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Su CT, Chen JC, Sussman JB. Virtual care for multiple myeloma in the COVID-19 era: interrupted time series analysis of veterans health administration data. Leuk Lymphoma 2023; 64:1035-1039. [PMID: 36924453 PMCID: PMC10432619 DOI: 10.1080/10428194.2023.2189989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/02/2023] [Accepted: 01/22/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Christopher T. Su
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI
| | - Jason C. Chen
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jeremy B. Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Carmichael J, Seymour F, McIlroy G, Tayabali S, Amerikanou R, Feyler S, Popat R, Pratt G, Parrish C, Ashcroft AJ, Jackson GH, Cook G. Delayed diagnosis resulting in increased disease burden in multiple myeloma: the legacy of the COVID-19 pandemic. Blood Cancer J 2023; 13:38. [PMID: 36922489 PMCID: PMC10015143 DOI: 10.1038/s41408-023-00795-w] [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: 11/04/2022] [Revised: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 03/17/2023] Open
Abstract
The COVID-19 pandemic has had global healthcare impacts, including high mortality from SARS-CoV-2 infection in cancer patients; individuals with multiple myeloma (MM) are especially susceptible to poor outcomes. However, even for MM patients who avoided severe infection, the ramifications of the pandemic have been considerable. The consequences of necessary socio-geographical behavior adaptation, including prolonged shielding and interruptions in delivery of non-pandemic medical services are yet to be fully understood. Using a real-world dataset of 323 consecutive newly diagnosed MM patients in England, we investigated the impact of the COVID-19 pandemic on routes to myeloma diagnosis, disease stage at presentation and relevant clinical outcomes. We demonstrate increasing MM presentations via emergency services and increased rates of bony and extra-medullary disease. Differences were seen in choice of induction therapy and the proportion of eligible patients undertaking autologous stem cell transplantation. Whilst survival was statistically inferior for emergency presentations, significant survival differences have yet to be demonstrated for the entire cohort diagnosed during the pandemic, making extended follow-up critical in this group. This dataset highlights wide-ranging issues facing MM patients consequent of the COVID-19 pandemic, with full impacts for clinicians and policy-makers yet to be elucidated.
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Affiliation(s)
- Jonathan Carmichael
- Leeds Institute of Clinical Trial research & Leeds Cancer Centre, University of Leeds, Leeds, UK
- NIHR Medtech & In Vitro Diagnostics Cooperative (Leeds), Leeds, UK
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Frances Seymour
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Graham McIlroy
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarrah Tayabali
- Dept of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rosie Amerikanou
- Dept of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sylvia Feyler
- Dept of Haematology, Calderdale & Huddersfield Foundation Trust, Huddersfield, UK
| | - Rakesh Popat
- Dept of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Parrish
- Leeds Institute of Clinical Trial research & Leeds Cancer Centre, University of Leeds, Leeds, UK
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - A John Ashcroft
- Dept of Haematology, Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK
| | - Graham H Jackson
- Department of Haematology, Newcastle University, Newcastle, UK
- College of Myeloma (UK), London, UK
| | - Gordon Cook
- Leeds Institute of Clinical Trial research & Leeds Cancer Centre, University of Leeds, Leeds, UK.
- NIHR Medtech & In Vitro Diagnostics Cooperative (Leeds), Leeds, UK.
- Dept of Haematology, Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK.
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3
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Evered J, Andersen L, Foxwell A, Iroegbu C, Whitney C. The impact and implications of virtual supportive cancer care during the COVID-19 pandemic: integrating patient and clinician perspectives. Support Care Cancer 2022; 30:9945-9952. [PMID: 36208318 PMCID: PMC9547569 DOI: 10.1007/s00520-022-07393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
Purpose Many cancer centers made rapid shifts in supportive care delivery modalities at the onset of the COVID-19 pandemic. Improving virtual supportive cancer care requires deeply understanding both patient’s and clinician’s experiences. We aimed to integrate the perspectives of clinicians and patients to describe the transition to virtual supportive cancer care during COVID-19. Methods In clinical-academic partnership between a multi-site cancer care center in the Northeastern USA and a school of nursing, we conducted a study using dimensional analysis method. Theoretical sampling drove recruitment of patients and clinicians who engaged in virtual supportive cancer care from March 15, 2020 to December 15, 2020. In this sub-analysis, we coded the dimensional analysis data from semi-structured interviews using a descriptive approach with inductive conventional content analysis. Results We interviewed 17 clinicians, 18 patients, and 3 care partners about their experiences. We integrate patient and clinician perspectives in four in vivo categories: “When COVID hit,” “Not an IT expert,” “Those little moments,” and “The mothership.” Conclusion The findings uncover shared patient and clinician fears of missing or sub-optimal care at the onset of COVID-19, technological and relational challenges to engaging in care, and the mixed impacts of virtual care on access, convenience, and efficiency. This analysis suggests concrete action items to improve virtual supportive care for patients and clinicians. The findings corroborate the importance of convenience, access, and efficiency as care quality indicators and suggest potential to emphasize the clinician-patient relationship as an additional indicator of care quality.
