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Ali A, Huszti E, Noordin S, Ali U, Sale JEM. Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis. Osteoporos Int 2024; 35:1497-1511. [PMID: 38740589 DOI: 10.1007/s00198-024-07078-5] [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: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This systematic review seeks to evaluate the proportion of fragility fracture patients screened in secondary fracture prevention programs who were indicated for pharmacological treatment, received prescriptions for bone-active medications, and initiated the prescribed medication. Additionally, the study aims to analyze equity in pharmacological treatment by examining equity-related variables including age, sex, gender, race, education, income, and geographic location. METHODS We conducted a systematic review to ascertain the proportion of fragility fracture patients indicated for treatment who received prescriptions and/or initiated bone-active medication through secondary fracture prevention programs. We also examined treatment indications reported in studies and eligibility criteria to confirm patients who were eligible for treatment. To compute the pooled proportions for medication prescription and initiation, we carried out a single group proportional meta-analysis. We also extracted the proportions of patients who received a prescription and/or began treatment based on age, sex, race, education, socioeconomic status, location, and chronic conditions. RESULTS This review included 122 studies covering 114 programs. The pooled prescription rate was 77%, and the estimated medication initiation rate was 71%. Subgroup analysis revealed no significant difference in treatment initiation between the Fracture Liaison Service and other programs. Across all studies, age, sex, and socioeconomic status were the only equity variables reported in relation to treatment outcomes. CONCLUSION Our systematic review emphasizes the need for standardized reporting guidelines in post-fracture interventions. Moreover, considering equity stratifiers in the analysis of health outcomes will help address inequities and improve the overall quality and reach of secondary fracture prevention programs.
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Affiliation(s)
- Anum Ali
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada.
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Shahryar Noordin
- Department of Surgery, Aga Khan University, National Stadium Rd, P.O. Box 3500, Karachi City, Sindh, Pakistan
| | - Usman Ali
- Department of Surgery, Aga Khan University, National Stadium Rd, P.O. Box 3500, Karachi City, Sindh, Pakistan
| | - Joanna E M Sale
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 5th Floor - 149 College Street, Toronto, ON, M5B 1W8, Canada
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Saldanha EF, Powis M, Sharma D, Espin-Garcia O, Hack S, Cavalher F, Costa MR, Simoes M, Li H, Baiad A, Chen K, Mohmand Z, Nakhla P, Aguiar S, Riechelmann R, Krzyzanowska MK. Impact of the Early Phase of the COVID-19 Pandemic on the Quality of Care for Colorectal and Anal Cancers at Comprehensive Cancer Centers on Two Continents. JCO Glob Oncol 2024; 10:e2400037. [PMID: 39348613 DOI: 10.1200/go.24.00037] [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: 01/25/2024] [Revised: 06/18/2024] [Accepted: 07/29/2024] [Indexed: 10/02/2024] Open
Abstract
PURPOSE The early phase of the COVID-19 pandemic affected cancer care globally. Evaluating the impact of the pandemic on the quality of cancer care delivery is crucial for understanding how changes in care delivery may influence outcomes. Our study compared care delivered during the early phase of the pandemic with the same period in the previous year at two institutions across continents (Princess Margaret Cancer Center [PM] in Canada and A.C. Camargo Cancer Center [AC] in Brazil). METHODS Patients newly diagnosed with colorectal or anal cancer between February and December 2019 and the same period in 2020 were analyzed. Sociodemographic and clinical characteristics and performance of individual indicators within and between centers and between the peri-COVID-19 and control cohorts were tested using Cohen's h test to assess the standardized differences between the two groups. RESULTS Among 925 patients, distinct effects of the early COVID-19 pandemic on oncology services were observed. AC experienced a 50% reduction in patient consultations (98 v 197) versus a 12.5% reduction at PM (294 v 336). Similarly, AC experienced a higher proportion of stage IV disease presentations (42.9% v 29.9%; P = .015) and an increase in treatment delay (61.9% v 9.7%; P < .001) compared with prepandemic. At PM, a 10% increase in treatment interruption (32.4% v 22.3%; P < .001) and a higher rate of discontinuation of radiotherapy (9.4% v 1.1%; P < .001) were observed during the pandemic. Postsurgical readmission rates increased in both AC (20.9% v 2.6%; P < .001) and PM (10.5% v 3.6%; P < .01). CONCLUSION The early phase of the COVID-19 pandemic affected the quality of care delivery for colorectal and anal cancers at both centers. However, the magnitude of this impact was greater in Brazil.
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Affiliation(s)
- Erick F Saldanha
- A.C. Camargo Cancer Center, Sao Paulo, Brazil
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
| | - Melanie Powis
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Divya Sharma
- Biostatistics Division, Princess Margaret Cancer Centre, Toronto, Canada
| | - Osvaldo Espin-Garcia
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
- Biostatistics Division, Princess Margaret Cancer Centre, Toronto, Canada
- Epidemiology and Biostatistics, Western University, London, Canada
- Dalla Lana School of Public Health and Statistical Sciences, University of Toronto, Toronto, Canada
| | - Saidah Hack
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | | | - Huaqi Li
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
| | - Abed Baiad
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
| | - Kevin Chen
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
| | - Zuhul Mohmand
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
| | - Peter Nakhla
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | - Monika K Krzyzanowska
- Cancer Quality Lab (CQual), Princess Margaret Cancer Centre, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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3
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Lo Moro G, Ragusa P, Previti C, Comandone A, Airoldi M, Aglietta M, Siliquini R. Impact of the pandemic on surgical oncology in Piedmont, Italy: A retrospective observational study. J Surg Oncol 2024; 129:1165-1170. [PMID: 38419194 DOI: 10.1002/jso.27606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/10/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND METHODS This retrospective observational study analyzes how the COVID-19 pandemic affected surgical oncology healthcare in a large sample from Piedmont, Northern Italy. Patients admitted for regular hospitalization were included (n = 99 651). Data from 2020 were compared to the averages from 2016 to 2019, stratified by tumor site, year, month, and admission method, using interrupted time series analysis post-March 2020. RESULTS In 2020, oncological surgeries decreased by 12.3% (n = 17 923) compared to the 2016-2019 average (n = 20 432), notably dropping post-March (incidence rate ratio = 0.858; p < 0.001). The greatest reduction was observed for breast (-19.2%), colon (-18.2%), bladder (-17.5%), kidney (-14.2%), and prostate (-14%) surgeries. There was a huge reduction in nonemergency admissions (-13.6%), especially for colon (-23.8%), breast (-19.4%), and bladder (-18.7%). The proportion of hospitalizations with emergency access increased (p < 0.001). CONCLUSIONS The COVID-19 pandemic led to a significant decrease in cancer surgeries in Piedmont in 2020, with an increase in the proportion of admissions through emergency access. DISCUSSION The research provides valuable insights for comparing data with other regions and evaluating the effectiveness of efforts to recover lost surgical procedures. These findings can be useful to policymakers in developing coordinated measures and more efficient access strategies to healthcare services in any future emergency situations.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Paolo Ragusa
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Christian Previti
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Alessandro Comandone
- Rete Oncologica del Piemonte e della Valle d'Aosta, A.O.U. City of Health and Science of Turin, Turin, Italy
- Department of Oncology, San Giovanni Bosco Hospital, Turin, Italy
| | - Mario Airoldi
- Rete Oncologica del Piemonte e della Valle d'Aosta, A.O.U. City of Health and Science of Turin, Turin, Italy
- Oncology Unit 2, A.O.U. City of Health and Science of Turin, Turin, Italy
| | - Massimo Aglietta
- Rete Oncologica del Piemonte e della Valle d'Aosta, A.O.U. City of Health and Science of Turin, Turin, Italy
- Department of Oncology, University of Turin, Turin, Italy
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Roberta Siliquini
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
- Molinette Hospital, A.O.U. City of Health and Science of Turin, Turin, Italy
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Powis M, Sutradhar R, Singh S, Alibhai S, Hack S, Baiad A, Chen K, Li H, Mohmand Z, Krzyzanowska MK. The Impact of the Pandemic on the Quality of Colorectal and Anal Cancer Care, and 2-Year Clinical Outcomes. Curr Oncol 2024; 31:2328-2340. [PMID: 38668076 PMCID: PMC11048770 DOI: 10.3390/curroncol31040173] [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: 02/27/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
We undertook a retrospective study to compare the quality of care delivered to a cohort of newly diagnosed adults with colon, rectal or anal cancer during the early phase of COVID-19 (02/20-12/20) relative to the same period in the year prior (the comparator cohort), and examine the impact of the pandemic on 2-year disease progression and all-cause mortality. We observed poorer performance on a number of quality measures, such as approximately three times as many patients in the COVID-19 cohort experienced 30-day post-surgical readmission (10.5% vs. 3.6%; SD:0.27). Despite these differences, we observed no statistically significant adjusted associations between COVID-19 and time to either all-cause mortality (HR: 0.88, 95% CI: 0.61-1.27, p = 0.50) or disease progression (HR: 1.16, 95% CI: 0.82-1.64, p = 0.41). However, there was a substantial reduction in new patient consults during the early phase of COVID-19 (12.2% decrease), which appeared to disproportionally impact patients who traditionally experience sociodemographic disparities in access to care, given that the COVID-19 cohort skewed younger and there were fewer patients from neighborhoods with the highest Housing and Dwelling, ands Age and Labour Force marginalization quintiles. Future work is needed to understand the more downstream effects of COVID-19 related changes on cancer care to inform planning for future disruptions in care.
