1
|
Raman KS, Ninomiya MM, Bovill ES, Doherty C, Macadam SA, Laeken NV, Isaac KV. Temporal Sequencing of Multimodal Treatment in Immediate Breast Reconstruction and Implications for Wait Times: A Regional Canadian Cross-Sectional Study. Plast Surg (Oakv) 2023. [DOI: 10.1177/22925503231152261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Introduction: Treatment of breast cancer requires a multimodal approach with numerous independent specialists. Immediate breast reconstruction (IBR) adds another layer of coordination to comprehensive breast cancer care. To optimize health outcomes for patients seeking IBR, it is essential to efficiently coordinate the temporal sequence of care modalities inclusive of reconstruction. Methods: In this cross-sectional study, patients undergoing IBR following complete or partial mastectomy at one health centre from 2015 to 2021 were included. Patients were categorized into two main groups defined by the first treatment modality received, namely surgery first and Neoadjuvant Chemotherapy. Primary outcome measures were wait times for diagnostic investigations, initiation of treatment, and transitions between therapeutic modalities. Results: Of 195 patients, 158 underwent surgery first, and 37 underwent neoadjuvant chemotherapy. Median wait time from first consultation to first treatment initiated in the neoadjuvant cohort was shorter by 11.5 days as compared to the Surgery First cohort (21.5 +/− 19 vs 33.0 +/− 28 days; P = 0.001). Twenty-three (82%) of the surgery first and 11 (38%) of the neoadjuvant cohort patients waited longer than 8 weeks for initiation of radiotherapy ( P = 0.001). Following surgical intervention, the majority of patients failed to meet target benchmarks for transition to chemotherapy ( n = 25, 53%) and transition to radiotherapy ( n = 26, 93%; P < 0.001). Conclusion: Patients undergoing IBR may incur delays in the setting of upfront surgery and in transitioning to adjuvant therapies. In the setting of breast reconstruction, further efforts are required to achieve target wait-times in multimodal breast cancer care.
Collapse
Affiliation(s)
- Karanvir S. Raman
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maya Morton Ninomiya
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esta S. Bovill
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheina A. Macadam
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Van Laeken
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn V. Isaac
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Ewart E, Barton A, Chen L, Cuthbert R, Toplak K, Burrows A. Assurance of Timely Access to Breast Cancer Diagnosis and Treatment by a Regional Breast Health Clinic Serving Both Urban and Rural-Remote Communities. Curr Oncol 2023; 30:1232-1242. [PMID: 36661744 PMCID: PMC9858490 DOI: 10.3390/curroncol30010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
In response to breast cancer diagnostic regional wait times exceeding both national and provincial standards and to symptomatic patient referrals for diagnostic mammography taking longer than abnormal screening mammography referrals, the Rae Fawcett Breast Health Clinic (RFBHC) was opened in 2017 in a mid-sized Canadian hospital serving both urban and rural-remote communities. We investigated whether the RFBHC improved wait times to breast cancer diagnosis, improved compliance with national and provincial breast cancer standards, and decreased the wait time disparity associated with referral source. Statistical analyses of wait time differences were conducted between patients who were diagnosed with breast cancer prior to and after the RFBHC establishment. Study group compliance with national and provincial standards and wait time differences by referral source were also analysed. A survey was administered to assess overall patient experience with the RFBHC and clinic wait times. RFBHC patients had a shorter mean wait to breast cancer diagnosis (24.4 vs. 45.7 days, p ≤ 0.001) and a shorter mean wait to initial breast cancer treatment (49.1 vs. 78.9 days, p ≤ 0.001) than pre-RFBHC patients. After the RFBHC establishment, patients who attended the RFBHC had a shorter mean wait time to breast cancer diagnosis (24.4 vs. 36.9 days, p = 0.005) and to initial treatment (49.1 vs. 73.1 days, p ≤ 0.001) than patients who did not attend the clinic. Compliance with national and provincial breast cancer standards improved after the RFBHC establishment and the wait time disparity between screening mammography referrals and symptomatic patient referrals decreased. Survey results indicate that the RFBHC is meeting patient expectations. We concluded that the establishment of a breast health clinic in a Canadian center serving urban and rural-remote communities improved breast diagnostic services.
