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Gwanika Y, Rice HE, Metcalf M, Espinoza P, Kajoka HD, Rice HE, Staton C, Mmbaga BT, Majaliwa E, Smith ER, Cotache-Condor C. Impact of the COVID-19 pandemic in childhood and adolescent cancer care in northern Tanzania: a cross-sectional study. BMC Cancer 2024; 24:457. [PMID: 38609910 PMCID: PMC11010397 DOI: 10.1186/s12885-024-12168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic has strained healthcare systems and presented unique challenges for children requiring cancer care, particularly in low- and middle-income countries. This study aimed to assess the impact of the COVID-19 pandemic on access to cancer care for children and adolescents in Northern Tanzania. METHODS In this cross-sectional study, we assessed the demographic and clinical characteristics of 547 pediatric and adolescent cancer patients (ages 0-19 years old) between 2016 and 2022 using the population-based Kilimanjaro Cancer Registry (KCR). We categorized data into pre-COVID-19 (2016-2019) and COVID-19 (2020-2022) eras, and performed descriptive analyses of diagnostic, treatment, and demographic information. A secondary analysis was conducted on a subset of 167 patients with stage of diagnosis at presentation. RESULTS Overall admissions nearly doubled during the pandemic (n = 190 versus 357). The variety of diagnoses attended at KCMC increased during the pandemic, with only five groups of diseases reported in 2016 to twelve groups of diseases in 2021. Most patients were diagnosed at a late stage (stage III or IV) across eras, with the proportion of under-five years old patients increasing late-diagnoses from 29.4% (before the pandemic), 52.8% (during the pandemic), when compared to the overall cohort. Around 95% of children in this age category reported late-stage diagnosis during the pandemic. Six out of the twelve cancer site groups also reported an increase in late-stage diagnosis. During the pandemic, the proportion of children receiving surgery increased from 15.8 to 30.8% (p < 0.001). CONCLUSION Childhood and adolescent cancer care changed in Northern Tanzania during the COVID-19 pandemic, with increased late-stage diagnoses presentations among younger patients and the increased use of surgical therapies in the context of a growing practice. Understanding the impact of the COVID-19 pandemic on pediatric and adolescent cancer care can help us better adapt healthcare systems and interventions to the emerging needs of children and adolescents with cancer in the midst of a health crisis.
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Affiliation(s)
- Yotham Gwanika
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Hannah E Rice
- Duke Primary Care, Population Health, Duke University, Durham, NC, USA
| | | | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Happiness D Kajoka
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
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Vempuluru VS, Maniar A, Kaliki S. Global retinoblastoma studies: A review. Clin Exp Ophthalmol 2024; 52:334-354. [PMID: 38263682 DOI: 10.1111/ceo.14357] [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: 08/17/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
In the current era of global health awareness for retinoblastoma (RB), the challenge that lies ahead of us is providing optimal care for children affected with RB in underdeveloped nations. The understanding of similarities and disparities between various nations across the world aids in achieving comparable outcomes. With dissolving geographic barriers and evolving collaboration, global collaborative studies on RB are becoming increasingly common. They provide real-world, robust evidence on several aspects of RB. This review discusses insights gained from global RB studies regarding the demographics, certain aspects of etiopathogenesis and epidemiology, international travel burden, disparities in clinical presentations based on national income levels, management protocols, pathology, treatment outcomes, and the effect of COVID-19 on RB care across the world. These insights are likely to impact individual practice as well as inform policy reforms.
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Affiliation(s)
- Vijitha S Vempuluru
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Arpita Maniar
- Duke Eye Center, Duke University, Durham, North Carolina, USA
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
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Wong SL, Johnston E, Rossell N, Malogolowkin M, Rios L, Gómez García W, Antillon-Klussmann F, Fu L, Fuentes-Alabi S, Quintero Delgado K, Ortiz Morales D, Rodriguez-Loza C, Apesoa-Varano EC, Friedrich P, Alvarez E. The Effect of COVID-19 on Oncology Care for Adolescents and Young Adults in Latin America. J Adolesc Young Adult Oncol 2024. [PMID: 38502817 DOI: 10.1089/jayao.2023.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Children with cancer in low- and middle-income countries were disproportionately impacted by the COVID-19 pandemic, but little is known about how adolescents and young adults (AYAs) with cancer were affected. Sixty-seven physicians and nonphysician providers were interviewed about their experiences caring for AYAs with cancer in Latin America. Quotes related to the COVID-19 pandemic were identified and grouped into themes. Barriers from the COVID-19 pandemic included limited space, restrictions on travel, reduced funding, limited staff, limited services, and changes to treatment. However, improvements to care that arose from the COVID-19 pandemic included better access to distance learning and telemedicine.