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Affiliation(s)
- Melanie Powis
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Cancer Quality Laboratory (CQuaL), Princess Margaret Cancer Centre, Toronto, ON M5G 1X6, Canada
| | - Rinku Sutradhar
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
| | - Simron Singh
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Shabbir Alibhai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Saidah Hack
- Cancer Quality Laboratory (CQuaL), Princess Margaret Cancer Centre, Toronto, ON M5G 1X6, Canada
| | - Abed Baiad
- Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Kevin Chen
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Huaqi Li
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Zuhal Mohmand
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
| | - Monika K. Krzyzanowska
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada; (R.S.); (S.S.); (M.K.K.)
- Cancer Quality Laboratory (CQuaL), Princess Margaret Cancer Centre, Toronto, ON M5G 1X6, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada; (K.C.); (Z.M.)
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
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Janczewski LM, Browner AE, Cotler JH, Palis BE, Chan K, Joung RH, Bentrem DJ, Merkow RP, Boffa DJ, Nelson H. Survival Among Patients With High-Risk Gastrointestinal Cancers During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e240160. [PMID: 38441896 PMCID: PMC10915687 DOI: 10.1001/jamanetworkopen.2024.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/30/2023] [Indexed: 03/07/2024] Open
Abstract
Importance Prior reports demonstrated that patients with cancer experienced worse outcomes from pandemic-related stressors and COVID-19 infection. Patients with certain malignant neoplasms, such as high-risk gastrointestinal (HRGI) cancers, may have been particularly affected. Objective To evaluate disruptions in care and outcomes among patients with HRGI cancers during the COVID-19 pandemic, assessing for signs of long-term changes in populations and survival. Design, Setting, and Participants This retrospective cohort study used data from the National Cancer Database to identify patients with HRGI cancer (esophageal, gastric, primary liver, or pancreatic) diagnosed between January 1, 2018, and December 31, 2020. Data were analyzed between August 23 and September 4, 2023. Main Outcome and Measures Trends in monthly new cases and proportions by stage in 2020 were compared with the prior 2 years. Kaplan-Meier curves and Cox regression were used to assess 1-year mortality in 2020 compared with 2018 to 2019. Proportional monthly trends and multivariable logistic regression were used to evaluate 30-day and 90-day mortality in 2020 compared with prior years. Results Of the 156 937 patients included in this study, 54 994 (35.0%) were aged 60 to 69 years and 100 050 (63.8%) were men. There was a substantial decrease in newly diagnosed HRGI cancers in March to May 2020, which returned to prepandemic levels by July 2020. For stage, there was a proportional decrease in the diagnosis of stage I (-3.9%) and stage II (-2.3%) disease, with an increase in stage IV disease (7.1%) during the early months of the pandemic. Despite a slight decrease in 1-year survival rates in 2020 (50.7% in 2018 and 2019 vs 47.4% in 2020), survival curves remained unchanged between years (all P > .05). After adjusting for confounders, diagnosis in 2020 was not associated with increased 1-year mortality compared with 2018 to 2019 (hazard ratio, 0.99; 95% CI, 0.97-1.01). The rates of 30-day (2.1% in 2018, 2.0% in 2019, and 2.1% in 2020) and 90-day (4.3% in 2018, 4.4% in 2019, and 4.6% in 2020) operative mortality also remained similar. Conclusions and Relevance In this retrospective cohort study, a period of underdiagnosis and increase in stage IV disease was observed for HRGI cancers during the pandemic; however, there was no change in 1-year survival or operative mortality. These results demonstrate the risks associated with gaps in care and the tremendous efforts of the cancer community to ensure quality care delivery during the pandemic. Future research should investigate long-term survival changes among all cancer types as additional follow-up data are accrued.
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Affiliation(s)
- Lauren M. Janczewski
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Bryan E. Palis
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Kelley Chan
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Rachel H. Joung
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David J. Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ryan P. Merkow
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, Illinois
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Živković Radojević M, Milosavljević N, Jankovic S, Grujić M, Janković K, Folić M. Impact of Emergency Situations on the Level of Fear and Anxiety in Oncology Patients During Radiotherapy in a Developing Country. Cureus 2024; 16:e57129. [PMID: 38681399 PMCID: PMC11055572 DOI: 10.7759/cureus.57129] [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] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE To analyze the level of fear and anxiety related to radiotherapy in oncology patients treated before and during the COVID-19 pandemic, as well as to examine whether the advancement of radiotherapy centers leads to any reduction in the patient's fear in emergency situations. METHODS Two cross-sectional studies were conducted in two time frames (2016 and 2022) based on the analysis of the intensity of anxiety and fear of radiotherapy in oncology patients with assistance. A questionnaire for assessing fear of radiotherapy in oncology patients and Zung's and Beck's self-reported anxiety scales were used. The first part of the research integrated all data of research interest obtained from patients treated with radiotherapy during 2016, and the second cross-sectional study included all patients treated in 2022 during the COVID-19 pandemic. The study was prepared according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. RESULTS The first cross-sectional study had 154 participants who had been treated with radiotherapy, while in the second study, there were 159 patients. Patients treated in 2022 show significantly higher levels of fear and anxiety. External beam radiotherapy and brachytherapy simultaneously used in both studies increased the level of fear and anxiety. CONCLUSION The conducted research showed exceptional differences in the intensity of fear and anxiety in patients treated with radiotherapy in different health situations, as was the case during the COVID-19 pandemic, with a significant impact on the stability of the health system and the challenges to providing standard services.