Collapse
Affiliation(s)
| | | | | | - Ross Cuthbert
- Department of Surgery, The University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC V5Z 1M9, Canada
| | | | | |
Collapse
|
3
|
Sung N, Muthusamy A, Finn N, Stuart E, Fox J, Yeo B. Surgical management of breast cancer in Victoria: A state‐wide audit. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Nakjun Sung
- Melbourne Medical School University of Melbourne Melbourne Victoria Australia
| | - Arun Muthusamy
- Olivia Newton‐John Cancer Wellness and Research Centre Austin Health Melbourne Victoria Australia
| | - Norah Finn
- Cancer Council Victoria Melbourne Victoria Australia
- Department of Health Melbourne Victoria Australia
| | - Ella Stuart
- Cancer Council Victoria Melbourne Victoria Australia
- Department of Health Melbourne Victoria Australia
| | - Jane Fox
- Department of Breast Services Monash Health Melbourne Victoria Australia
| | - Belinda Yeo
- Olivia Newton‐John Cancer Wellness and Research Centre Austin Health Melbourne Victoria Australia
| |
Collapse
|
4
|
Kara H, Arikan AE, Dulgeroglu O, Tutar B, Tokat F, Uras C. Has the COVID-19 Pandemic Affected Breast Cancer Stage and Surgical Volume? Front Surg 2022; 9:811108. [PMID: 35198597 PMCID: PMC8859320 DOI: 10.3389/fsurg.2022.811108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute. Methods Data of 332 patients who were diagnosed and treated for breast cancer between December 2019 and November 2020 were evaluated retrospectively according to periods of pandemic. Results A significant decrease in the number of operations, especially upfront surgeries rather than surgeries after neoadjuvant chemotherapy, was detected in the early period of the COVID-19 pandemic. It was found that patients with complaints were mostly admitted during this period (p = 0.024). No statistical significance was found for age, sex, side of the tumor, type of tumor, surgery to breast, and axilla. Following the early period of the pandemic, it was observed that patients with mostly luminal, early-stage, and less axillary nodal involvement (p < 0.05) were admitted, and as a result, it was founded that upfront surgeries increased, although no change in TNM staging was observed. However, it did affect the decision of initial treatment. Thus, the number of upfront surgeries was significantly higher than the NCT group (p = 0.027) following the early period. Conclusion Surgical volume is significantly affected in the early period of the COVID-19 pandemic. To overcome overload due to delayed surgeries related to pandemics, some hospitals should be spared for oncological treatments. Following the early period, mostly luminal type, early-stage patients were admitted, probably because of increased self-awareness and short wave duration, but the breast cancer stage was not affected.
Collapse
Affiliation(s)
- Halil Kara
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Akif Enes Arikan
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- *Correspondence: Akif Enes Arikan
| | - Onur Dulgeroglu
- Vocational School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Burcin Tutar
- Department of Radiology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Fatma Tokat
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of Pathology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cihan Uras
- Department of General Senology, Research Institute of Senology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| |
Collapse
|
5
|
Chen R, Yang J, Zhao X, Fu Z, Wang Z, Qiu C, Wu Y, Yang R, Liu W, Huang Y, Chen J. Pattern of Time-to-Surgery in Patients With Breast Cancer at Different Stages of the COVID-19 Pandemic. Front Oncol 2022; 11:820638. [PMID: 35096625 PMCID: PMC8790243 DOI: 10.3389/fonc.2021.820638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background The management of cancer surgeries is under unprecedented challenges during the COVID-19 pandemic, and the breast cancer patients may face a time-delay in the treatment. This retrospective study aimed to present the pattern of time-to-surgery (TTS) and analyze the features of breast cancer patients under the different stages of the COVID-19 pandemic. Methods Patients who received surgeries for breast cancers at West China Hospital between February 15, 2020 and April 30, 2020 (the outbreak and post-peak stages), and between March 10, 2021 and May 25, 2021 (the normalization stage) were included. TTS was calculated as the time interval between the pathological diagnosis and surgical treatment of breast cancer patients. And the pandemic was divided into three stages based on the time when the patients were pathologically diagnosed and the severity of pandemic at that time point. TTS, demographic and clinicopathological features were collected from medical records. Results A total of 367 patients were included. As for demographic features, it demonstrated statistically significant differences in insurance type (p<0.001) and regular screening (p<0.001), as well as age (p=0.013) and menstrual status (p=0.004). As for clinicopathological features, axillary involvement (p=0.019) was a factor that differed among three stages. The overall TTS was 23.56 ± 21.39 days. TTS for patients who were diagnosed during the outbreak of COVID-19 were longer than those diagnosed during pandemic post-peak and normalization stage (p<0.001). Pandemic stage (p<0.001) and excision biopsy before surgery (OR, 6.459; 95% CI, 2.225-18.755; p=0.001) were markedly correlated with the TTS of patients. Conclusions TTS of breast cancer patients significantly varied in different stages of the COVID-19 pandemic. And breast cancer patients’ daily lives and disease treatments were affected by the pandemic in many aspects, such as health insurance access, physical screening and change of therapeutic schedules. As the time-delay may cause negative influences on patients’ disease, we should minimize the occurrence of such time-delay. It is vital to come up with comprehensive measures to deal with unexpected situations in case the pandemic occurs.
