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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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Janczewski LM, Cotler J, Merkow RP, Palis B, Nelson H, Mullett T, Boffa DJ. Alterations in Cancer Treatment During the First Year of the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6:e2340148. [PMID: 37902756 PMCID: PMC10616721 DOI: 10.1001/jamanetworkopen.2023.40148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/15/2023] [Indexed: 10/31/2023] Open
Abstract
Importance The COVID-19 pandemic created challenges to the evaluation and treatment of cancer, and abrupt resource diversion toward patients with COVID-19 put cancer treatment on hold for many patients. Previous reports have shown substantial declines in cancer screening and diagnoses in 2020; however, the extent to which the delivery of cancer care was altered remains unclear. Objective To assess alterations in cancer treatment in the US during the first year of the COVID-19 pandemic. Design, Setting, and Participants This retrospective cohort study used data from the National Cancer Database (NCDB) on patients older than 18 years with newly diagnosed cancer from January 1, 2018, to December 31, 2020. Main Outcomes and Measures The main outcomes were accessibility (time to treatment, travel distance, and multi-institutional care), availability (proportional changes in cancer treatment between years), and utilization (reductions by treatment modality, hospital type) of cancer treatment in 2020 compared with 2018 to 2019. Autoregressive models forecasted expected findings for 2020 based on observations from prior years. Results Of 1 229 654 patients identified in the NCDB in 2020, 1 074 225 were treated for cancer, representing a 16.8% reduction from what was expected. Patients were predominately female (53.8%), with a median age of 66 years (IQR, 57-74 years), similar to demographics in 2018 and 2019. Median time between diagnosis and treatment was 26 days (IQR, 0-36 days) in 2020, and median travel distance for care was 11.1 miles (IQR, 5.0-25.3 miles), similar to 2018 and 2019. In 2020, fewer patients traveled longer distances (20.2% reduction of patients traveling >35 miles). The proportions of patients treated with chemotherapy (32.0%), radiation (29.5%), and surgery (57.1%) were similar to those in 2018 and 2019. Overall, 146 805 fewer patients than expected underwent surgery, 80 480 fewer received radiation, and 68 014 fewer received chemotherapy. Academic hospitals experienced the greatest reduction in cancer surgery and treatment, with a decrease of approximately 484 patients (-19.0%) per hospital compared with 99 patients (-12.6%) at community hospitals and 110 patients (-12.8%) at integrated networks. Conclusions and Relevance This study found that among patients diagnosed with cancer in 2020, access and availability of treatment remained intact; however, reductions in treated patients varied across treatment modalities and were greater at academic hospitals than at community hospitals and integrated networks compared with expected values. These results suggest the resilience of cancer service lines and frame the economic losses from reductions in cancer treatment during the pandemic.
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Affiliation(s)
- Lauren M. Janczewski
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Joseph Cotler
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Ryan P. Merkow
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons Cancer Programs, Chicago, Illinois
- Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Bryan Palis
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, Illinois
| | - Timothy Mullett
- Department of Surgery, University of Kentucky College of Medicine, Lexington
| | - Daniel J. Boffa
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Kim H, Cho IK, Lee D, Kim K, Lee J, Cho E, Park CHK, Chung S. Effect of Cancer-Related Dysfunctional Beliefs About Sleep on Fear of Cancer Progression in the Coronavirus Pandemic. J Korean Med Sci 2022; 37:e272. [PMID: 36123961 PMCID: PMC9485067 DOI: 10.3346/jkms.2022.37.e272] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to explore clinical correlates of fear of progression (FoP) among patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic and examine the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS). METHODS Medical charts of patients with cancer who visited a psycho-oncology clinic between July and November 2021 were reviewed. Baseline socio-demographic and cancer-related variables were collected. Patients' self-report questionnaires, regarding FoP, depression (Patient Health Questionnaire-9 items; PHQ-9), viral anxiety (Stress and Anxiety to Viral Epidemics-6 items; SAVE-6), C-DBS, and other distress, were investigated. Pearson's correlation and linear regression were performed to examine the risk factors of FoP. Mediation effect analysis with the bootstrap method with 2,000 resamples was implemented. RESULTS A total of 231 patients were included in the analysis. Linear regression revealed that FoP was predicted by age (β = -0.14, P = 0.003), PHQ-9 (β = 0.48, P < 0.001), SAVE-6 (β = 0.34, P < 0.001), and C-DBS (β = 0.15, P = 0.005). FoP was directly influenced by SAVE-6 and mediated by C-DBS, while it was directly influenced by PHQ-9 with no mediation effect. CONCLUSION During the COVID-19 pandemic, the FoP of patients with cancer was associated with younger age, depression, viral anxiety, and C-DBS. Depression and viral anxiety directly influenced FoP, while C-DBS mediated the association between viral anxiety and FoP. Therefore, oncology healthcare professionals are recommended to assess C-DBS of their patients when they are highly distressed from FoP.