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Affiliation(s)
| | - Neda Milosavljević
- Clinical Oncology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, SRB
| | - Slobodan Jankovic
- Pharmacology and Therapeutics, University of Kragujevac, Kragujevac, SRB
| | - Miloš Grujić
- Clinical Oncology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, SRB
| | - Katarina Janković
- Clinical Oncology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, SRB
| | - Marko Folić
- Clinical Pharmacology, University of Kragujevac, Faculty of Medical Sciences, Kragujevac, SRB
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7
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Murphy CC, Tavakkoli A, Wani S, Singal AG. Pandemic-Related Changes in Incidence and Mortality Rates of Gastrointestinal Cancers During 2020. Am J Gastroenterol 2024; 119:382-387. [PMID: 37791616 PMCID: PMC10873074 DOI: 10.14309/ajg.0000000000002526] [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: 06/11/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Coronavirus Disease 2019 disrupted cancer-related care in early 2020. METHODS We used population-based cancer registry data to estimate incidence and mortality rates of gastrointestinal cancers between 2016 and 2020. RESULTS Incidence rates were unchanged from 2016 to 2019 but decreased in 2020, with the largest declines for colorectal cancer (rate ratio [RR] 0.88; 95% confidence interval [CI] 0.87-0.90) and hepatocellular carcinoma (RR 0.85; 95% CI 0.82-0.88). Mortality rates of colorectal cancer (RR 1.06; 95% CI 1.04-1.08) and esophageal adenocarcinoma (RR 1.06; 95% CI 1.00-1.13) increased in 2020. DISCUSSION Incidence and mortality rates of gastrointestinal cancers may increase in the future given pandemic-related delays in 2020.
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Affiliation(s)
- Caitlin C Murphy
- University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, Texas, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anna Tavakkoli
- University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, Texas, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sachin Wani
- University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, Texas, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amit G Singal
- University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Houston, Texas, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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8
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Slotman E, Fransen HP, van Laarhoven HWM, van den Beuken-van Everdingen MHJ, Tjan-Heijnen VCG, Huijben AMT, Jager A, van Zuylen L, Kuip EJM, van der Linden YM, Raijmakers NJH, Siesling S. Reduction in potentially inappropriate end-of-life hospital care for cancer patients during the COVID-19 pandemic: A retrospective population-based study. Palliat Med 2024; 38:140-149. [PMID: 38142283 PMCID: PMC10798006 DOI: 10.1177/02692163231217373] [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] [Indexed: 12/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life cancer care during the pandemic. AIM To investigate potentially inappropriate end-of-life hospital care for cancer patients before and during the COVID-19 pandemic. DESIGN Retrospective population-based cohort study using data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Potentially inappropriate care in the last month of life (chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission or hospital death) was compared between four COVID-19 periods and corresponding periods in 2018/2019. PARTICIPANTS A total of 112,919 cancer patients (⩾18 years) who died between January 2018 and May 2021 were included. RESULTS Fewer patients received potentially inappropriate end-of-life care during the COVID-19 pandemic compared to previous years, especially during the first COVID-19 peak (22.4% vs 26.0%). Regression analysis showed lower odds of potentially inappropriate end-of-life care during all COVID-19 periods (between OR 0.81; 95% CI 0.74-0.88 and OR 0.92; 95% CI 0.87-0.97) after adjustment for age, sex and cancer type. For the individual indicators, fewer patients experienced multiple or long hospitalizations, intensive care unit admission or hospital death during the pandemic. CONCLUSIONS Cancer patients received less potentially inappropriate end-of-life care during the COVID-19 pandemic. Because several factors may have contributed, it is unclear whether this reflects better quality care. However, these findings raise important questions about what pandemic-induced changes in care practices can help provide appropriate end-of-life care for future patients in the context of increasing patient numbers and limited resources.
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Affiliation(s)
- Ellis Slotman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Hanneke WM van Laarhoven
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Vivianne CG Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Auke MT Huijben
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien JM Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud Medical Center, Nijmegen, The Netherlands
| | - Yvette M van der Linden
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Natasja JH Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Technical Medical Centre, Enschede, The Netherlands
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9
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Powis M, Sutradhar R, Hack S, Alibhai SM, Berlin A, Singh S, Krzyzanowska MK. Patient Perceptions of the Impact of the COVID Pandemic on the Quality of Their Gastrointestinal Cancer Care. J Patient Exp 2023; 10:23743735231223849. [PMID: 38162188 PMCID: PMC10757436 DOI: 10.1177/23743735231223849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
We surveyed patients who had a received care for a gastrointestinal cancer between 03/2020 and 05/2021 to understand their perceptions of the impact of the Covid pandemic on cancer care delivery and quality of care. Three-hundred fifty-eight respondents provided evaluable responses (response rate: 17.3%). Approximately half of respondents (46.4%) perceived that they had experienced a pandemic-related cancer care modification; most changes were initiated by a clinician or the cancer center (44.6%). Relative to White patients those from Racialized Groups (OR: 1.91, 95% CI: 1.03-3.54) were more likely to report a cancer treatment change. Additionally, relative to patients in follow-up, those who were newly diagnosed (OR: 2.39; 95% CI: 1.21-4.71) were more likely to report a change. Compared to White patients, patients from Racialized Groups were approximately twice as likely to report perceiving that virtual visits during Covid negatively impacted the quality of their care (OR: 2.21; 95% CI: 0.96-5.08). These findings potentially reflect pre-existing systemic disparities in quality of and access to care, as well as differences in how care is experienced by patients from Racialized Groups.
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Affiliation(s)
- Melanie Powis
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Saidah Hack
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Shabbir M.H. Alibhai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Simron Singh
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Monika K. Krzyzanowska
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
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10
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Chtourou A, Sanchez PV, Golden T, Chen HS, Schwartz SM, Wu XC, Hernandez BY, Harrison JN, Penberthy L, Negoita S. Impact on the Volume of Pathology Reports Before and During the COVID-19 Pandemic in SEER Cancer Registries. Cancer Epidemiol Biomarkers Prev 2023; 32:1591-1598. [PMID: 37594474 PMCID: PMC10618747 DOI: 10.1158/1055-9965.epi-23-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/02/2023] [Accepted: 08/16/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Health care procedures including cancer screening and diagnosis were interrupted due to the COVID-19 pandemic. The extent of this impact on cancer care in the United States is not fully understood. We investigated pathology report volume as a reflection of trends in oncology services pre-pandemic and during the pandemic. METHODS Electronic pathology reports were obtained from 11 U.S. central cancer registries from NCI's SEER Program. The reports were sorted by cancer site and document type using a validated algorithm. Joinpoint regression was used to model temporal trends from January 2018 to February 2020, project expected counts from March 2020 to February 2021 and calculate observed-to-expected ratios. Results were stratified by sex, age, cancer site, and report type. RESULTS During the first 3 months of the pandemic, pathology report volume decreased by 25.5% and 17.4% for biopsy and surgery reports, respectively. The 12-month O/E ratio (March 2020-February 2021) was lowest for women (O/E 0.90) and patients 65 years and older (O/E 0.91) and lower for cancers with screening (melanoma skin, O/E 0.86; breast, O/E 0.88; lung O/E 0.89, prostate, O/E 0.90; colorectal, O/E 0.91) when compared with all other cancers combined. CONCLUSIONS These findings indicate a decrease in cancer diagnosis, likely due to the COVID-19 pandemic. This decrease in the number of pathology reports may result in a stage shift causing a subsequent longer-term impact on survival patterns. IMPACT Investigation on the longer-term impact of the pandemic on pathology services is vital to understand if cancer care delivery levels continue to be affected.
