions. CONCLUSION The COVID-19 pandemic significantly reduced the performance rate of pap smears, conizations, and mammograms. The initiation of adjuvant treatment for early-stage breast cancer was most susceptible to COVID-19's health system disruption. Furthermore, the downward trend of treatment of advanced cervical cancer was interrupted. Therefore, public health policies are urgently needed to decrease the incidence of advanced cervical and breast cancers caused by delayed diagnosis and treatment initiation. The COVID-19 control policies resulted in reduction of cancer patients' delivery of care. This study evaluated the pandemic's influence in key procedures of breast and cervical cancer chain of care in São Paulo, Brazil. We observed a substantial reduction in the number of mammograms, pap smears, and conizations performed since the onset of the COVID-19 pandemic. In addition, stage I and II breast cancer adjuvant treatment presented a reduced realization rate, whereas palliative treatment delivered for advanced cervical cancer increased. Our results support the need for public health policies focused on mitigating the long-term effects of COVID-19 in cancer-related mortality.
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Affiliation(s)
- Mateus B.O. Duarte
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Uberlândia Cancer Hospital, Federal University of Uberlândia, UFU, Uberlândia, Minas Gerais, Brazil
| | - Juliana L.P. Argenton
- Fundação de Desenvolvimento da Universidade Estadual de Campinas (FUNCAMP), Campinas, São Paulo, Brazil
| | - José B.C. Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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New Challenges in Surgical Approaches for Colorectal Cancer during the COVID-19 Pandemic. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
(1) Background: The COVID-19 pandemic put a great burden on national healthcare systems, causing delays and disruptions in the medical care of non-COVID-19 patients. This paper aims to analyze the COVID-19 pandemic impact upon the quality of care in colorectal surgery. (2) Materials and Methods: We performed a retrospective study on the colorectal cancer cases operated in the Fourth Department of General Surgery, Emergency Hospital Bucharest Romania, over the period March 2020–February 2021 (pandemic group) vs. March 2019–February 2020 (non-pandemic group). (3) Results: The number of patients in the pandemic group decreased by 70% (36 vs. 118 patients), with lower accessibility from rural areas (11.1% vs. 37.2%, p = 0.035). Most cases in the pandemic group were emergencies (69% vs. 37.3%, p = 0.009), admitted for bowel obstruction (63.8% vs. 27.9%, p = 0.008). There was no in-hospital COVID-19 infection in patients operated for colorectal cancer. The 30-day mortality was significantly higher in the pandemic group (25% vs. 6.7%, p = 0.017), mostly due to septic shock (36.1% vs. 5%, p = 0.0001). (4) Conclusions: Colorectal cancer surgery may be performed safely during the COVID-19 pandemic, with strict adherence to the SARS-CoV-2 prevention protocols. However, the significant increase in colorectal cancers in the emergency was associated with worse outcomes and higher mortality during the COVID-19 pandemic.
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Johansson AL, Larønningen S, Skovlund CW, Kristiansen MF, Mørch LS, Friis S, Johannesen TB, Myklebust TÅ, Skog A, Pettersson D, Birgisson H, Virtanen A, Malila N, Pitkäniemi J, Tanskanen T, Tryggvadóttir L, Ursin G, Lambe M. The impact of the COVID-19 pandemic on cancer diagnosis based on pathology notifications: A comparison across the Nordic countries during 2020. Int J Cancer 2022; 151:381-395. [PMID: 35419824 PMCID: PMC9087674 DOI: 10.1002/ijc.34029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
The severity of the COVID-19 pandemic and subsequent mitigation strategies have varied across the Nordic countries. In a joint Nordic population-based effort, we compared patterns of new cancer cases and notifications between the Nordic countries during 2020. We used pathology notifications to cancer registries in Denmark, the Faroe Islands, Finland, Iceland, Norway and Sweden to determine monthly numbers of pathology notifications of malignant and in-situ tumors from January to December 2020 compared to 2019 (2017-2019 for Iceland and the Faroe Islands). We compared new cancer cases per month based on unique individuals with pathology notifications. In April and May 2020, the numbers of new malignant cases declined in all Nordic countries, except the Faroe Islands, compared to previous year(s). The largest reduction was observed in Sweden (May: -31.2%, 95% CI -33.9, -28.3), followed by significant declines in Finland, Denmark and Norway, and a non-significant decline in Iceland. In Denmark, Norway, Sweden and Finland the reporting rates during the second half of 2020 rose to almost the same level as in 2019. However, in Sweden and Finland, the increase did not compensate for the spring decline (annual reduction -6.2% and -3.6%, respectively). Overall, similar patterns were observed for in-situ tumors. The COVID-19 pandemic led to a decline in rates of new cancer cases in Sweden, Finland, Denmark and Norway, with the most pronounced reduction in Sweden. Possible explanations include the severity of the pandemic, temporary halting of screening activities and changes in healthcare seeking behaviour.