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Affiliation(s)
- Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Inn-Kyu Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Dongin Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Kyumin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Eulah Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Korea.
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Gimson E, Greca Dottori M, Clunie G, Yan Zheng C, Wiseman T, Joyce E, McGregor A, McNair H. Not as simple as "fear of the unknown": A qualitative study exploring anxiety in the radiotherapy department. Eur J Cancer Care (Engl) 2022; 31:e13564. [PMID: 35191096 PMCID: PMC10909434 DOI: 10.1111/ecc.13564] [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: 07/08/2021] [Revised: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is understood about the anxiety experienced by cancer patients undergoing radiotherapy or investigative imaging. Our aim was to identify sources of anxiety, the points along the cancer journey where anxiety occurred and methods to alleviate it. METHODS Six focus groups were conducted with cancer patients (n = 17), caregivers (n = 3) and healthcare practitioners (HCPs; n = 10) in the radiotherapy department. Patients described specific elements in the care pathway which induced anxiety, while HCPs focused on their perception of the patient experience. Thematic analysis was used to analyse data. RESULTS Three broad themes emerged: The Environment, The Individual and The Unknown. The physical environment of the hospital, inside the scanner for example, emerged as a key source of anxiety. The impact of cancer on patients' individual lives was significant, with many feeling isolated. The majority of participants described anxiety associated with the unknown. HCPs reported difficulty in identifying the anxious patient. CONCLUSIONS Anxiety is experienced throughout the cancer pathway. Common sources include the physical environment and the uncertainty associated with having cancer. Identifying both anxiety-inducing factors, and the anxious patients themselves, is crucial to enable targeted interventions to alleviate anxiety.
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Affiliation(s)
- Eliza Gimson
- Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | | | - Gemma Clunie
- Faculty of MedicineDepartment of Surgery & Cancer, Imperial College LondonLondonUK
| | | | - Theresa Wiseman
- Applied Health ResearchThe Royal Marsden NHS Foundation TrustLondonUK
| | | | | | - Helen McNair
- The Royal Marsden NHS Foundation Trust, Translational Therapeutic RadiographyThe Institute of Cancer ResearchLondonUK
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Ghamari SH, Abbasi-Kangevari M, Zamani N, Hassanian-Moghaddam H, Kolahi AA. Priorities Towards Fair Allocation of Ventilators During COVID-19 Pandemic: A Delphi Study. Front Med (Lausanne) 2022; 8:769508. [PMID: 35141240 PMCID: PMC8818721 DOI: 10.3389/fmed.2021.769508] [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: 09/02/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022] Open
Abstract
Background COVID-19 pandemic has resulted in severe shortage in vital resources, including invasive mechanical ventilators. The current imbalance between demand and supply of mechanical ventilators has called for investigations on the fair allocation of mechanical ventilators. Objective To determine the priorities of the medical experts towards the fair allocation of ventilators during the COVID-19 pandemic. Methods This study was conducted from May 28 to Aug 20, 2020. The questionnaire was sent to 50 medical specialists as the Delphi panel. Participants were asked to rate each prioritising factor: “−1” for low priority, “+1” for high priority, and “Zero” for equal priority. Results Among 38 experts who responded to the email, the responses of 35 were analysed. 31 (88.6%) participants recommended that pregnant women be considered high priority in allocating ventilators, 27 (77.1%) mothers of children <5 years, 26 (74.3%) patients under 80-years, and 23 (65.7%) front-line-healthcare-workers. In contrast, 28 (80.0) participants recommended that patients who are terminally ill should be considered as a low priority, 27 (77.1%) patients with active-malignancy, 25 (71.4%) neurodegenerative diseases, and 16 (45.7%) patients aged >80. The panel did not reach a consensus regarding the role of patients' laboratory profiles, underlying diseases, or drug abuse in the prioritisation of ventilators. Conclusions The panel considered pregnant mothers, mothers of children under 5 years, age groups younger than 80, and front-line healthcare workers to have high priority in allocating mechanical ventilators.