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Affiliation(s)
- Samantha L Wong
- School of Medicine, University of California Davis, Sacramento, California, USA
| | - Emily Johnston
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nuria Rossell
- Independent Medical Anthropology Researcher, San Salvador, El Salvador
| | - Marcio Malogolowkin
- Division of Pediatric Hematology and Oncology, Davis School of Medicine, University of California, Sacramento, California, USA
| | - Ligia Rios
- Department of Pediatrics, Unidad de Oncología Pediátrica y del Adolescente, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Wendy Gómez García
- Department of Oncology, Dr. Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
- National Cancer Institute, INCART, Santo Domingo, Dominican Republic
| | - Federico Antillon-Klussmann
- Department of Hematology/Oncology, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- School of Medicine, Francisco Marroquín University, Guatemala City, Guatemala
| | - Ligia Fu
- Department of Pediatrics, Hospital Escuela, Tegucigalpa, Honduras
| | - Soad Fuentes-Alabi
- Department of Pediatric Oncology, National Program for Childhood Cancer, Ayudame a Vivir Foundation/National Children's Hospital Benjamin Bloom, San Salvador, El Salvador
| | - Karina Quintero Delgado
- Department of Pediatrics, Hospital del Niño Dr. José Renán Esquivel, Oncología, Panama City, Panama
| | | | - Carolina Rodriguez-Loza
- Department of Pediatric Oncology, National Program for Childhood Cancer, Ayudame a Vivir Foundation/National Children's Hospital Benjamin Bloom, San Salvador, El Salvador
| | | | - Paola Friedrich
- St. Jude Children's Research Hospital, Global Pediatric Medicine, Memphis, Tennessee, USA
| | - Elysia Alvarez
- Division of Pediatric Hematology and Oncology, Davis School of Medicine, University of California, Sacramento, California, USA
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Hashmi SK, Bodea J, Patni T, Angel S, Bhakta NH, Jeha S, Karol SE, Ribeiro RC, Rubnitz JE, Wolf J, Li Y, Pui CH, Hijano DR, Inaba H. COVID-19 in Pediatric Patients With Acute Lymphoblastic Leukemia or Lymphoma. JAMA Netw Open 2024; 7:e2355727. [PMID: 38363571 PMCID: PMC10873761 DOI: 10.1001/jamanetworkopen.2023.55727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
Importance COVID-19 in pediatric patients with acute lymphoblastic leukemia or lymphoma (ALL/LLy) has not been described in detail and may affect chemotherapy administration and long-term outcomes. Objective To describe the clinical presentation of COVID-19 and chemotherapy modifications in pediatric patients with ALL/LLy. Design, Setting, and Participants This is a retrospective case series of patients at St Jude Children's Research Hospital and its affiliate sites with newly diagnosed ALL/LLy who were treated on the Total XVII protocol (NCT03117751) between March 30, 2020, and June 20, 2022. Participants included patients aged 1 to 18 years who were receiving protocol chemotherapy. Acute symptoms and chemotherapy modifications were evaluated for 60 days after the COVID-19 diagnosis, and viral clearance, adverse events, and second SARS-CoV-2 infections were followed up during the 27-month study period. Exposures SARS-CoV-2; all patients were screened at least weekly and at symptom onset and/or after known exposure to SARS-CoV-2. Main Outcomes and Measures Description of the spectrum of COVID-19 illness and chemotherapy modifications. Results Of 308 pediatric patients, 110 (36%) developed COVID-19 at a median age of 8.2 (IQR, 5.3-14.5) years. Sixty-eight patients (62%) were male. Most patients were in the continuation/maintenance phase of chemotherapy (101 [92%]). Severe disease was rare (7 [6%]) but was associated with older age, higher white blood cell counts at ALL/LLy diagnosis, lower absolute lymphocyte counts at COVID-19 diagnosis, abnormal chest imaging findings, and SARS-CoV-2 reinfection. Rare but serious thrombotic events included pulmonary embolism and cerebral venous sinus thrombosis (n = 1 for each). No multisystem inflammatory syndrome in children or death was seen. SARS-CoV-2 reinfection occurred in 11 patients (10%) and was associated with older age and with receiving standard or high-risk vs low-risk ALL/LLy therapy. Chemotherapy interruptions occurred in 96 patients (87%) and were longer for patients with severe disease, SARS-CoV-2 reinfection, and/or a COVID-19 diagnosis during the pre-Omicron variant period vs the post-Omicron period (after December 27, 2021). Conclusions and Relevance In this case series of COVID-19 in pediatric patients with ALL/LLy, severe COVID-19 was rare, but chemotherapy administration was affected in most patients. Long-term studies are needed to establish the outcomes of COVID-19 in this population.