Collapse
Affiliation(s)
- Ruixian Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiqiao Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Zhao
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhoukai Fu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhu Wang
- Laboratory of Molecular Diagnosis of Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhao Wu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoning Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weijing Liu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ya Huang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Cui X. The Prevalence and Death Risk of Male Breast Cancer: A Study Based on the Surveillance, Epidemiology, and End Results Database. Am J Mens Health 2022; 16:15579883221074818. [PMID: 35094596 PMCID: PMC8808035 DOI: 10.1177/15579883221074818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was to investigate the prevalence and death risk of male breast cancer (MBC) patients. The prevalence trend was based on the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017. A competitive risk analysis was performed to analyze the death risk of MBC patients. Hazard ratio (HR) and 95% confidence intervals (CIs) were calculated. The results indicated that the prevalence of MBC after the standardization of the total population increased in 1975–2017 and its annual percentage change (APC) was 0.536% (95% CI = [0.362%, 0.713%]). The prevalence of MBC was rapidly increased in patients aged ≥70 years (APC = 0.780%; 95% CI = [0.491%, 1.076%]) and Grade Ⅱ tumors (APC = 1.462%; 95% CI = [1.260%, 1.686%]). The 1-, 3-, and 5-year cumulative mortality of MBC patients who died of MBC was 2.23% (95% CI = [1.61%, 2.85%]), 7.56% (95% CI = [6.33%, 8.78%]), and 13.10% (95% CI = [11.10%, 11.32%]), respectively. Competitive risk analysis demonstrated that Blacks (HR = 1.76; 95% CI = [1.12, 2.77]), Grade 3 (HR = 2.56; 95% CI = [1.03, 6.35]), AJCC (American Joint Committee on Cancer) Stage Ⅲ (HR = 3.04; 95% CI = [1.76, 5.26]), and AJCC Stage Ⅳ (HR = 7.27; 95% CI = [1.36, 38.83]) were associated with an increased MBC-specific death risk, whereas married status (HR = 0.40; 95% CI = [0.25, 0.64]), surgery (HR = 0.25; 95% CI = [0.12, 0.50]), Luminal A subtype (HR = 0.20; 95% CI = [0.07, 0.53]), and Luminal B subtype (HR = 0.29; 95% CI = [0.10, 0.87]) were related to a reduced MBC-specific death risk. In addition, similar results can be observed in patients with surgery recommended and done (p < .05). This study may provide evidence for the prevalence trend, cumulative mortality, and death risk of MBC patients.
Collapse
Affiliation(s)
- Xiaofei Cui
- Department of Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China.,Molecular Oncology Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| |
Collapse
|
7
|
Su Y, Zheng X, Ouyang Z. The Relationship between Time to Surgery (TTS) and Survival in Breast Cancer: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1773-1782. [PMID: 34722372 PMCID: PMC8542807 DOI: 10.18502/ijph.v50i9.7048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/20/2021] [Indexed: 01/10/2023]
Abstract
Background: Curative operation is the practical and primary therapy for masses of breast cancers. In contrast, the correlation between the time interval from breast cancer diagnosis to curative surgery and survival is still uncertain. Methods: An electronic literature search was conducted on PubMed/Medline and EMBASE (between Jan 2000 and Jan 2020). Primary endpoints were overall survival (OS) or Disease-Free Survival (DFS). The HR with 95% confidence intervals were calculated using a random-effects or fixed-effects model. Results: The combined HR for OS was 1. 10 (95% CI 1. 08–1. 11; P=0. 000) by fixed-effects model, no statistically significant heterogeneity was found (P=1. 000; I2=0%), and this difference was statistically significant (Z=11. 99; P=0. 000). Conclusion: This meta-analysis showed a significant adverse association between more prolonged time to surgery (TTS) and lower overall survival in patients with breast cancer. It is reasonable to minimize that interval between diagnosis and curative surgery.
Collapse
Affiliation(s)
- Yongcheng Su
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen Fujian 361003, China
| | - Xiaogang Zheng
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen Fujian 361003, China
| | - Zhong Ouyang
- Department of Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen Fujian 361003, China
| |
Collapse
|
8
|
Eijkelboom AH, de Munck L, Vrancken Peeters MJTFD, Broeders MJM, Strobbe LJA, Bos MEMM, Schmidt MK, Guerrero Paez C, Smidt ML, Bessems M, Verloop J, Linn S, Lobbes MBI, Honkoop AH, van den Bongard DHJG, Westenend PJ, Wesseling J, Menke-van der Houven van Oordt CW, Tjan-Heijnen VCG, Siesling S. Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study. J Hematol Oncol 2021; 14:64. [PMID: 33865430 PMCID: PMC8052935 DOI: 10.1186/s13045-021-01073-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. METHODS Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2-17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. RESULTS Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease (p < 0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR]wks2-8: 2.04, ORwks9-11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (ORwks12-13: 0.52) or by breast conserving surgery (ORwks14-17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (ORwks9-11: 0.59, ORwks12-13: 0.66), but more likely for those diagnosed at the end (ORwks14-17: 1.31). Primary hormonal treatment was more common (ORwks2-8: 1.23, ORwks9-11: 1.92, ORwks12-13: 3.01). Only women diagnosed in weeks 2-8 of 2020 experienced treatment delays. CONCLUSION The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.