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Affiliation(s)
- Anna Lv Johansson
- Cancer Registry of Norway, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Marnar Fríðheim Kristiansen
- Center of Health Science, Faculty of Health Sciences, Tórshavn, Faroe Islands.,National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Lina Steinrud Mørch
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | | | - Tor Åge Myklebust
- Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Anna Skog
- Cancer Registry of Norway, Oslo, Norway
| | | | - Helgi Birgisson
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland
| | - Anni Virtanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland.,Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tomas Tanskanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Laufey Tryggvadóttir
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Regional Cancer Center Central Sweden, Uppsala, Sweden
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Xiao H, Liu F, He Y, Dai X, Liu Z, Jian W, Unger JM. Unequal impact of the COVID-19 pandemic on paediatric cancer care: a population-based cohort study in China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 19:100347. [PMID: 35005670 PMCID: PMC8718443 DOI: 10.1016/j.lanwpc.2021.100347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022]
Abstract
Background The COVID-19 pandemic has had widespread adverse collateral effects on health care delivery for non-COVID-19 disease conditions. Paediatric oncology care is reliant on prompt testing and diagnosis and on timely and coordinated multimodal treatment, all of which have been impacted by the pandemic. This study aimed to quantify the initial and enduring effects of the COVID-19 pandemic on the utilization of paediatric cancer care and to examine whether the pandemic differentially impacted specific demographic groups. Method We performed an interrupted time series analysis using negative binomial regression to estimate the change in the monthly admissions for paediatric cancer patients (Age 0-17) associated with the COVID-19 pandemic and subsequent lockdown policies. We obtained data from deidentified individual electronic medical records of paediatric cancer inpatients admitted between January 1, 2015 and May 31, 2021 to a tertiary hospital that provides general and specialized healthcare services to an estimated population of 8.4 million in Jining China. Relative risk (RR) estimates representing monthly admissions compared with expected admissions had the pandemic not occurred were derived. The number of inpatient admissions lost due to the pandemic were estimated. Findings The overall denominator for the paediatric population was 1 858 209 individuals in January 2015, which increased to 2 043 803 by May 2021. In total, there were 4 901 admissions for paediatric cancer during the study period, including 1 479 (30%) since February 2020 when the lockdown was implemented. A 33% reduction (95% CI: -43% to -22%) in admissions was observed in February 2020, with the largest relative reduction (-48%, 95% CI: -64% to -24%) among first-time admissions and admissions for patients from rural districts (-46%, 95% CI: -55% to -36%). Admissions quickly rebounded in March 2020 when many government-imposed mobility restrictions were lifted, and continued to resume gradually over time since April 2020, leading to a full recovery as of November 2020. However, the recovery for first-time admissions, and among female patients, younger patients (<5 years) and patients from rural districts was slower over time and incomplete (first-time admissions and rural patients) as of January 2021. Interpretation The COVID-19 pandemic has had substantial impact on the timely utilization of paediatric oncology services in China, particularly in the early stage of the first wave. Importantly, some population groups were disproportionately affected and the recovery of admissions among those subgroups has been slow and incomplete, warranting targeted approaches to address potentially exacerbated gender and socio-economic inequalities in access to healthcare resources.