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Affiliation(s)
- Saman K. Hashmi
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jessica Bodea
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tushar Patni
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Savannah Angel
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Nickhill H. Bhakta
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sima Jeha
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Seth E. Karol
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Raul C. Ribeiro
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Jeffrey E. Rubnitz
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Joshua Wolf
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yimei Li
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Diego R. Hijano
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Hiroto Inaba
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
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Zawitkowska J, Drabko K, Lejman M, Kowalczyk A, Czyżewski K, Dziedzic M, Jaremek K, Zalas-Więcek P, Szmydki-Baran A, Hutnik Ł, Czogała W, Balwierz W, Żak I, Salamonowicz-Bodzioch M, Kazanowska B, Wróbel G, Frączkiewicz J, Kałwak K, Tomaszewska R, Szczepański T, Zając-Spychała O, Wachowiak J, Płonowski M, Krawczuk-Rybak M, Królak A, Ociepa T, Urasiński T, Pierlejewski F, Młynarski W, Urbańska-Rakus J, Machnik K, Pająk S, Badowska W, Brzeski T, Mycko K, Mańko-Glińska H, Urbanek-Dądela A, Karolczyk G, Mizia-Malarz A, Stolpa W, Skowron-Kandzia K, Musiał J, Chaber R, Irga-Jaworska N, Bień E, Styczyński J. Incidence of bacterial and fungal infections in Polish pediatric patients with acute lymphoblastic leukemia during the pandemic. Sci Rep 2023; 13:22619. [PMID: 38114744 PMCID: PMC10730514 DOI: 10.1038/s41598-023-50093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023] Open
Abstract
The most common complications related to the treatment of childhood acute lymphoblastic leukemia (ALL) are infections. The aim of the study was to analyze the incidence and mortality rates among pediatric patients with ALL who were treated in 17 Polish pediatric hematology centers in 2020-2021 during the pandemic. Additionally, we compared these results with those of our previous study, which we conducted in the years 2012-2017. The retrospective analysis included 460 patients aged 1-18 years with newly diagnosed ALL. In our study, 361/460 (78.5%) children were reported to have microbiologically documented bacterial infections during chemotherapy. Ten patients (2.8%) died due to sepsis. Fungal infections were reported in 99 children (21.5%), of whom five (5.1%) died due to the infection. We especially observed an increase in bacterial infections during the pandemic period compared to the previous study. The directions of our actions should be to consider antibiotic prophylaxis, shorten the duration of hospitalization, and educate parents and medical staff about complications (mainly infections) during anticancer therapy. It is necessary to continue clinical studies evaluating infection prophylaxis to improve outcomes in childhood ALL patients.
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Affiliation(s)
- Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland.