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Affiliation(s)
- Amina Chtourou
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Pamela V. Sanchez
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Todd Golden
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Huann-Sheng Chen
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Stephen M. Schwartz
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Los Angeles
| | | | - Jovanka N. Harrison
- New York State Cancer Registry, New York State Department of Health, Albany, New York
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Serban Negoita
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
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11
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Myers C, Bennett K, Cahir C. Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes. Int J Qual Health Care 2023; 35:mzad048. [PMID: 37497806 PMCID: PMC10373113 DOI: 10.1093/intqhc/mzad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, health services for breast cancer (BC) have been disrupted. Our scoping review examines the impact of the COVID-19 pandemic on BC services, health outcomes, and well-being for women. Additionally, this review identifies social inequalities specific to BC during the pandemic. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, the literature search was conducted using scientific databases starting from March 2020 through November 2021. Studies were identified and selected by two researchers based on inclusion criteria, and the relevant data were extracted and charted to summarize the findings. Ninety-three articles were included in this review. Main themes included are as follows: (i) the impact of COVID-19 on BC services; (ii) the impact of COVID-19 on health outcomes and well-being in women with BC; and (iii) any variation in the impact of COVID-19 on BC by social determinants of health. There were apparent disruptions to BC services across the cancer continuum, especially screening services. Clinical repercussions were a result of such disruptions, and women with BC experienced worsened quality of life and psychosocial well-being. Finally, there were social inequalities dependent on social determinants of health such as age, race, insurance status, and region. Due to the disruption of BC services during the COVID-19 pandemic, women were impacted on their health and overall well-being. The variation in impact demonstrates how health inequities have been exacerbated during the pandemic. This comprehensive review will inform timely health-care changes to minimize long-term impacts of the pandemic and improve evidence-based multidisciplinary needs.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
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12
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Troncone A, Cascella C, Chianese A, Zanfardino A, Pizzini B, Iafusco D. Psychological consequences of the COVID-19 pandemic in people with type 1 diabetes: A systematic literature review. J Psychosom Res 2023; 168:111206. [PMID: 36913765 PMCID: PMC9972771 DOI: 10.1016/j.jpsychores.2023.111206] [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: 01/03/2023] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors. METHODS A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included. RESULTS Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5-60.7%, n = 13 studies), anxiety (7-27.5%, n = 16 studies), and distress (14-86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality. CONCLUSIONS Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy.
| | - Barbara Pizzini
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy
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13
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Pumphrey I, Serventi F, Kahakwa A, Massawe A, Henke AA, Henke O. Impact of COVID-19 on delivery of oncology services in Northern Tanzania: a cross-sectional study of community health workers and patients undergoing cancer treatment at the Kilimanjaro Christian Medical Centre. BMJ Open 2023; 13:e069142. [PMID: 37080627 PMCID: PMC10123862 DOI: 10.1136/bmjopen-2022-069142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To ascertain how the COVID-19 pandemic was perceived by oncology patients and community health workers (CHWs) and whether this contributed to disruptions in cancer care. DESIGN Cross-sectional study using (1) structured telephone interviews with patients and (2) structured questionnaires completed by CHWs. SETTING Outpatient and community care at Kilimanjaro Christian Medical Centre's Cancer Care Centre (KCMCCCC), Northern Tanzania. PARTICIPANTS 300 oncology patients (158 men and 142 women) who had attended KCMCCCC between January and April 2020 and 78 CHWs (16 men and 62 women) in the KCMC regional palliative care network who conducted home visits to patients with cancer during the period January to April 2020. PRIMARY OUTCOME MEASURES For patients, missed appointments and fear of COVID-19 more than postponement of their treatment. For CHWs, no primary outcome (a broad range of questions on perception of the pandemic were asked). RESULTS 30% of patients said they missed appointments due to the pandemic, the most commonly cited reasons being financial problems (37%) and fear of acquiring COVID-19 infection during travel and/or in the hospital (37%). Only 12.7% of patients said they feared COVID-19 more than postponement of cancer treatment. 88% of CHWs noticed differences in delivering home care since the start of the pandemic, with 58% saying they had noticed more patients dying and 74% saying that more patients were relying on local healers. 31% of CHWs said they feared home visits because of COVID-19 and 46% perceived patients feared home visits due to COVID-19. However, 92% felt home visits should continue. CONCLUSION These results indicated that while there was a significant degree of disruption and fear around the COVID-19 pandemic, the majority of patients and CHWs did not fear of COVID-19 more than disruption to cancer care. This highlights the importance to these groups of maintaining access to vital cancer services.
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Affiliation(s)
- India Pumphrey
- Institute for Tropical Medicine and Public Health, Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Furaha Serventi
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Atukuzwe Kahakwa
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Anna Massawe
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Antje Annaliese Henke
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
- Institute for Medical Epidemiology, Biostatistics and Informatics, Center of Health Sciences, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Oliver Henke
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
- Institute for Hygiene and Public Health, Section Global Health, University of Bonn, Bonn, Germany
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14
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Taylor S, Stanworth M, Eastwood C, Gomes F, Khatoon B, Yorke J. Understanding the experiences of lung cancer patients during the COVID-19 pandemic: a qualitative interview study. Qual Life Res 2023; 32:701-711. [PMID: 36342627 PMCID: PMC9638463 DOI: 10.1007/s11136-022-03283-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The study explores experiences of lung cancer patients during COVID-19 and considers how changes to care delivery and personal lives affected patient needs. METHODS Semi-structured telephone interviews were conducted to explore experiences of lung cancer patients during COVID-19. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Interview participants were purposively selected based on age, gender, treatment status, timing of diagnosis (pre/post first COVID-19 lockdown) from a sample of lung cancer patients (any histological subtype/any cancer stage/any point in treatment) who had completed a questionnaire exploring how participants' lives were impacted by the pandemic and their thoughts on clinical care and remote communication. RESULTS Thirty lung cancer patients who participated in the questionnaire study were approached and participated in an interview. Three themes were identified: (1) Adapting to new modes of communication (focusing on experiences of remote communication); (2) Experience of care delivery during the pandemic (describing how all aspects of care delivery had been affected); (3) Impact of the COVID-19 pandemic on quality of life (QOL) (focus on the psychological impact and feeling of reduced support). Themes 1 and 2 are heavily interlinked and both had bearing on patients' QOL experience. CONCLUSION Lung cancer patients were impacted psychologically by changes to care delivery and changes in their personal life. The findings highlight some benefits to remote consultations but the stage of the treatment pathway and illness trajectory should be considered when determining if this is appropriate. Participants felt support from peers, family and friends was limited during the pandemic.