Collapse
Affiliation(s)
- Anouk H Eijkelboom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538 SW, Nijmegen, The Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Monique E M M Bos
- Department of Medical Oncology, Erasmus Medical Centre Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Cristina Guerrero Paez
- Dutch Breast Cancer Society (BVN), Godebaldkwartier 363, 3511 DT, Utrecht, The Netherlands
| | - Marjolein L Smidt
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- GROW School for Oncology and Development Biology, Maastricht University, Univeristeitssingel 40, 6220 ER, Maastricht, the Netherlands
| | - Maud Bessems
- Department of Surgery, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Janneke Verloop
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Sabine Linn
- Division of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marc B I Lobbes
- GROW School for Oncology and Development Biology, Maastricht University, Univeristeitssingel 40, 6220 ER, Maastricht, the Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Dr. H. van der Hoffplein 1, 6162 BG, Geleen, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | | | - Pieter J Westenend
- Laboratory of Pathology, Karel Lotsyweg 145, 3318 AL, Dordrecht, The Netherlands
| | - Jelle Wesseling
- Division of Diagnostic Oncology and Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - C Willemien Menke-van der Houven van Oordt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
| |
Collapse
|
9
|
Alcaide Lucena M, Martínez Martínez C, Rodríguez González CJ, Ayala Carbonero G, Bosquet Daza A, Legerén Álvarez M, de Reyes Lartategui S. Consecuencias de la pandemia COVID-19 en la unidad de patología mamaria en un hospital de segundo nivel. Nuestra experiencia. REVISTA DE SENOLOGÍA Y PATOLOGÍA MAMARIA 2021. [PMCID: PMC7505591 DOI: 10.1016/j.senol.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introducción La pandemia por COVID-19 ha modificado nuestra actividad asistencial habitual en los últimos meses. Debido al colapso hospitalario se han suspendido consultas, pruebas diagnósticas e intervenciones quirúrgicas, con el objetivo también de reducir la exposición de pacientes al SARS-CoV-2 en el medio hospitalario. Sin embargo, esto ha provocado un retraso en la atención de otros problemas sanitarios. Material y métodos Analizamos y comparamos los datos de la Unidad de Mama en un hospital de segundo nivel, en cuanto a la actividad del Programa de Diagnóstico Precoz de Cáncer de Mama (PDPCM), los diagnósticos de cáncer realizados, así como las pacientes intervenidas durante los meses de marzo a mayo de 2020, con respecto al mismo período del año anterior. Resultados El número de pacientes atendidas en el PDPCM en los meses de marzo a mayo de 2020 se ha reducido en un 91,7%, y las pacientes atendidas en el Servicio de Radiodiagnóstico del hospital en un 54,2%. La actividad quirúrgica también se ha visto mermada en un 57,69% con respecto al mismo periodo del año anterior. Conclusiones La disminución de la actividad del PDPCM y Radiología conllevan a un retraso diagnóstico que concluirá con un aumento de lista de espera y demora en el tratamiento, lo que posiblemente derive en un diagnóstico en estadios más avanzados de la enfermedad.
Collapse
|
10
|
Johnson BA, Waddimba AC, Ogola GO, Fleshman JW, Preskitt JT. A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic. Am J Surg 2020; 222:311-318. [PMID: 33317814 PMCID: PMC7834494 DOI: 10.1016/j.amjsurg.2020.12.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
Background Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers. Methods PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included. Results Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28–1.65), lung (HR 1.04, 95%CI 1.02–1.06) and colon (HR 1.24, 95%CI 1.12–1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16–1.40) and II (HR 1.13, 95%CI 1.02–1.24) but not in stage III (HR 1.20, 95%CI 0.94–1.53). Conclusion Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival. Delaying cancer surgeries during the COVID-19 pandemic may impact survival. Surgical delays of 12 weeks decreases survival in breast, lung and colon cancers. Surgical delays worsen survival in stage I and II breast cancers but not stage III. Triage recommendations for future waves of COVID-19 should consider this evidence.
Collapse
Affiliation(s)
- Brett A Johnson
- College of Medicine, Texas A&M Health Science Center, Dallas Campus, Texas, United States; Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - Anthony C Waddimba
- Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States; Baylor Scott and White Research Institute, Dallas, TX, United States.
| | - Gerald O Ogola
- Baylor Scott and White Research Institute, Dallas, TX, United States; Biostatistics, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - James W Fleshman
- Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - John T Preskitt
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| |
Collapse
|
11
|
Ak N, Vatansever S. "Door to Treatment" Outcomes of Cancer Patients during the COVID-19 Pandemic. Chemotherapy 2020; 65:141-146. [PMID: 33279902 PMCID: PMC7801967 DOI: 10.1159/000511884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/27/2020] [Indexed: 11/19/2022]
Abstract
Background The novel coronavirus disease 2019 has become a worldwide threat. We aimed to explore reflections of these unexpected changes to newly diagnosed cancer patients. Method We searched the 2 months after the index case of our country. The first admission day and the first day of intravenous treatment of newly diagnosed patients were recorded. Results In the 60 days measured during the pandemic, the total number of patients on polyclinics was 159/weekdays, and the total applied chemotherapy cycles were 276/week. For comparison, the total numbers in the previous year were 267/weekday and 363/week for polyclinic and applied chemotherapy cycles, respectively. The total number of newly admitted patients in 2020 was 283. For comparison, the number of new patients in the same 60-day period in 2019 was 495. Patients who were admitted for adjuvant treatment required a median of 8 days for the first course, those who were admitted for neoadjuvant treatment required 12 days, and metastatic patients required 14 days; there were no significant differences between treatment types (p = 0.233). However, the median treatment time was 11.5 and 17 days, in 2020 and in 2019, respectively. A significant difference was observed between the 2 groups (p < 0.001). Conclusion The effective shift of workers and accurate regulations have not resulted in apparent delays in patient care. While a decrease in the number of patients has detected, faster healthcare service was introduced to newly diagnosed patients. The reason for the decrease in the number of patients should be investigated with new studies.