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Monika Lejman
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Adrian Kowalczyk
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Czyżewski
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Magdalena Dziedzic
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Kamila Jaremek
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Patrycja Zalas-Więcek
- Department of Microbiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Anna Szmydki-Baran
- Department of Hematology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Hutnik
- Department of Hematology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Czogała
- Department of Pediatric Oncology and Hematology, Intitute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Intitute of Pediatrics, Jagiellonian University Medical College, Kraków, Poland
| | - Iwona Żak
- Department of Microbiology, University Children's Hospital, Jagiellonian University Medical College, Kraków, Poland
| | | | - Bernarda Kazanowska
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Grażyna Wróbel
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Jowita Frączkiewicz
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Haematology, Wroclaw Medical University, Wroclaw, Poland
| | - Renata Tomaszewska
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Szczepański
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Katowice, Poland
| | - Olga Zając-Spychała
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Płonowski
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology, Hematology, Medical University of Bialystok, Bialystok, Poland
| | - Aleksandra Królak
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Ociepa
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Filip Pierlejewski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | | | - Katarzyna Machnik
- Unit of Pediatric Hematology and Oncology, City Hospital, Chorzow, Poland
| | - Sonia Pająk
- Unit of Pediatric Hematology and Oncology, City Hospital, Chorzow, Poland
| | - Wanda Badowska
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Tomasz Brzeski
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Katarzyna Mycko
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Hanna Mańko-Glińska
- Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Agnieszka Urbanek-Dądela
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, Kielce, Poland
| | - Grażyna Karolczyk
- Department of Pediatric Oncology and Hematology, Collegium Medium of Jan Kochanowski University in Kielce, Kielce, Poland
| | - Agnieszka Mizia-Malarz
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Weronika Stolpa
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Skowron-Kandzia
- Department of Oncology, Hematology and Chemotherapy, Upper Silesia Children's Care Health, Medical University of Silesia, Katowice, Poland
| | - Jakub Musiał
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Radosław Chaber
- Clinic of Pediatric Oncology and Hematology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Ewa Bień
- Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk, Gdańsk, Poland
| | - Jan Styczyński
- Student Scientific Society of Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
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Kanemo P, Musa KM, Deenadayalan V, Litvin R, Odeyemi OE, Shaka A, Baskaran N, Shaka H. Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission: A nationwide analysis. World J Clin Oncol 2023; 14:311-323. [PMID: 37700808 PMCID: PMC10494557 DOI: 10.5306/wjco.v14.i8.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases. However, little focus has been given to its effect on cancer treatment. AIM To determine the effect of COVID-19 pandemic on cancer patients' care. METHODS A retrospective review of a Nationwide Readmission Database (NRD) was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy (IPCT) during the COVID-19 pandemic in 2020. Two cohorts were defined based on readmission within 30 d and 90 d. Demographic information, readmission rates, hospital-specific variables, length of hospital stay (LOS), and treatment costs were analyzed. Comorbidities were assessed using the Elixhauser comorbidity index. Multivariate Cox regression analysis was performed to identify independent predictors of readmission. Statistical analysis was conducted using Stata® Version 16 software. As the NRD data is anonymous and cannot be used to identify patients, institutional review board approval was not required for this study. RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic. Among the 30-day index admission cohort, 55005 patients were included, with 32903 readmissions observed, resulting in a readmission rate of 59.8%. For the 90-day index admission cohort, 33142 patients were included, with 24503 readmissions observed, leading to a readmission rate of 73.93%. The most common causes of readmission included encounters with chemotherapy (66.7%), neutropenia (4.36%), and sepsis (3.3%). Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts. The total cost of readmission for both cohorts amounted to 1193000000.00 dollars. Major predictors of 30-day readmission included peripheral vascular disorders [Hazard ratio (HR) = 1.09, P < 0.05], paralysis (HR = 1.26, P < 0.001), and human immunodeficiency virus/acquired immuno-deficiency syndrome (HR = 1.14, P = 0.03). Predictors of 90-day readmission included lymphoma (HR = 1.14, P < 0.01), paralysis (HR = 1.21, P = 0.02), and peripheral vascular disorders (HR = 1.15, P < 0.01). CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT. These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.