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Affiliation(s)
- Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK. .,School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Melissa Stanworth
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Charlotte Eastwood
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Fabio Gomes
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.,Medical Oncology Department, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Binish Khatoon
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.,School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK.,School of Nursing and Midwifery, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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15
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Dowling M, Eicher M, Drury A. Experiences of cancer care in COVID-19: A longitudinal qualitative study. Eur J Oncol Nurs 2022; 61:102228. [PMID: 36334337 PMCID: PMC9576914 DOI: 10.1016/j.ejon.2022.102228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to explore the cancer care experiences of people living with and beyond cancer during COVID-19 in Ireland. METHODS The study adopted a longitudinal qualitative design using semi-structured interviews with sixteen participants. Interviews were undertaken on three occasions over six months (January-June 2021). The National Comprehensive Cancer Network Distress Thermometer (NCCN DT), and Connor-Davidson-Resilience Scale (CD-RISC2) were also used as part of the interviews to measure distress and resilience. Thematic analysis of interview data was conducted and participants' self-rating for distress and resilience was analysed using descriptive statistics. RESULTS Sixteen patients participated. The findings revealed participants' constant fear of COVID-19 over time and efforts to stay safe by following the 'rules'. Isolation was a common experience as COVID-19 restrictions resulted in being alone when attending the hospital for treatment and limited support from family and friends. Telephone follow-up was limited in terms of support and patients' opportunity to ask questions. For a minority, COVID-19 restrictions meant they were 'not missing out'. On average, participants reported moderate to high levels of resilience at all time points. Distress scores were low but trended upwards from T1 to T2. CONCLUSIONS The findings highlight the need to avoid restrictions on carers accompanying their close relatives to the hospital for treatment. An evaluation of the effects of the rapid introduction of telephone follow-up on patient outcomes is warranted.
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Affiliation(s)
- Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland.
| | - Manuela Eicher
- Department of Oncology, Lausanne University Hospital (CHUV), Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Amanda Drury
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Ireland.
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16
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Ragavan MV, Legaspi N, LaLanne A, Hong JC, Small EJ, Borno HT. Analysis of Serious Adverse Event Reporting for Patients Enrolled in Cancer Clinical Trials During the COVID-19 Pandemic. JAMA Oncol 2022; 8:1849-1851. [PMID: 36301577 PMCID: PMC9614670 DOI: 10.1001/jamaoncol.2022.4919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This cross-sectional study assesses whether a change occurred in reporting of serious adverse events for patients in oncology clinical trials in the US during the COVID-19 pandemic.
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Affiliation(s)
- Meera V. Ragavan
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Nichole Legaspi
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Alyssa LaLanne
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - Julian C. Hong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco,Department of Radiation Oncology, University of California, San Francisco, San Francisco,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco
| | - Eric J. Small
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - Hala T. Borno
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco,Trial Library, San Francisco, California
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17
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Teglia F, Angelini M, Casolari G, Astolfi L, Boffetta P. Global Association of COVID-19 Pandemic Measures with Cancer Treatment: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225490. [PMID: 36428583 PMCID: PMC9688091 DOI: 10.3390/cancers14225490] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has put a serious strain on health services, including cancer treatment. OBJECTIVE This study aimed to investigate the changes in cancer treatment worldwide during the first phase of the SARS-CoV-2 outbreak. DATA SOURCES Pubmed, Proquest, and Scopus databases were searched comprehensively for articles published between 1 January 2020 and 12 December 2021, in order to perform a systematic review and meta-analysis conducted following the PRISMA statement. STUDY SELECTION Studies and articles that reported data on the number of or variation in cancer treatments between the pandemic and pre-pandemic periods, comprising oncological surgery, radiotherapy, and systemic therapies, were included. DATA EXTRACTION AND SYNTHESIS Data were extracted from two pairs of independent reviewers. The weighted average of the percentage variation was calculated between the two periods to assess the change in the number of cancer treatments performed during the pandemic. Stratified analyses were performed by type of treatment, geographic area, time period, study setting, and type of cancer. RESULTS Among the 47 articles retained, we found an overall reduction of -18.7% (95% CI, -24.1 to -13.3) in the total number of cancer treatments administered during the COVID-19 pandemic compared to the previous periods. Surgical treatment had a larger decrease compared to medical treatment (-33.9% versus -12.6%). For all three types of treatments, we identified a U-shaped temporal trend during the entire period January-October 2020. Significant decreases were also identified for different types of cancer, in particular for skin cancer (-34.7% [95% CI, -46.8 to -22.5]) and for all geographic areas, in particular, Asia (-42.1% [95% CI, -49.6 to -34.7]). CONCLUSIONS AND RELEVANCE The interruption, delay, and modifications to cancer treatment due to the COVID-19 pandemic are expected to alter the quality of care and patient outcomes.
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Affiliation(s)
- Federica Teglia
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Marco Angelini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Giulia Casolari
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Laura Astolfi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, New York, NY 40138, USA
- Correspondence:
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18
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Das AV, Kaliki S. Year 1 of COVID-19 pandemic in India: Effect of lockdown and unlock on the presentation of patients with ocular and periocular tumors at a referral center. Oman J Ophthalmol 2022; 15:304-308. [PMID: 36760937 PMCID: PMC9905914 DOI: 10.4103/ojo.ojo_273_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/26/2022] [Accepted: 04/06/2022] [Indexed: 02/11/2023] Open
Abstract
PURPOSE The purpose of the study is to describe the impact of lockdown and unlock phases of the COVID-19 pandemic on the presentation of ocular and periocular tumors at a referral center in India. MATERIALS AND METHODS This cross-sectional, hospital-based study included 5811 patients presenting between March 25, 2017, and March 31, 2021. The data on the patients diagnosed with ocular and periocular tumors in one or both eyes presenting during the lockdown and unlock phases were compared with the respective time periods in the previous 3 years before COVID-19. RESULTS The patient numbers dropped by 85% (45/295) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 33% reduction in patients requiring inter-state travel. There was complete recovery of the outpatient numbers to 105% (139/132) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen in patients with malignant tumors (145%) and was lower in those with benign tumors (89%) than pre-COVID-19 volumes by March 2021. There was an increase in the patients presenting with malignant tumors (49%; P = 0.45) during the lockdown phase. The proportion of patients requiring inter-state travel showed a near-complete recovery to 88% of pre-COVID-19 distribution by March 2021. CONCLUSION The 1st year of the COVID-19 pandemic saw a significant decline in the number of patients presenting with ocular and periocular tumors. There was an increase in the proportion of malignant tumors and a decrease in benign tumors during the lockdown phase. During unlock period, there was a near-complete recovery in the patients requiring inter-state travel to access eye care services.
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Affiliation(s)
- Anthony Vipin Das
- Department of Eye Smart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India,Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- Ocular Oncology Services, The Operation Eyesight Universal Institute for Eye Cancer (SK), L V Prasad Eye Institute, Hyderabad, Telangana, India,Address for correspondence: Dr. Swathi Kaliki, The Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad - 500 034, Telangana, India. E-mail:
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19
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Fu R, Sutradhar R, Dare A, Li Q, Hanna TP, Chan KKW, Irish JC, Coburn N, Hallet J, Singh S, Parmar A, Earle CC, Lapointe-Shaw L, Krzyzanowska MK, Finelli A, Louie AV, Witterick IJ, Mahar A, Urbach DR, McIsaac DI, Enepekides D, Look Hong NJ, Eskander A. Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic? Curr Oncol 2022; 29:7732-7744. [PMID: 36290888 PMCID: PMC9600641 DOI: 10.3390/curroncol29100611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis. Competing-risks regression models with interaction effects were used to quantify the association between COVID-19 period (receiving a cancer diagnosis before or on/after 15 March 2020) and receipt of surgical reSection 9-months after first chemotherapy. Among 51,653 patients, 8.5% (n = 19,558) of them ultimately underwent surgery 9-months after chemotherapy initiation. Receipt of surgery was higher during the pandemic than before (sHR 1.07, 95% CI 1.02-1.13). Material deprivation was independently associated with lower receipt of surgery (least vs. most deprived quintile: sHR 1.11, 95% CI 1.04-1.17), but did not change with the pandemic. The surgical rate increase was most pronounced for breast cancer (sHR 1.13, 95% CI 1.06-1.20). These pandemic-related shifts in cancer treatment requires further evaluations to understand the long-term consequences. Persistent material deprivation-related inequity in cancer surgical access needs to be addressed.