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Affiliation(s)
- Hong Xiao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,The SWOG Cancer Research Network Statistics and Data Management Center
| | - Fang Liu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yao He
- Department of Global Health, University of Washington, Seattle, WA
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, Seattle, WA.,Department of Health Metrics Sciences, University of Washington, Seattle, WA
| | - Zhenhui Liu
- Affiliated Hospital of Jining Medical University, Shandong, China
| | - Weiyan Jian
- School of Public Health, Peking University, Beijing, China
| | - Joseph M Unger
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,The SWOG Cancer Research Network Statistics and Data Management Center
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Dalmartello M, La Vecchia C, Bertuccio P, Boffetta P, Levi F, Negri E, Malvezzi M. European cancer mortality predictions for the year 2022 with focus on ovarian cancer. Ann Oncol 2022; 33:330-339. [DOI: 10.1016/j.annonc.2021.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022] Open
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Crocetto F, Buonerba L, Scafuri L, Caputo V, Barone B, Sciarra A, Verde A, Calogero A, Buonerba C, Lorenzo GD. COVID-19 and prostate cancer: a complex scenario with multiple facets. Future Sci OA 2021; 8:FSO. [PMID: 34898669 PMCID: PMC8621215 DOI: 10.2144/fsoa-2021-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/14/2021] [Indexed: 01/18/2023] Open
Affiliation(s)
- Felice Crocetto
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, 80131, Italy
| | - Luciana Buonerba
- Oncology Unit, Hospital 'Andrea Tortora', ASL Salerno, Pagani, Italy
| | - Luca Scafuri
- Oncology Unit, Hospital 'Andrea Tortora', ASL Salerno, Pagani, Italy.,Associazione O.R.A., Somma Vesuviana, Naples, Italy
| | - Vincenzo Caputo
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, 80131, Italy
| | - Biagio Barone
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, 80131, Italy
| | - Antonella Sciarra
- Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Naples, NA, Italy
| | | | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, 80131, Italy
| | - Carlo Buonerba
- Oncology Unit, Hospital 'Andrea Tortora', ASL Salerno, Pagani, Italy.,Associazione O.R.A., Somma Vesuviana, Naples, Italy
| | - Giuseppe Di Lorenzo
- Oncology Unit, Hospital 'Andrea Tortora', ASL Salerno, Pagani, Italy.,Associazione O.R.A., Somma Vesuviana, Naples, Italy.,Department of Medicine & Health Science, University of Molise, Campobasso, Italy
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Elkrief A, Wu JT, Jani C, Enriquez KT, Glover M, Shah MR, Shaikh HG, Beeghly-Fadiel A, French B, Jhawar SR, Johnson DB, McKay RR, Rivera DR, Reuben DY, Shah S, Tinianov SL, Vinh DC, Mishra S, Warner JL. Learning through a Pandemic: The Current State of Knowledge on COVID-19 and Cancer. Cancer Discov 2021; 12:303-330. [PMID: 34893494 DOI: 10.1158/2159-8290.cd-21-1368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
The ongoing COVID-19 pandemic has left patients with current or past history of cancer facing disparate consequences at every stage of the cancer trajectory. This comprehensive review offers a landscape analysis of the current state of the literature on COVID-19 and cancer including the immune response to COVID-19, risk factors for severe disease, and impact of anticancer therapies. We also review the latest data on treatment of COVID-19 and vaccination safety and efficacy in patients with cancer, as well as impact of the pandemic on cancer care, including the urgent need for rapid evidence generation and real-world study designs.
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Affiliation(s)
- Arielle Elkrief
- Hemato-Oncology, University of Montreal Research Center (CRCHUM)
| | | | | | - Kyle T Enriquez
- Medical Scientist Training Program, Vanderbilt University School of Medicine
| | | | - Mansi R Shah
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey
| | | | | | | | - Sachin R Jhawar
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center
| | | | | | | | - Daniel Y Reuben
- Hematology and Oncology, Medical University of South Carolina
| | | | | | | | - Sanjay Mishra
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center
| | - Jeremy L Warner
- Medicine and Biomedical Informatics, Vanderbilt University Medical Center
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Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Müller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutiérrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Cáceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474-e487. [PMID: 34735817 DOI: 10.1016/s1470-2045(21)00492-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.