Collapse
Affiliation(s)
- Naziye Ak
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey, .,Department of Internal Medicine, Division of Medical Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Sezai Vatansever
- Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.,Department of Internal Medicine, Division of Medical Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
12
|
Helissey C, Cessot A, Boudin L, Romeo E, Prieux C, Ghebriou D, Schernberg A, Grellier N, Joly C, Bauduceau O, Thibault C, Mamou E, Raynal G, Serey Eiffel S, Le Floch H, Ricard D, Brureau L. Evaluation of medical practices in oncology in the context of the COVID-19 pandemic in France: Physicians' point of view: the PRATICOVID study. Cancer Med 2020; 9:8875-8883. [PMID: 33022134 PMCID: PMC7675575 DOI: 10.1002/cam4.3503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023] Open
Abstract
The cancer population seems to be more susceptible to COVID‐19 infection and have worse outcomes. We had to adapt our medical practice to protect our patients without compromising their cancer prognosis. The national PRATICOVID study aims to describe the adaptation of cancer patient care for this population. We analyzed data from nine different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic. The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic. We analyzed 435 medical procedures between 9th of March and 30th of April. Because of the COVID‐19 pandemic, 47.6% of the outpatients received modified patient care. Twenty‐four percent of scheduled surgeries were postponed, or were performed without perioperative chemotherapy, 18.4% followed a hypofractioned schedule, and 57% had an adaptive systemic protocol (stopped, oral protocol, and spacing between treatments). Seventy percent of physicians used telemedicine. During this period, 67% of the physicians did not feel distressed taking care of their patients. However, 70% of physicians are worried about the aftermath of the lockdown, as regards future patient care. The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care. But physicians are worried about the aftereffects of the lockdown specifically in regard to care pathway issues.
Collapse
Affiliation(s)
- Carole Helissey
- Clinical Research unit, Military Hospital Begin, Saint-Mandé, France
| | - Anatole Cessot
- Department of Medical oncology, Clinique HARTMANN, Neuilly-sur-Seine, France
| | - Laurys Boudin
- Department of Medical oncology, Military Hospital Sainte-Anne, Toulon, France
| | - Emile Romeo
- Department of Medical oncology, Military Hospital Sainte-Anne, Toulon, France
| | - Caroline Prieux
- Department of Gastroenterology, Military Hospital Percy, Clamart, France
| | - Djamel Ghebriou
- Department of Oncology, Tenon University Hospital, Institut Universitaire de Cancérologie AP-HP. Sorbonne Université, Paris, France
| | | | - Noemie Grellier
- Department of Radiation oncology, Hôpital Henri Mondor, Créteil, France
| | - Charlotte Joly
- Department of Medical Oncology, Hôpital Henri Mondor, Créteil, France
| | - Olivier Bauduceau
- Department of Radiation Oncology, Clinique HARTMANN, Neuilly-sur-Seine, France
| | | | - Elodie Mamou
- Clinical Research unit, Military Hospital Begin, Saint-Mandé, France
| | - Gauthier Raynal
- Department of Urology, Clinque Métivet, Saint-Maur-des Fossés, France
| | | | - Hervé Le Floch
- Department of Pulmonology, Military Hospital Percy, Clamart, France
| | - Damien Ricard
- Department of Neurology, Military Hospital Percy, Clamart, France
| | - Laurent Brureau
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR-S 1085, Pointe-à-Pitre, France
| |
Collapse
|
13
|
Jafari A, Rezaei-Tavirani M, Karami S, Yazdani M, Zali H, Jafari Z. Cancer Care Management During the COVID-19 Pandemic. Risk Manag Healthc Policy 2020; 13:1711-1721. [PMID: 33061705 PMCID: PMC7520144 DOI: 10.2147/rmhp.s261357] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023] Open
Abstract
New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing around the world. Currently, health care services are mainly focused on responding to and controlling the unique challenges of the coronavirus disease 2019 (COVID-19) pandemic. These changes, along with the higher susceptibility of patients with cancer to infections, have profound effects on other critical aspects of care and pose a serious challenge for the treatment of such patients. During the COVID-19 pandemic, it is important to provide strategies for managing the treatment of patients with cancer to limit COVID-19-associated risks at this difficult time. The present study set out to summarize the latest research on epidemiology, pathogenesis, and clinical features of COVID-19. We also address some of the current challenges associated with the management of patients with cancer during the COVID-19 pandemic and provide practical guidance to clinically deal with these challenges.