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Affiliation(s)
- Rui Fu
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Rinku Sutradhar
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Anna Dare
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Qing Li
- ICES, Toronto, ON M4N 3M5, Canada
| | - Timothy P. Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON K7L 3N6, Canada
- Ontario Institute for Cancer Research (OICR), Toronto, ON M5G 0A3, Canada
| | - Kelvin K. W. Chan
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Jonathan C. Irish
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head & Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON M5G 1X5, Canada
| | - Natalie Coburn
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Julie Hallet
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Simron Singh
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Ambica Parmar
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Craig C. Earle
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lauren Lapointe-Shaw
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Monika K. Krzyzanowska
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Antonio Finelli
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Ian J. Witterick
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Odette Cancer Centre—Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Ontario Health—Cancer Care Ontario, Toronto, ON M5G 2L7, Canada
| | - Alyson Mahar
- School of Nursing, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - David R. Urbach
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Surgery, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Daniel I. McIsaac
- ICES, Toronto, ON M4N 3M5, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Danny Enepekides
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
| | - Nicole J. Look Hong
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Antoine Eskander
- ICES, Toronto, ON M4N 3M5, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON M5G 1X5, Canada
- Correspondence: ; Tel.: +1-416-480-6705
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20
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Smeallie E, Rosenthal L, Johnson A, Roslin C, Hassett AL, Choi SW. Enhancing Resilience in Family Caregivers Using an mHealth App. Appl Clin Inform 2022; 13:1194-1206. [PMID: 36283418 PMCID: PMC9771688 DOI: 10.1055/a-1967-8721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/19/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We previously developed a mobile health (mHealth) app (Roadmap) to promote the resilience of family caregivers during the acute phases of care in patients undergoing hematopoietic cell transplantation (HCT). OBJECTIVE This study explored users' perspectives on the uptake of Roadmap's multicomponent features and the app's utility in promoting resilience. METHODS Fifteen participants were randomized to the full version of the app that included resilience-building activities and the other 15 were randomized to the control version that included a limited view of the app (i.e., without any resilience-building activities). They were instructed to use the app for 120 days. Semistructured qualitative interviews were then conducted with users as part of an ongoing, larger Roadmap study (NCT04094844). During the interview, caregiver participants were asked about their overall experiences with the app, frequency of use, features used, facilitators of and barriers to use, and their perspectives on its utility in promoting resilience. Data were professionally transcribed, coded, and categorized through content analysis. RESULTS Interviews were conducted with 30 participants, which included 23 females and 7 males. The median age of the population was 58 years (range, 23-82). The four main themes that emerged included app use, ease of use, user experiences, and ability to foster resilience. The subthemes identified related to facilitators (convenience and not harmful), barriers (caregiver burden and being too overwhelmed during the acute phases of HCT care), resilience (optimism/positivity and self-care), and app design improvements (personalization and notifications/reminders). CONCLUSION The qualitative evaluation provided insights into which components were utilized and how one, or a combination of the multicomponent features, may be enhancing users' experiences. Lessons learned suggest that the Roadmap app contributed to promoting resilience during the acute phases of HCT care. Nonetheless, features that provided enhanced personalization may further improve longer-term engagement.
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Affiliation(s)
- Eleanor Smeallie
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Lindsay Rosenthal
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Amanda Johnson
- Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon, United States
| | - Chloe Roslin
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, United States
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21
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Milch V, Nelson AE, Austen M, Hector D, Turnbull S, Sathiaraj R, Der Vartanian C, Wang R, Anderiesz C, Keefe D. Conceptual Framework for Cancer Care During a Pandemic Incorporating Evidence From the COVID-19 Pandemic. JCO Glob Oncol 2022; 8:e2200043. [PMID: 35917484 PMCID: PMC9470141 DOI: 10.1200/go.22.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With successive infection waves and the spread of more infectious variants, the COVID-19 pandemic continues to have major impacts on health care. To achieve best outcomes for patients with cancer during a pandemic, efforts to minimize the increased risk of severe pandemic infection must be carefully balanced against unintended adverse impacts of the pandemic on cancer care, with consideration to available health system capacity. Cancer Australia's conceptual framework for cancer care during a pandemic provides a planning resource for health services and policy-makers that can be broadly applied globally and to similar pandemics. METHODS Evidence on the impact of the COVID-19 pandemic on cancer care and health system capacity to June 2021 was reviewed, and the conceptual framework was developed and updated. RESULTS Components of health system capacity vary during a pandemic, and capacity relative to pandemic numbers and severity affects resources available for cancer care delivery. The challenges of successive pandemic waves and high numbers of pandemic cases necessitate consideration of changing health system capacity in decision making about cancer care. Cancer Australia’s conceptual framework provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimizing infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption. CONCLUSION Evidence from the COVID-19 pandemic supports continuation of cancer care wherever possible during similar pandemics. Cancer Australia's conceptual framework, underpinned by principles for optimal cancer care, informs decision making across the cancer care continuum. It incorporates consideration of changes in health system capacity and capacity for cancer care, in relation to pandemic progression, enabling broad applicability to different global settings.
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Affiliation(s)
- Vivienne Milch
- Cancer Australia, Sydney, New South Wales, Australia
- The University of Notre Dame, Sydney, New South Wales, Australia
| | - Anne E. Nelson
- Evidence Review Contractor, Sydney, New South Wales, Australia
| | | | - Debra Hector
- Cancer Australia, Sydney, New South Wales, Australia
| | | | | | | | - Rhona Wang
- Cancer Australia, Sydney, New South Wales, Australia
| | - Cleola Anderiesz
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- National Breast Cancer Foundation, Sydney, New South Wales, Australia
| | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
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22
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Sood D, Dhiman A, Ong CT, Liu AY, Belanski J, Turaga KK, Eng OS. The Impact of COVID-19-Related Delays on Surgical Management of Peritoneal Surface Malignancies. Ann Surg Oncol 2022; 29:5377-5378. [PMID: 35503391 PMCID: PMC9063612 DOI: 10.1245/s10434-022-11814-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Divya Sood
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Ankit Dhiman
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Cecilia T Ong
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Andrea Y Liu
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Jennifer Belanski
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kiran K Turaga
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Division of Surgical Oncology, Department of Surgery, University of California - Irvine, 333 City Boulevard, West, Suite 1600, Orange, CA, USA.
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23
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Treiman K, Kranzler EC, Moultrie R, Arena L, Mack N, Fortune E, Garcia R, Street RL. Patients' Experiences with Cancer Care: Impact of the COVID-19 Pandemic. J Patient Exp 2022; 9:23743735221092567. [PMID: 35480966 PMCID: PMC9036334 DOI: 10.1177/23743735221092567] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic heightened the psychosocial impact of a cancer diagnosis as patients face concerns about the risk of infection and serious disease and uncertainties about the impact on their treatment. We conducted an online survey (n = 317) and focus groups (n = 19) with patients to examine their experiences with cancer care during the pandemic. Most survey respondents (68%) reported one or more disruptions or delays in care, including appointments switched to telehealth (49%). Patients perceived both benefits (e.g., convenience) and drawbacks (e.g., more impersonal) to telehealth. For many patients, COVID-19-related restrictions on bringing family members to support them during appointments was a major concern and left them feeling alone and vulnerable during treatment. Patients' self-reported coping during the pandemic was positively associated with age, education, and income (P < .05 for each) and better communication with their doctors during telehealth sessions (P < .001). Study findings highlight the importance of patient-centered care and communication to help patients cope with the challenges of the pandemic. Further research is needed to develop guidelines for use of telehealth as part of patient-centered cancer care.