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Meerwein CM, Stadler TM, Balermpas P, Soyka MB, Holzmann D. Diagnostic pathway and stage migration of sinonasal malignancies in the era of the COVID-19 pandemic. Laryngoscope Investig Otolaryngol 2021; 6:904-910. [PMID: 34667832 PMCID: PMC8513453 DOI: 10.1002/lio2.640] [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] [Received: 05/05/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic bears the risk of delayed cancer diagnoses. METHODS Study on the diagnostic pathway of sinonasal malignancies during the COVID-19 pandemic. RESULTS Median time from first symptom to treatment initiation was not increased during the pandemic: 137 days (interquartile range [IQR] 104-193) vs 139 days (IQR 103-219) (P = .60). Median time from first appointment at our institution to treatment initiation was even reduced in 2020: 18 days (IQR 11-25) vs 11 days (IQR 7-17) (P = .02). A trend toward advanced tumor stages during the pandemic was seen: 11/30 patients (36.7%) ≥ stage 4 in 2018 to 2019 vs 12/19 patients (63.2%) ≥ stage 4 in 2020 (P = .064). CONCLUSION Both, time to diagnosis and time to treatment initiation were similar during the pandemic. However, a higher proportion of advanced tumors stages was observed. Despite the pandemic, we provided a swift diagnostic workflow, including a virtual tumor board decision and a prompt treatment initiation. Level of Evidence: 4.
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Affiliation(s)
- Christian M. Meerwein
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversity Hospital ZurichZurichSwitzerland
- University of ZurichZurichSwitzerland
| | - Thomas M. Stadler
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversity Hospital ZurichZurichSwitzerland
- University of ZurichZurichSwitzerland
| | - Panagiotis Balermpas
- University of ZurichZurichSwitzerland
- Department of Radiation OncologyUniversity Hospital ZurichZurichSwitzerland
| | - Michael B. Soyka
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversity Hospital ZurichZurichSwitzerland
- University of ZurichZurichSwitzerland
| | - David Holzmann
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversity Hospital ZurichZurichSwitzerland
- University of ZurichZurichSwitzerland
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7
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Dhada S, Stewart D, Cheema E, Hadi MA, Paudyal V. Cancer Services During the COVID-19 Pandemic: Systematic Review of Patient's and Caregiver's Experiences. Cancer Manag Res 2021; 13:5875-5887. [PMID: 34349561 PMCID: PMC8328387 DOI: 10.2147/cmar.s318115] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Cancer patients have faced intersecting crises during the COVID-19 pandemic. This review aimed to examine patients' and caregivers' experiences of accessing cancer services during the pandemic and its perceived impact on their psychological wellbeing. PATIENTS AND METHODS A protocol-led (CRD42020214906) systematic review was conducted by searching six databases including EMBASE, MEDLINE and CINAHL for articles published in English-language between 1/2020 and 12/2020. Data were extracted using a pilot-tested, structured data extraction form. Thematic synthesis of data was undertaken and reported as per the PRISMA guideline. RESULTS A total of 1110 articles were screened, of which 19 studies met the inclusion criteria. Studies originated from 10 different countries including the US, UK, India and China. Extracted data were categorised into seven themes. Postponement and delays in cancer screening and treatment, drug shortages and inadequate nursing care were commonly experienced by patients. Hospital closures, resource constraints, national lockdowns and patient reluctance to use health services due to infection worries contributed to the delay. Financial and social distress, isolation, and spiritual distress were also commonly reported. Caregivers in addition felt anxious about infecting cancer patients with COVID-19. CONCLUSION Patients and caregivers experienced delays in cancer screening, treatment and care during the COVID-19 pandemic and negatively affected their psychological wellbeing. Their views and preferences should be accounted to minimise the impact of the current and any future pandemics and ensure resilient cancer services. PROTOCOL REGISTRATION Published protocol registered with Centre for Review and Dissemination CRD42020214906 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214906).