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Affiliation(s)
- Philip Kanemo
- Department of Internal Medicine, Rapides Regional Medical Center, Alexandria, LA 71301, United States
| | - Keffi Mubarak Musa
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria 88445, Kaduna, Nigeria
| | - Vaishali Deenadayalan
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60623, United States
| | - Rafaella Litvin
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60623, United States
| | - Olubunmi Emmanuel Odeyemi
- Department of Internal Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso 210101, Oyo, Nigeria
| | - Abdultawab Shaka
- Department of Medicine, Windsor University School of Medicine, St. Kitts, Frankfort, IL 60423, United States
| | - Naveen Baskaran
- Department of Medicine, University of Florida, Gainesville, FL 32610, United States
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60623, United States
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Vieira Filho JF, Ribeiro VN, do Nascimento ÁMA, Maria Alves de Melo M. Infections in Children with Cancer Admitted in an Oncology Reference Hospital: A Cross-sectional Study. Curr Microbiol 2023; 80:315. [PMID: 37544971 DOI: 10.1007/s00284-023-03420-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
Pediatric oncology patients are usually immunosuppressed due to factors such as the neoplasm and its treatment, making them more susceptible to infections. This article aims to determine the infection profile of pediatric oncology patients admitted to an oncology reference hospital in Natal, Rio Grande do Norte, Brazil. A retrospective and cross-sectional study was conducted, collecting data from patients hospitalized due to infection in a pediatric oncology unit exclusively for the Brazilian public health system, spanning from 2018 to 2021. A total of 168 episodes of infections were identified in 96 patients, resulting in 157 hospitalizations. Among the patients with infections, 62.4% had hematological malignancies, and out of these cases, 74.6% specifically had Acute Lymphoid Leukemia. The Escherichia coli (31.9%) was the most prevalent microorganism isolated from the samples. Multidrug-resistant microorganisms accounted for 52% of all identified microorganisms. Fluoroquinolones and beta-lactam were the most prevalent antibiotic classes in the analyzed antibiograms. Factors such as Sex, type of cancer, chemotherapy in the last 30 days, were found to be associated with the occurrence of infection (p < 0.05). Conducting epidemiological studies regarding infections in pediatric oncology is crucial to development of empirical protocols, and the implementation of strategies to better control future infections.
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Affiliation(s)
- Jonas Fernandes Vieira Filho
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | - Viviane Nunes Ribeiro
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | | | - Menilla Maria Alves de Melo
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil.
- Department of Pharmacy, Pesquisa e Inovação, Instituto de Ensino, Liga Norte Riograndense Contra o Câncer Hospital, Av. Miguel Castro, Nossa Senhora de Nazaré, Natal, 1355, CEP 59062-000, Rio Grande do Norte, Brazil.
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Roy P, van Peer SE, Dandis R, Duncan C, de Aguirre‐Neto JC, Verschuur A, de Camargo B, Karim‐Kos HE, Boschetti L, Spreafico F, Ramirez‐Villar GL, Graf N, van Tinteren H, Pritchard‐Jones K, van den Heuvel‐Eibrink MM. Impact of the COVID-19 pandemic on paediatric renal tumour presentation and management, a SIOP renal tumour study group study. Cancer Med 2023; 12:17098-17111. [PMID: 37496317 PMCID: PMC10501283 DOI: 10.1002/cam4.6358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/26/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had global catastrophic effects on the management of non-communicable diseases including paediatric cancers. Restrictions during the start of 2020 complicated timely referrals of patients to specialized centres. We aimed to evaluate the pandemic's impact on the number of new diagnoses, disease characteristics and management delay for paediatric renal tumour patients included in the SIOP-RTSG-UMBRELLA study, as compared with data from a historical SIOP-RTSG trial (2005-2009). METHODS The number of intensive care admissions, population mobility rates and national lockdown periods/restrictions were used as proxies of the pandemic's severity and impact on societies. Clinical and tumour data were extracted from the SIOP-RTSG-UMBRELLA study and from historical SIOP-RTSG trials. RESULTS During the first lockdown in Europe, the number of newly diagnosed patients decreased following restrictions and population immobilisation. Additionally, there was a higher proportion of advanced disease (37% vs. 17% before and after COVID-9, p < 0.001) and larger median tumour volume (559 cm3 vs. 328 and 434 cm3 before and after, p < 0.0001). Also in Brazil, the proportion of advanced disease was higher during the national decrease in mobilisation and start of restrictions (50% and 24% vs. 11% and 18% before and after, p < 0.01). Tumour volume in Brazil was also higher during the first months of COVID-19 (599 cm3 vs. 459 and 514 cm3 ), although not significant (p = 0.17). We did not observe any delays in referral time nor in time to start treatment, even though COVID-19 restrictions may have caused children to reach care later. CONCLUSION The COVID-19 pandemic briefly changed the tumour characteristics of children presenting with renal tumours. The longer-term impact on clinical outcomes will be kept under review.