Collapse
Affiliation(s)
- Ameneh Jafari
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Samira Karami
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Yazdani
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Hakimeh Zali
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Jafari
- 9Dey Manzariye Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
14
|
Tsang-Wright F, Tasoulis MK, Roche N, MacNeill F. Breast cancer surgery after the COVID-19 pandemic. Future Oncol 2020; 16:2687-2690. [PMID: 32815421 PMCID: PMC7439762 DOI: 10.2217/fon-2020-0619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Fiona Tsang-Wright
- Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust, Queen Alexandra Road, High Wycombe, HP11 2TT, UK
| | | | - Nicola Roche
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK
| | - Fiona MacNeill
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, SW3 6JJ, London, UK
| |
Collapse
|
15
|
Xu J, Bromley L, Chew G, Yeo B. "First Do No Harm": Significance of Delays from Diagnosis to Surgery in Patients with Non-metastatic Breast Cancer. World J Surg 2020; 44:3812-3820. [PMID: 32776194 DOI: 10.1007/s00268-020-05725-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The majority of patients with non-metastatic breast cancer will undergo surgery. This involves complex decisions that inevitably increase time from diagnosis to surgery beyond the currently recommended 30 days. This study aims to analyse factors that increase time to surgery and establish whether it is justifiable in the context of improved individualised breast cancer management. METHODS A retrospective analysis of all patients at Austin Health surgically managed for non-metastatic invasive breast carcinoma between 2013 and 2019 was conducted. Time to surgery (TTS) was defined as time between informed diagnosis and cancer surgery. The patients were grouped into TTS groups of ≤30 days and >30 days. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to evaluate the impact of time interval between diagnosis and surgery. RESULTS Seven hundred and thirty-one patients were included in our TTS analysis, only half of this cohort received surgery within the recommended 30 days. Many of the factors identified to be associated with increased TTS are the key to optimal management. Median follow-up for the cohort was 30 months. Between wait groups of ≤30 and >30 days, there were no significant association found between TTS and survival outcomes for DFS (HR 1.20 95% CI 0.56-2.60) and OS (HR 1.58 95% CI 0.82-3.03). CONCLUSION Breast cancer management involves complex factors that significantly increase TTS. Surgery within 30 days of diagnosis is not associated with improved DFS and OS. Outcomes from this study support a revision of current recommendations for TTS in non-metastatic breast cancer care.
Collapse
Affiliation(s)
- Jennifer Xu
- University of Melbourne, Parkville, VIC, 3010, Australia. .,Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
| | - Luke Bromley
- University of Melbourne, Parkville, VIC, 3010, Australia
| | - Grace Chew
- Department of Surgery, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Department of Surgery, Northern Health, 185 Cooper St, Epping, VIC, 3076, Australia.,St Vincent's BreastScreen, 41 Victoria Pde, Fitzroy, VIC, 3065, Australia
| | - Belinda Yeo
- Department of Medical Oncology, Olivia Newton John Cancer Research Institute, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Department of Medical Oncology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, VIC, 3086, Australia
| |
Collapse
|
16
|
Adapting care for older cancer patients during the COVID-19 pandemic: Recommendations from the International Society of Geriatric Oncology (SIOG) COVID-19 Working Group. J Geriatr Oncol 2020; 11:1190-1198. [PMID: 32709495 PMCID: PMC7365054 DOI: 10.1016/j.jgo.2020.07.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/10/2020] [Indexed: 12/25/2022]
Abstract
The COVID-19 pandemic poses a barrier to equal and evidence-based management of cancer in older adults. The International Society of Geriatric Oncology (SIOG) formed a panel of experts to develop consensus recommendations on the implications of the pandemic on several aspects of cancer care in this age group including geriatric assessment (GA), surgery, radiotherapy, systemic treatment, palliative care and research. Age and cancer diagnosis are significant predictors of adverse outcomes of the COVID-19 infection. In this setting, GA is particularly valuable to drive decision-making. GA may aid estimating physiologic reserve and adaptive capability, assessing risk-benefits of either providing or temporarily withholding treatments, and determining patient preferences to help inform treatment decisions. In a resource-constrained setting, geriatric screening tools may be administered remotely to identify patients requiring comprehensive GA. Tele-health is also crucial to ensure adequate continuity of care and minimize the risk of infection exposure. In general, therapeutic decisions should favor the most effective and least invasive approach with the lowest risk of adverse outcomes. In selected cases, this might require deferring or omitting surgery, radiotherapy or systemic treatments especially where benefits are marginal and alternative safe therapeutic options are available. Ongoing research is necessary to expand knowledge of the management of cancer in older adults. However, the pandemic presents a significant barrier and efforts should be made to ensure equitable access to clinical trials and prospective data collection to elucidate the outcomes of COVID-19 in this population.