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Affiliation(s)
- Symran Dhada
- College of Medical and Dental Sciences, School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Ejaz Cheema
- College of Medical and Dental Sciences, School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Muhammad Abdul Hadi
- College of Medical and Dental Sciences, School of Pharmacy, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- College of Medical and Dental Sciences, School of Pharmacy, University of Birmingham, Birmingham, UK
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8
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Hulbert-Williams NJ, Leslie M, Hulbert-Williams L, Smith E, Howells L, Pinato DJ. Evaluating the impact of COVID-19 on supportive care needs, psychological distress and quality of life in UK cancer survivors and their support network. Eur J Cancer Care (Engl) 2021; 30:e13442. [PMID: 33764611 PMCID: PMC8250124 DOI: 10.1111/ecc.13442] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/12/2021] [Accepted: 03/03/2021] [Indexed: 12/21/2022]
Abstract
Objectives The COVID‐19 pandemic is having considerable impact on cancer care, including restricted access to hospital‐based care, treatment and psychosocial support. We investigated the impact on unmet needs and psychosocial well‐being. Methods One hundred and forty four participants (77% female), including people with cancer and their support networks, were recruited. The most prevalent diagnosis was breast cancer. Forty‐one participants recruited pre‐pandemic were compared with 103 participants recruited during the COVID‐19 pandemic. We measured participants' unmet supportive care needs, psychological distress and quality of life. Results Half of our patient respondents reported unexpected changes to treatment following pandemic onset, with widespread confusion about their longer‐term consequences. Although overall need levels have not increased, specific needs have changed in prominence. People with cancer reported significantly reduced anxiety (p = 0.049) and improved quality of life (p = 0.032) following pandemic onset, but support network participants reported reduced quality of life (p = 0.009), and non‐significantly elevated anxiety, stress and depression. Conclusion Psychological well‐being of people with cancer has not been detrimentally affected by pandemic onset. Reliance on home‐based support to compensate for the lost availability of structured healthcare pathways may, however, explain significant and detrimental effects on the well‐being and quality of life of people in their support and informal care networks.
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Affiliation(s)
| | - Monica Leslie
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - Lee Hulbert-Williams
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - Eilidh Smith
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | | | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
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Lee SF, Nikšić M, Rachet B, Sanchez MJ, Luque-Fernandez MA. Socioeconomic Inequalities and Ethnicity Are Associated with a Positive COVID-19 Test among Cancer Patients in the UK Biobank Cohort. Cancers (Basel) 2021; 13:1514. [PMID: 33806016 PMCID: PMC8037247 DOI: 10.3390/cancers13071514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 12/30/2022] Open
Abstract
We explored the role of socioeconomic inequalities in COVID-19 incidence among cancer patients during the first wave of the pandemic. We conducted a case-control study within the UK Biobank cohort linked to the COVID-19 tests results available from 16 March 2020 until 23 August 2020. The main exposure variable was socioeconomic status, assessed using the Townsend Deprivation Index. Among 18,917 participants with an incident malignancy in the UK Biobank cohort, 89 tested positive for COVID-19. The overall COVID-19 incidence was 4.7 cases per 1000 incident cancer patients (95%CI 3.8-5.8). Compared with the least deprived cancer patients, those living in the most deprived areas had an almost three times higher risk of testing positive (RR 2.6, 95%CI 1.1-5.8). Other independent risk factors were ethnic minority background, obesity, unemployment, smoking, and being diagnosed with a haematological cancer for less than five years. A consistent pattern of socioeconomic inequalities in COVID-19 among incident cancer patients in the UK highlights the need to prioritise the cancer patients living in the most deprived areas in vaccination planning. This socio-demographic profiling of vulnerable cancer patients at increased risk of infection can inform prevention strategies and policy improvements for the coming pandemic waves.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong;
| | - Maja Nikšić
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (M.N.); (B.R.)
| | - Bernard Rachet
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (M.N.); (B.R.)
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Maria-Jose Sanchez
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, 18071 Granada, Spain;
- Cancer Registry of Granada, Andalusian School of Public Health, 18011 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health, CIBERESP), 28029 Madrid, Spain
| | - Miguel Angel Luque-Fernandez
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; (M.N.); (B.R.)