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Affiliation(s)
- Prakriti Roy
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | | | - Rana Dandis
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | | | | | - Arnauld Verschuur
- Department of Paediatric Oncology & HaematologyLa Timone Children's HospitalMarseilleFrance
| | - Beatriz de Camargo
- Grupo Brasileiro de Tumores Renais (Brazilian Renal Tumor Group)São PauloBrazil
| | - Henrike E. Karim‐Kos
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Department of ResearchNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
| | - Luna Boschetti
- Department of Medical Oncology and Hematology, Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei Tumori di MilanMilanItaly
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei Tumori di MilanMilanItaly
| | | | - Norbert Graf
- Department of Paediatric Oncology & HaematologySaarland UniversityHomburgGermany
| | | | - Kathy Pritchard‐Jones
- UCL Great Ormond Street Institute of Child Health, University College LondonLondonUK
| | - Marry M. van den Heuvel‐Eibrink
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
- Division of Child Health, Wilhelmina Children's HospitalUniversity Medical Center UtrechtThe Netherlands
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Tsagkaris C, Trygonis N, Spyrou V, Koulouris A. Telemedicine in Care of Sarcoma Patients beyond the COVID-19 Pandemic: Challenges and Opportunities. Cancers (Basel) 2023; 15:3700. [PMID: 37509361 PMCID: PMC10378403 DOI: 10.3390/cancers15143700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created a challenging environment for sarcoma patients. Most oncology societies published guidelines or recommendations prioritizing sarcoma patients and established telehealth as an efficient method of approaching them. The aim of this review is the assessment of current evidence regarding the utilization of telemedicine in diagnosis, treatment modalities, telerehabilitation and satisfaction among sarcoma patients and healthcare providers (HP). METHODS This systematic review was carried out using the databases PubMed and Ovid MEDLINE according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS The application of telemedicine to the management of sarcoma has yielded improved clinical and psychological outcomes. Specifically, significant progress has been demonstrated in the areas of tele-oncology and telerehabilitation during the last decade, and the COVID-19 outbreak has accelerated this transition toward them. Telehealth has been proven efficient in a wide spectrum of applications from consultations on physical therapy and psychological support to virtual care symptom management. Both HP and patients reported satisfaction with telehealth services at levels comparable to in-person visits. CONCLUSIONS Telehealth has already unveiled many opportunities in tailoring individualized care, and its role in the management of sarcoma patients has been established in the post-COVID-19 era, as well.
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Affiliation(s)
- Christos Tsagkaris
- European Student Think Tank, Public Health and Policy Working Group, 1058 DE Amsterdam, The Netherlands
| | - Nikolaos Trygonis
- Department of Orthopaedics, University Hospital of Heraklion, 70013 Heraklion, Greece
| | - Vasiliki Spyrou
- Post Covid Department, Theme Female Health, Karolinska University Hospital, 14157 Stockholm, Sweden
| | - Andreas Koulouris
- Department of Oncology-Pathology, Karolinska Institute, 17176 Stockholm, Sweden
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, 17177 Stockholm, Sweden
- Faculty of Medicine, University of Crete, 70013 Heraklion, Greece
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10
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Putro YAP, Magetsari R, Mahyudin F, Basuki MH, Saraswati PA, Huwaidi AF. Impact of the COVID-19 on the surgical management of bone and soft tissue sarcoma: A systematic review. J Orthop 2023; 38:1-6. [PMID: 36875225 PMCID: PMC9957659 DOI: 10.1016/j.jor.2023.