Collapse
|
17
|
Garcia D, Siegel JB, Mahvi DA, Zhang B, Mahvi DM, Camp ER, Graybill W, Savage SJ, Giordano A, Giordano S, Carneiro-Pla D, Javid M, Lesher AP, Abbott A, DeMore NK. What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer. ACTA ACUST UNITED AC 2020; 3:1-11. [PMID: 34142081 PMCID: PMC8208646 DOI: 10.31487/j.cor.2020.06.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The impact of the COVID-19 pandemic has spread beyond those infected with SARS-CoV-2. Its widespread consequences have affected cancer patients whose surgeries may be delayed in order to minimize exposure and conserve resources. Methods Experts in each surgical oncology subspecialty were selected to perform a review of the relevant literature. Articles were obtained through PubMed searches in each cancer subtype using the following terms: delay to surgery, time to surgery, outcomes, and survival. Results Delays in surgery > 4 weeks in breast cancer, ductal carcinoma in situ, T1 pancreatic cancer, ovarian cancer, and pediatric osteosarcoma, negatively impacted survival. Studies on hepatocellular cancer, colon cancer, and melanoma (Stage I) demonstrated reduced survival with delays > 3 months. Conclusion Studies have shown that short-term surgical delays can result in negative impacts on patient outcomes in multiple cancer types as well as in situ carcinoma. Conversely, other cancers such as gastric cancer, advanced melanoma and pancreatic cancer, well-differentiated thyroid cancer, and several genitourinary cancers demonstrated no significant outcome differences with surgical delays.
Collapse
Affiliation(s)
- Denise Garcia
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julie B Siegel
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Mahvi
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - Biqi Zhang
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - David M Mahvi
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - E Ramsay Camp
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Whitney Graybill
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Antonio Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise Carneiro-Pla
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mahsa Javid
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aaron P Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea Abbott
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nancy Klauber DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
18
|
Al‐Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, Wolff RA, Ibrahim NK, Chua ML, Hotte SJ, Meyers BM, Elfiki T, Curigliano G, Eng C, Grothey A, Xie C. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist 2020; 25:e936-e945. [PMID: 32243668 PMCID: PMC7288661 DOI: 10.1634/theoncologist.2020-0213] [Citation(s) in RCA: 431] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.
Collapse
Affiliation(s)
- Humaid O. Al‐Shamsi
- Medical Oncology Department, Alzahra Hospital DubaiDubaiUnited Arab Emirates
- Department of Medicine, University of SharjahSharjahUnited Arab Emirates
- Emirates Oncology SocietyDubaiUnited Arab Emirates
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, Medicine, McMaster UniversityHamiltonOntarioCanada
- Medicine, McMaster UniversityHamiltonOntarioCanada
| | - Ahmad Alhuraiji
- Department of Hematology, Kuwait Cancer Control CenterKuwait
| | - Eric A. Coomes
- Division of Infectious Disease, Department of Medicine, University of TorontoTorontoOntarioCanada
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Robert A. Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Nuhad K. Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Melvin L.K. Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Center SingaporeSingapore
- Oncology Academic Program, Duke‐NUS Medical SchoolSingapore
- Cong Hua's InstituteSingapore
| | - Sebastien J. Hotte
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Brandon M. Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Tarek Elfiki
- Windsor Regional Cancer CenterWindsorOntarioCanada
- Department of Oncology, Schulich School of Medicine, University of Western OntarioLondonOntarioCanada
| | - Giuseppe Curigliano
- Department of Oncology and Hemato‐Oncology University of MilanMilanItaly
- Division of Early Drug Development for Innovative Therapy, University of MilanMilanItaly
- European Institute of OncologyMilanItaly
- IRCCS, University of MilanoMilanItaly
| | - Cathy Eng
- Vanderbilt‐Ingram Cancer CenterNashvilleTennesseeUSA
| | - Axel Grothey
- West Cancer Center, University of TennesseeMemphisTennesseeUSA
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan UniversityWuhanPeople's Republic of China
| |
Collapse
|
19
|
Abstract
Purpose of Review The outbreak of the novel coronavirus disease 2019 (COVID-19) has emerged to be the biggest global health threat worldwide, which has now infected over 1.7 million people and claimed more than 100,000 lives around the world. Under these unprecedented circumstances, there are no well-established guidelines for cancer patients. Recent Findings The risk for serious disease and death in COVID-19 cases increases with advancing age and presence of comorbid health conditions. Since the emergence of the first case in Wuhan, China, in December 2019, tremendous research efforts have been underway to understand the mechanisms of infectivity and transmissibility of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a fatal virus responsible for abysmal survival outcomes. To minimize the mortality rate, it becomes prudent to identify symptoms promptly and employ treatments appropriately. Even though no cure has been established, multiple clinical trials are underway to determine the most optimal strategy. Managing cancer patients under these circumstances is rather challenging, given their vulnerable status and the aggressive nature of their underlying disease. Summary In this comprehensive review, we discuss the impact of COVID-19 on health and the immune system of those affected, reviewing the latest treatment approaches and ongoing clinical trials. Additionally, we discuss challenges faced while treating cancer patients and propose potential approaches to manage this vulnerable population during this pandemic.