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), University of Granada, 18071 Granada, Spain;
- Cancer Registry of Granada, Andalusian School of Public Health, 18011 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health, CIBERESP), 28029 Madrid, Spain
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Lee JB, Jung M, Kim JH, Kim BH, Kim Y, Kim YS, Kim BC, Kim J, Moon SH, Park KU, Park M, Park HJ, Sim SH, Yoon HM, Lee SJ, Lee E, Chun JY, Chung YK, Jung SY, Chung J, Lee ES, Chung HC, Yun T, Rha SY. Guidelines for Cancer Care during the COVID-19 Pandemic in South Korea. Cancer Res Treat 2021; 53:323-329. [PMID: 33721486 PMCID: PMC8053855 DOI: 10.4143/crt.2020.1256] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
At the end of 2019, the cause of pneumonia outbreaks in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In February 2020, the World Health Organization named the disease cause by SARS-CoV-2 as coronavirus disease 2019 (COVID-19). In response to the pandemic, the Korean Cancer Association formed the COVID-19 task force to develop practice guidelines. This special article introduces the clinical practice guidelines for cancer patients which will help oncologists best manage cancer patients during the COVID-19 pandemic.
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Affiliation(s)
- Jii Bum Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Song-dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea
| | - June Hyuk Kim
- Orthopaedic Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Bo Hyun Kim
- Center for Liver and Pancreatobiliary Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- Division of Cancer Prevention & Early Detection, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sung Ho Moon
- Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Keon-Uk Park
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyeon Jin Park
- Department of Pediatrics, Center for Pediatric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Hoon Sim
- Breast Cancer Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Soo Jung Lee
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Eunyoung Lee
- Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea
| | - June Young Chun
- Department of Internal Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Youn Kyung Chung
- Department of Obstetrics and Gynecology, National Cancer Center, Goyang, Korea
| | - So-Youn Jung
- Breast Cancer Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jinsoo Chung
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Breast Cancer Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyun Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Song-dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea
| | - Tak Yun
- Center for Rare Cancers, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.,Song-dang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea
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Duncan R, Szabo B, Jackson QL, Crain M, Lett C, Masters C, Spinks R, Uhrig LK, Gullatte MM. Care and Coping During COVID-19: Practice Changes and Innovations in the Oncology Setting. Clin J Oncol Nurs 2021; 25:48-55. [PMID: 33480874 DOI: 10.1188/21.cjon.48-55] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has required healthcare systems to transform the delivery of care. Although the core principles of care for patients with cancer have not changed, this pandemic has led to heightened awareness concerning the fragility of patients with cancer and how healthcare systems can protect them. OBJECTIVES The aims were to identify and implement inpatient and ambulatory care clinical practice changes during the COVID-19 pandemic, based on defining moments and coping strategies from clinical oncology nurses, advanced practice RNs, nurse leaders, and researchers. METHODS This article presents a Lean Six Sigma framework, accompanied by numerous rapid cycle tests of change. FINDINGS The COVID-19 pandemic required clinical healthcare providers at the authors' institution to focus on seven priority areas. Nurses tested and implemented practice changes.
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Gundavda MK, Gundavda KK. Cancer or COVID-19? A Review of Guidelines for Safe Cancer Care in the Wake of the Pandemic. ACTA ACUST UNITED AC 2020; 2:2691-2701. [PMID: 33251481 PMCID: PMC7679239 DOI: 10.1007/s42399-020-00632-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
In the wake of the COVID-19 pandemic, due to reasons beyond control, health care workers have struggled to deliver treatment for the patients with cancer. The concern for otherwise healthy patients with curable cancers that require timely intervention or therapy is the risk of contracting COVID-19 may outweigh the benefits of cancer treatment. Lack of international guidelines leaves health care providers with a case-to-case approach for delivering optimal cancer care in the wake of the pandemic. Transition to telemedicine has somewhat bridged the gap for in-office visits, but there is a continuing challenge of delays in cancer screening or significant decline of new diagnoses of cancers due to the pandemic. We aim to propose a balance in risk from treatment delay versus risks from COVID-19 with emphasis on treatment modality (surgery, radiation, and systemic therapy) as well as supportive care for cancer patients, and therefore have reviewed the publications and recommendations from international societies and study groups available as of October 2020.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedic Oncology, P. D. Hinduja National Hospital and Medical Research Centre, Andheri West, Mumbai, Maharashtra 400053 India
| | - Kaival K Gundavda
- Department of Surgical Oncology, Tata Memorial hospital, 93, Ground floor, Main Building, Mumbai, Maharashrta 400012 India
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