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Affiliation(s)
- Carlos H Barrios
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Bettina G Müller
- Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Francisco Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cancer Tuxtla Gutiérrez, Chiapas, México; Latin American School of Oncology (ELO), México City, México
| | - Ji Seok Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dewpoint Therapeutics, Boston, MA, USA
| | | | - Lucia Delgado
- Faculty of Medicine, University of Uruguay, Montevideo, Uruguay; Honorary Commission for the Fight Against Cancer, Montevideo, Uruguay
| | - Luiz A Santini
- Center of Strategic Studies of FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
| | - Nelson Teich
- Teich Health Care Consulting, Rio de Janeiro, Brazil
| | - Pamela C Chavez
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Pedro E R Liedke
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Pesquisa Clínica em Oncologia, Porto Alegre, Brazil
| | - Pedro Exman
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Suyapa A Bejarano Cáceres
- Medicine Universidad Católica de Honduras, San Pedro Sula, Honduras; Department of Clinical Oncology, Liga Contra el Cáncer, San Pedro Sula, Honduras
| | | | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Yolanda Vargas
- Unidad de Cuidados Paliativos y Clínica de Alivio del Dolor Oncológico, Instituto Oncológico Nacional, Ciudad de Panamá, Panamá
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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Guven DC, Sahin TK, Yildirim HC, Cesmeci E, Incesu FGG, Tahillioglu Y, Ucgul E, Aksun MS, Gurbuz SC, Aktepe OH, Arik Z, Dizdar O, Yalcin S, Aksoy S, Kilickap S, Kertmen N. Newly diagnosed cancer and the COVID-19 pandemic: tumour stage migration and higher early mortality. BMJ Support Palliat Care 2021:bmjspcare-2021-003301. [PMID: 34711656 DOI: 10.1136/bmjspcare-2021-003301] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/07/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND We compared the new outpatient clinic referrals during the first 10 months of the COVID-19 pandemic with the year before. METHODS We compared baseline characteristics of the 2208 new referrals in 2020 (n=922) and 2019 (n=1286) with Χ2 and Mann-Whitney U tests and calculated ORs with binary logistic regression. To evaluate the expected changes in the cancer survival secondary to stage migration, we used the 5-year survival data of Survival, Epidemiology and End Results (SEER) Program 2010-2016. RESULTS The percentage of patients with inoperable or metastatic disease was significantly increased during the pandemic (49.8% vs 39%, OR: 1.553, 95% CI: 1.309 to 1.843, p<0.001). We observed a significant decrease in the percentage of patients diagnosed via the screening methods (18.8% vs 28.7%, OR: 1.698, 95% CI: 1.240 to 2.325, p=0.001). The 90-day mortality after the cancer diagnosis was significantly higher during the pandemic (10.5% vs 6.6%, OR: 1.661, 95% CI: 1.225 to 2.252, p=0.001). Due to the increased advanced-stage disease rate at first referral, significant decreases in 5-year survival rates were expected for breast cancer (-8.9%), colorectal cancer (-11.1%), cervix cancer (-10.3%) and melanoma (-7%). CONCLUSION We think that collaborative efforts are paramount to prevent the pandemic of late cancer diagnoses and ensure patient safety during the pandemic.
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Affiliation(s)
- Deniz Can Guven
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hasan Cagri Yildirim
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Engin Cesmeci
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Yagmur Tahillioglu
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Enes Ucgul
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Melek Seren Aksun
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Suleyman Cagin Gurbuz
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oktay Halit Aktepe
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Zafer Arik
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Omer Dizdar
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Suayib Yalcin
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Sercan Aksoy
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
| | - Saadettin Kilickap
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
- Department of Medical Oncology, Istinye University, Istanbul, Turkey
| | - Neyran Kertmen
- Cancer Institute, Department of Medical Oncology, Hacettepe University, Ankara, Turkey
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44
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Anticipating the COVID-19-related surge in cancer care demand is urgent in Latin America and the Caribbean. Lancet Oncol 2021; 22:1350-1352. [PMID: 34487692 PMCID: PMC8415896 DOI: 10.1016/s1470-2045(21)00484-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022]
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Paris E. Importance of modelling for cancer management during COVID-19. Lancet Oncol 2021; 22:1352-1353. [PMID: 34487691 PMCID: PMC8415888 DOI: 10.1016/s1470-2045(21)00408-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Enrique Paris
- Government of Chile Ministry of Health, Santiago 8320064, Chile.
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