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Affiliation(s)
- Katherine Treiman
- Translation Health Science Division, RTI International, Research Triangle Park, NC, USA
| | - Elissa C. Kranzler
- Fors Marsh Group, formerly Cancer Support Community, Philadelphia, PA, USA
| | - Rebecca Moultrie
- Translation Health Science Division, RTI International, Research Triangle Park, NC, USA
| | - Laura Arena
- Translation Health Science Division, RTI International, Research Triangle Park, NC, USA
| | - Nicole Mack
- Social Statistics Program, RTI International, Research Triangle Park, NC, USA
| | - Erica Fortune
- Cancer Support Community, Research and Training Institute, Philadelphia, PA, USA
| | - Reese Garcia
- Fight Colorectal Cancer, Research Advocacy Training and Support Program, Springfield, MO, USA
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
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24
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Walker MJ, Wang J, Mazuryk J, Skinner SM, Meggetto O, Ashu E, Habbous S, Nazeri Rad N, Espino-Hernández G, Wood R, Chaudhry M, Vahid S, Gao J, Gallo-Hershberg D, Gutierrez E, Zanchetta C, Langer D, Zwicker V, Rey M, Tammemägi MC, Tinmouth J, Kupets R, Chiarelli AM, Singh S, Warde P, Forbes L, Dobranowski J, Irish J, Rabeneck L. Delivery of Cancer Care in Ontario, Canada, During the First Year of the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e228855. [PMID: 35467731 PMCID: PMC9039771 DOI: 10.1001/jamanetworkopen.2022.8855] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has impacted cancer systems worldwide. Quantifying the changes is critical to informing the delivery of care while the pandemic continues, as well as for system recovery and future pandemic planning. OBJECTIVE To quantify change in the delivery of cancer services across the continuum of care during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study assessed cancer screening, imaging, diagnostic, treatment, and psychosocial oncological care services delivered in pediatric and adult populations in Ontario, Canada (population 14.7 million), from April 1, 2019, to March 1, 2021. Data were analyzed from May 1 to July 31, 2021. EXPOSURES COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Cancer service volumes from the first year of the COVID-19 pandemic, defined as April 1, 2020, to March 31, 2021, were compared with volumes during a prepandemic period of April 1, 2019, to March 31, 2020. RESULTS During the first year of the pandemic, there were a total of 4 476 693 cancer care services, compared with 5 644 105 services in the year prior, a difference of 20.7% fewer services of cancer care, representing a potential backlog of 1 167 412 cancer services. While there were less pronounced changes in systemic treatments, emergency and urgent imaging examinations (eg, 1.9% more parenteral systemic treatments) and surgical procedures (eg, 65% more urgent surgical procedures), major reductions were observed for most services beginning in March 2020. Compared with the year prior, during the first pandemic year, cancer screenings were reduced by 42.4% (-1 016 181 screening tests), cancer treatment surgical procedures by 14.1% (-8020 procedures), and radiation treatment visits by 21.0% (-141 629 visits). Biopsies to confirm cancer decreased by up to 41.2% and surgical cancer resections by up to 27.8% during the first pandemic wave. New consultation volumes also decreased, such as for systemic treatment (-8.2%) and radiation treatment (-9.3%). The use of virtual cancer care increased for systemic treatment and radiation treatment and psychosocial oncological care visits, increasing from 0% to 20% of total new or follow-up visits prior to the pandemic up to 78% of total visits in the first pandemic year. CONCLUSIONS AND RELEVANCE In this population-based cohort study in Ontario, Canada, large reductions in cancer service volumes were observed. While most services recovered to prepandemic levels at the end of the first pandemic year, a substantial care deficit likely accrued. The anticipated downstream morbidity and mortality associated with this deficit underscore the urgent need to address the backlog and recover cancer care and warrant further study.
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Affiliation(s)
- Meghan J. Walker
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | | | | | | | - Eta Ashu
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | | | | | | | - Ryan Wood
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | | | - Saba Vahid
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Julia Gao
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Daniela Gallo-Hershberg
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | | | | | | | - Michelle Rey
- Ontario Health–Cancer Care Ontario, Toronto, Canada
| | - Martin C. Tammemägi
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Health Sciences, Brock University, St Catharines, Canada
| | - Jill Tinmouth
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Rachel Kupets
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Anna M. Chiarelli
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Simron Singh
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, , Canada
| | - Padraig Warde
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Leta Forbes
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Canada
| | - Julian Dobranowski
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Radiology, McMaster University, Hamilton, Canada
- Niagara Health, St Catharines, Ontario, Canada
| | - Jonathan Irish
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Linda Rabeneck
- Ontario Health–Cancer Care Ontario, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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25
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Doll CM, Wakefield DV, Ringash J, Ingledew PA, Dawson LA, Eichler T, Schwartz DS. Impact of the COVID-19 Pandemic on Canadian Radiation Oncology Practices. Int J Radiat Oncol Biol Phys 2022; 113:513-517. [PMID: 35318953 PMCID: PMC8933870 DOI: 10.1016/j.ijrobp.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/27/2022] [Accepted: 03/13/2022] [Indexed: 11/24/2022]
Abstract
Purpose To survey Canadian radiation oncology (RO) practice leaders to determine the effect of the COVID-19 pandemic on radiation services and patient and staff issues in the early phase of the pandemic and 1 year later. Methods and Materials The RO leader (department or division head) from every Canadian cancer center with radiation services was identified. Two surveys were circulated to the identified leader via email from the Canadian Association of Radiation Oncology central office, using the SurveyMonkey survey tool: the first closed in June 2020 and the second (expanded) survey in June 2021, representing 2 points in time of the COVID-19 pandemic. Questions included patient volume, service interruptions and delays, and changes in scheduling and telemedicine use. Additional questions were included in the follow-up survey to determine further effects on disease presentation, volume, vaccination and access, and personnel issues. Results Telemedicine was widely adopted early in the pandemic and continued to be a common technique to communicate and connect with patients. Although many centers were deferring or delaying certain disease sites early in the pandemic, this was not as prevalent 1 year later. Reduced cancer screening and patients presenting with more advanced disease were concerns documented in the 2021 survey. A high level of concern regarding stress among health care professionals was identified. Conclusions Canadian RO centers have faced numerous challenges during the COVID-19 pandemic but continued to provide timely and essential cancer care for patients with cancer. Future evaluation of RO center practices will be important to continue to document and address the effect of the COVID-19 pandemic on issues relevant to RO leaders, patients, and staff.
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26
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Asayama K. Delicate but significant changes in blood pressure-the importance of clinical research by frontline clinicians. Hypertens Res 2022; 45:744-746. [PMID: 35145251 PMCID: PMC8830979 DOI: 10.1038/s41440-022-00865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. .,Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium. .,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.