Collapse
|
20
|
Salgarello M, Adesi LB, Visconti G, Pagliara DM, Mangialardi ML. Considerations for performing immediate breast reconstruction during the COVID-19 pandemic. Breast J 2020; 26:1485-1487. [PMID: 32383321 PMCID: PMC7267344 DOI: 10.1111/tbj.13876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Marzia Salgarello
- Unità di Chirurgia Plastica, Dipartimento Scienza della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Liliana Barone Adesi
- Unità di Chirurgia Plastica, Dipartimento Scienza della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giuseppe Visconti
- Unità di Chirurgia Plastica, Dipartimento Scienza della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Domenico Maria Pagliara
- Mater Olbia Hospital, Olbia, Italy.,Departement of Plastic Surgery Catholic, University of Rome "Agostino Gemelli", Rome, Italy
| | - Maria Lucia Mangialardi
- Unità di Chirurgia Plastica, Dipartimento Scienza della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
21
|
Abstract
We are facing a pandemic that is going to affect a significant part of the population. At the end of April in the world there are about 3,000,000 cases, with 205,000 deaths and 860,000 patients recovered. The response to this pandemic has in many cases led to a significant change in the daily work of caring for cancer patients, the good results of which depend largely on time-adjusted protocols and multidisciplinary treatments. We present a review of local, surgical and radiotherapy treatment together with authors’ recommendations made from personal experience on ways to act in the diagnosis and surgical treatment of breast cancer during the COVID-19 pandemic. The multidisciplinary Breast Committees must continue to meet weekly in videoconference format. All surgical actions and irradiations must be carried out with maximum safety for both the patients and the participating teams. Hypofractionation in radiation therapy should be the standard treatment. Sometimes it is recommended to apply a primary systemic treatment or even a primary irradiation. Great coordination between the surgical and oncology teams, both medical and radiotherapeutic, is essential.
Collapse
|
22
|
Male breast cancer: a closer look at patient and tumor characteristics and factors that affect survival using the National Cancer Database. Breast Cancer Res Treat 2020; 180:471-479. [PMID: 32040687 DOI: 10.1007/s10549-020-05556-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To comprehensively describe the tumor and clinical characteristics of breast cancer in a cohort of male patients and to assess the factors that affect survival. BACKGROUND Much of the standard care of male breast cancer is based on the diagnosis and treatment strategies of female breast cancer. However, important clinical differences between the two have been elucidated, which suggests the need for unique attention to male breast cancer. METHODS We evaluated the records of male patients who were diagnosed with breast cancer between 2004 and 2015 using the National Cancer Database (NCDB). Data obtained were demographic characteristics, clinical and tumor data, type of therapy, as well as survival data. We used descriptive statistics to characterize our study population. We then performed a survival and Cox proportional hazards analysis. RESULTS We identified 16,498 patients (median age: 63 years). Several treatment modalities were used, of which surgery was the most common (14,882 [90.4%]). The total follow-up time was 13 years (156 months). Five-year survival was 77.7% (95% CI 76.9-78.4) and 10-year survival was 60.7%. In a Cox proportional hazards model, mastectomy was associated with the greatest survival (hazard ratio [HR] 0.49; p < 0.001). CONCLUSION We report what is to our knowledge the largest national population-based cohort of male breast cancer patients. Importantly, our data suggests that similar to female patients, several treatment modalities are significantly associated with improved survival in male patients, particularly surgery. Increasing age, black race, government insurance, more comorbidities, and higher tumor stages are associated with decreased survival.
Collapse
|
23
|
Fonseca V, Brito M. Starting hormone therapy immediately after histological diagnosis of breast cancer. Breast J 2018; 24:693-694. [DOI: 10.1111/tbj.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Vasco Fonseca
- Centro Hospitalar de Lisboa Ocidental; Lisboa Portugal
| | | |
Collapse
|
24
|
No Effect of Pretreatment Breast MRI on the Timing of Surgical Treatment of Newly Diagnosed Breast Cancer. J Am Coll Radiol 2017; 14:1310-1315. [PMID: 28807386 DOI: 10.1016/j.jacr.2017.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/29/2017] [Accepted: 06/27/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although breast MRI has been shown to be more sensitive in the diagnosis of breast cancer than conventional mammography, one criticism breast MRI has faced in the preoperative treatment planning is that it can delay treatment. METHODS A retrospective analysis was performed of all women diagnosed and treated for breast cancer over three consecutive years at an American university hospital. The subjects were divided into two groups: those who received preoperative breast MRI and those who did not. There were 189 patients included in this study, of whom 109 (57.67%) received pretreatment breast MRI. RESULTS Median time to treatment was not significantly different between pretreatment MRI and no pretreatment MRI groups (32 days versus 34.5 days, P = .950). Adjusting for age, detection method, stage, and histology type did not change this conclusion. CONCLUSIONS At this institution, preoperative breast MRI for patients with newly diagnosed breast cancer seemed to have no significant effect on the timing of surgical treatment in cases of newly diagnosed breast cancer.
Collapse
|