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Affiliation(s)
- Jane Evered
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine CT, Madison, WI, 53711, USA. .,University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Lucy Andersen
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Anessa Foxwell
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christin Iroegbu
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Clare Whitney
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,Stony Brook University School of Nursing, Stony Brook, NJ, USA
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4
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Neparidze N, Wang R, Zeidan AM, Podoltsev NA, Shallis RM, Ma X, Davidoff AJ, Huntington SF. Changes in multiple myeloma treatment patterns during the early COVID-19 pandemic period. Leukemia 2022; 36:2136-2139. [PMID: 35761025 PMCID: PMC9243711 DOI: 10.1038/s41375-022-01633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Natalia Neparidze
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Amer M Zeidan
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Rory M Shallis
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- National Cancer Institute, NIH, Rockville, MD, USA
| | - Scott F Huntington
- Section of Hematology, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
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Jagannath S, Mikhael J, Nadeem O, Raje N. Digital Health for Patients With Multiple Myeloma: An Unmet Need. JCO Clin Cancer Inform 2021; 5:1096-1105. [PMID: 34735265 DOI: 10.1200/cci.20.00145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Multiple myeloma (MM) is associated with the highest symptom burden and lowest health-related quality of life (HRQoL) among patients with hematologic malignancies. HRQoL in MM is heterogeneous, varying over the course of disease, with the highest burden at diagnosis and relapse. Patients with MM are increasingly being treated with oral maintenance medications at home. As a result, longitudinal monitoring of medication adherence and patient-reported outcomes, including HRQoL, could inform on disease status, therapeutic tolerability, and satisfaction with care. Digital health technologies, including telemedicine, mobile health, and wearable devices, are poised to become an integral part of modern health care, in part due to the surge in telemedicine necessitated by the COVID-19 pandemic. Although the literature has many reports on the use of digital health technologies in other types of cancers, fewer studies report on their application to MM. In the current narrative review, we survey the applications of digital health for MM. Although there is evidence that some are associated with improved health outcomes, challenges exist that must be met to ensure more widespread adoption. These include the need for increased awareness by patients and health care providers, lack of access by the typical older patient with MM, absence of randomized clinical trials, and low integration with current workflows such as electronic health records. Following our summary of technologies that could benefit patients with MM, we end by describing our vision for how they can be integrated into each phase of the patient journey.
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Affiliation(s)
| | - Joseph Mikhael
- Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Phoenix, AZ
| | - Omar Nadeem
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Gupta K, Gandhi S, Mebane A, Singh A, Vishnuvardhan N, Patel E. Cancer patients and COVID-19: Mortality, serious complications, biomarkers, and ways forward. Cancer Treat Res Commun 2020; 26:100285. [PMID: 33360669 PMCID: PMC7832265 DOI: 10.1016/j.ctarc.2020.100285] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has particularly serious consequences for cancer patients, as they are at high risk for severe complications and mortality due to the virus since cancer patients are immunocompromised. Preliminary evidence suggests that patients with hematological, and metastatic malignancies are particularly susceptible to developing severe COVID-19 illness, which leads to poor prognosis. Biomarkers including C-reactive protein and interleukin-6 may be predictors of outcome and, therefore, crucial in assessing COVID-19 illness severity in cancer patients. A patient-specific risk and benefit inventory should be completed, and expert guidelines consulted when deciding to continue or postpone therapeutic interventions. This review presents preliminary evidence of COVID-19 infection and its impact on cancer, as well as discussion of general guidelines for the treatment and management of cancer patients with COVID-19.
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Affiliation(s)
- Kush Gupta
- Kasturba Medical College, Light House Hill Road, Mangalore, KA 575001, India.
| | - Shipra Gandhi
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA.
| | - Alexander Mebane
- Heart, Vascular & Leg Center, 5020 Commerce Dr, Bakersfield, CA, 93309, USA.
| | - Angelica Singh
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
| | - Nivetha Vishnuvardhan
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
| | - Eshan Patel
- NewYork-Presbyterian/Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, 11215 USA.
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Jain A, Ramasamy K. Potential 'significance' of monoclonal gammopathy of 'undetermined significance' during COVID-19 pandemic. Blood Cells Mol Dis 2020; 85:102481. [PMID: 32745940 PMCID: PMC7377999 DOI: 10.1016/j.bcmd.2020.102481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Ankur Jain
- Department of Haematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Karthik Ramasamy
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland; NIHR BRC Blood Theme, Oxford, United Kingdom of Great Britain and Northern Ireland; Oxford Myeloma Centre for Translational Research, United Kingdom of Great Britain and Northern Ireland
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Isidori A, de Leval L, Gergis U, Musto P, Porcu P. Management of Patients With Hematologic Malignancies During the COVID-19 Pandemic: Practical Considerations and Lessons to Be Learned. Front Oncol 2020; 10:1439. [PMID: 32923397 PMCID: PMC7456870 DOI: 10.3389/fonc.2020.01439] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has created unprecedented hurdles to the delivery of care to patients with cancer. Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression and lymphopenia. The first challenge, therefore, is how to continue to deliver effective, curative therapy to vulnerable patients and at the same time avoid exposing them, and their health care teams (HCT), to SARS-CoV-2. An additional challenge is the timely completion of the diagnostic and staging studies required to formulate appropriate treatment plans. Deferred procedures and avoidance of multiple trips to the surgical, diagnostic, and laboratory suites require same day consolidation of all procedures. With laboratory medicine absorbed by the need to deploy large scale COVID-testing, the availability of routine molecular tests is affected. Finally, we are increasingly faced with the challenge of making complex treatment decisions in SARS-CoV-2 positive patients with aggressive but potentially curable blood cancers. When to treat, how to treat, when to wait, how long to wait, how to predict and manage toxicities, and how to avoid compromising cure rates remains unknown. We present an outline of the scientific, medical, and operational challenges posed by the COVID-19 pandemic at selected American and European institutions and offer our current view of the key elements of a response. While the peak of the pandemic may be past us, in the absence of a vaccine risks remain, and our alertness and response to future challenges need to be refined and consolidated.
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Affiliation(s)
- Alessandro Isidori
- Hematology and Stem Cell Transplant Center, AORMN Hospital, Pesaro, Italy
| | - Laurence de Leval
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Usama Gergis
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, Department of Emergency and Organ Transplantation, “Aldo Moro” University School of Medicine, AOU Consorziale Policlinico, Bari, Italy
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
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