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27
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Nguyen M, Bain N, Grech L, Choi T, Harris S, Chau H, Freeman D, Kwok A, Williams J, McCartney A, Webber K, Day D, Segelov E. COVID-19 vaccination rates, intent, and hesitancy in patients with solid organ and blood cancers: A multicenter study. Asia Pac J Clin Oncol 2022; 18:570-577. [PMID: 35043559 DOI: 10.1111/ajco.13754] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION People with cancer are at higher risk of serious illness and death from COVID-19 infection. We investigated COVID-19 vaccine uptake among patients with solid organ and blood cancers and explored factors related to hesitancy. METHODS Cross-sectional online survey of adults with a history of cancer at three health services across metropolitan and regional Victoria. Vaccine hesitancy was measured by the validated Oxford COVID-19 vaccine hesitancy scale. RESULTS There were 1073 respondents: 56% female; median age 62 years (range 23 - 91). Commonest tumor types included breast 29%, gastrointestinal 19%, hematological 15%, genitourinary 15%, and lung 8%. Thirty-six percent had metastatic disease, and 54% were receiving active anticancer treatment. Eighty-four percent of respondents indicated positive intent toward COVID-19 vaccination, 10% were undecided, and 6% indicated negative attitudes. At least one vaccine dose had been received by 65% of respondents, leaving 35% unvaccinated. Fifty-eight percent of unvaccinated patients answered that they would "definitely" or "probably" take a vaccine. Higher vaccine uptake was significantly associated with older age, male gender, English as first language, longer time since cancer diagnosis, and not being on current anticancer treatment. Concerns regarding vaccine side effects, particularly thrombosis, and the desire for clear medical advice were prominent among unvaccinated respondents. CONCLUSION Despite being eligible for COVID-19 vaccination since March 2021, a substantial minority of patients with cancer remained unvaccinated as of August 2021. Targeted communication and educational resources addressing vaccine safety in the context of cancer are key to promoting vaccine uptake in this vulnerable population.
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Affiliation(s)
- Mike Nguyen
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Nathan Bain
- Oncology Department, Monash Health, Clayton, Victoria, Australia
| | - Lisa Grech
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Tammie Choi
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Sam Harris
- Bendigo Health, Bendigo, Victoria, Australia
| | - Hieu Chau
- Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Alastair Kwok
- Oncology Department, Monash Health, Clayton, Victoria, Australia
| | - Janne Williams
- Southern Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Amelia McCartney
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Kate Webber
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Daphne Day
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Eva Segelov
- Oncology Department, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Fiorindi A, Vezzoli M, Doglietto F, Zanin L, Saraceno G, Agosti E, Barbieri A, Bellocchi S, Bernucci C, Bongetta D, Cardia A, Costi E, Egidi M, Fioravanti A, Gasparotti R, Giussani C, Grimod G, Latronico N, Locatelli D, Mardighian D, Nodari G, Poli JC, Rasulo F, Roca E, Sicuri GM, Spena G, Stefini R, Vivaldi O, Zoia C, Calza S, Fontanella MM, Cenzato M. Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy. Acta Neurochir (Wien) 2022; 164:141-150. [PMID: 34694465 PMCID: PMC8542653 DOI: 10.1007/s00701-021-05013-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. METHODS In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017-2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. RESULTS Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The "diagnostic delay" was significantly increased (+ 68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value = 0.030), while "therapeutic delay" did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value = 0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p = 0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed p-values < 0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia. CONCLUSIONS We documented a significantly increased "diagnostic delay" for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was experiencing, the Lombardy regional reorganization model, which allowed centralization of neurosurgical emergencies such as SAHs, avoided a "therapeutic delay" and led to results overall comparable to the control period.
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Affiliation(s)
- Alessandro Fiorindi
- Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy.
| | - Marika Vezzoli
- Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy
| | - Luca Zanin
- Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy
| | - Giorgio Saraceno
- Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy
| | - Edoardo Agosti
- Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy
| | - Antonio Barbieri
- Neurosurgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy
| | | | | | - Daniele Bongetta
- Neurosurgery, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Andrea Cardia
- Neurosurgery, Humanitas Clinical and Research Center-IRRCS, Rozzano, Milan, Italy
| | - Emanuele Costi
- Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marcello Egidi
- Neurosurgery, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy
| | | | | | - Carlo Giussani
- Neurosurgery, San Gerardo Hospital, Monza, Università Milano-Bicocca, Milan, Italy
| | | | - Nicola Latronico
- NeuroAnesthesia and ICU, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy
| | - Davide Locatelli
- Neurosurgery, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Dikran Mardighian
- Neuroradiology, Spedali Civili, University of Brescia, Brescia, Italy
| | | | | | - Frank Rasulo
- NeuroAnesthesia and ICU, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy
| | - Elena Roca
- Neurosurgery, Fondazione Poliambulanza Hospital, Brescia, Italy
| | | | - Giannantonio Spena
- Neurosurgery, ASST Lecco, A. Manzoni Hospital, Lecco, Italy
- Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Oscar Vivaldi
- Neurosurgery, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Cesare Zoia
- Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Calza
- Biostatistics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Neurosurgery, Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, P.le Spedali Civili, 1-25123, Brescia, Italy
| | - Marco Cenzato
- Neurosurgery, Grande Ospedale Metropolitano di Niguarda, Milan, Italy
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Bansal R, Aishwarya A, Rao R, Christy MC, Sen M, Regani H, Bagai P, Reddy VA, Mulay K, Bongoni P, Honavar SG. Impact of COVID-19 nationwide lockdown on retinoblastoma treatment and outcome: A study of 476 eyes of 326 children. Indian J Ophthalmol 2021; 69:2617-2624. [PMID: 34571599 PMCID: PMC8597487 DOI: 10.4103/ijo.ijo_2243_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The novel coronavirus SARS-CoV-2 (COVID-19) and the resultant nationwide lockdown and travel restrictions led to difficulty in providing timely and regular treatment to patients with childhood cancers such as retinoblastoma. This study is aimed at assessing the demography, clinical presentation, treatment strategies, and outcome of treatment defaulters due to the lockdown. Methods Cross-sectional, observational study of retinoblastoma patients at a tertiary care ocular oncology center during the first wave of COVID-19 and the resulting nationwide lockdown. Results Of the 476 eyes of 326 patients undergoing active management with a median age of 57 months (range: 4-214 months), 205 (63%) patients returned for follow-up after a mean delay of 45.8 ± 24.3 weeks (range: 8-80 weeks) and 121 (37%) were defaulters according to the data analyzed till June 30, 2021. Distance of residence was ≥1000 km for 148 patients (46%). In terms of need for active treatment, the number of emergent cases was 2 (<1%), 11 (3%) were urgent, and 313 (96%) were semi-urgent. International classification groups D (n = 107 eyes, 23%) and E (n = 173 eyes, 36%) were in majority, and 13 eyes (4%) and 4 eyes (1%) were at stages 3 and 4, respectively. Prior to lockdown, 86 eyes (18%) had active tumor, which remained unchanged (n = 26, 30%) or worsened (n = 49, 60%) after failure to follow-up. Vision (47%), eye (92%), and life salvage (98%) were achieved by individualized protocol-based management after the patients returned for further management. Five children succumbed to intracranial extension. Conclusion The COVID-19-related nationwide lockdown has deprived retinoblastoma patients of optimal and timely management, leading to prolonged treatment interruptions, delays, permanent default, and death. It is of paramount importance for all the stakeholders to increase awareness, make necessary travel and logistic arrangements, and ensure continuity of care for children with retinoblastoma.
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Affiliation(s)
| | | | - Raksha Rao
- Narayana Nethralaya, Bangalore, Karnataka, India
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