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Background The COVID-19 pandemic had greatly and negatively impacted health services including the management of bone and soft tissue sarcoma. As disease progression is time-sensitive, decision taken by the oncology orthopedic surgeon on performing surgical treatment determines the patient outcome. On the other hand, as the world tried to control the spread of COVID-19 infection, treatment re-prioritization based on urgency level had to be done which consequently affect treatment provision for sarcoma patients. Patient and clinician's concern regarding the outbreak have also inflicted on treatment decision making. A systematic review was thought to be necessary to summarize the changes seen in managing primary malignant bone and soft tissue tumors. Methods We performed this systematic review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. The review protocol had been registered on PROSPERO with submission number CRD42022329430. We included studies which reported primary malignant tumor diagnosis and its surgical intervention from March 11th, 2020 onwards. The main outcome is to report changes implemented by different centers around the world in managing primary malignant bone tumors surgically in response to the pandemic. Three electronic medical databases were scoured and by applying eligibility criteria. Individual authors evaluated the articles' quality and risk of bias using the Newcastle-Ottawa Quality Assessment Scale other instruments developed by JBI of the University of Adelaide. The overall quality assessment of this systematic review was self-evaluated using the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Checklist. Results There were 26 studies included in the review with various study designs, conveyed in almost all continents. The outcomes from this review are change in surgery time, change in surgery type, and change in surgery indication in patients with primary bone and soft tissue sarcoma. Surgery timing has been experiencing delay since the pandemic occurred, including delay in the multidisciplinary forum, which were all related to lockdown regulations and travel restrictions. For surgery type, limb amputation was preferred compared to limb-salvage procedures due to shorter duration and simpler reconstruction with better control of malignancy. Meanwhile, the indications for surgical management are still based on the patient's demographics and disease stages. However, some would stall surgery regardless of malignancy infiltration and fracture risks which are indication for amputation. As expected, our meta-analysis showed higher post-surgical mortality in patients with malignant bone and soft tissue sarcoma during the COVID-19 pandemic with odds ratio of 1.14. Conclusion Surgical management of patients with primary bone and soft tissue sarcoma has seriously been affected due to adjustments to the COVID-19 pandemic. Other than institutional restrictions to contain the infection, patient and clinician's decisions to postpone treatment due to COVID-19 transmission concern were also impactful in treatment course. Delay in surgery timing has caused higher risk of worse surgical outcome during the pandemic, which is aggravated if the patient is infected by COVID-19 as well. As we transition into a post-COVID-19 pandemic period, we expect patients to be more lenient in returning for their treatment but by then disease progression might have taken place, resulting in worse overall prognosis. Limitation to this study were few assumptions made in the synthesis of numerical data and meta-analysis only for changes in surgery time outcome and lack of intervention studies included.
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Affiliation(s)
- Yuni Artha Prabowo Putro
- Department of Orthopedics and Traumatology, RSUP Dr. Sardjito Hospital, Jl. Kesehatan Sendowo No.1, Sleman, 55281, D.I.Yogyakarta, Indonesia.,Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman, 55281, D.I.Yogyakarta, Indonesia
| | - Rahadyan Magetsari
- Department of Orthopedics and Traumatology, RSUP Dr. Sardjito Hospital, Jl. Kesehatan Sendowo No.1, Sleman, 55281, D.I.Yogyakarta, Indonesia.,Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman, 55281, D.I.Yogyakarta, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Jl. Airlangga No.4 - 6, Gubeng, Surabaya, 60115, Jawa Timur, Indonesia.,Department of Orthopedics and Traumatology, RSUD Dr. Soetomo, Jl. Mayjen Prof. Dr. Moestopo No.6-8, Gubeng, Surabaya, 60286, Jawa Timur, Indonesia
| | - Muhammad Hardian Basuki
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Jl. Airlangga No.4 - 6, Gubeng, Surabaya, 60115, Jawa Timur, Indonesia.,Department of Orthopedics and Traumatology, RSUD Dr. Soetomo, Jl. Mayjen Prof. Dr. Moestopo No.6-8, Gubeng, Surabaya, 60286, Jawa Timur, Indonesia
| | - Paramita Ayu Saraswati
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman, 55281, D.I.Yogyakarta, Indonesia
| | - A Faiz Huwaidi
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Farmako, Sendowo, Sekip Utara, Sleman, 55281, D.I.Yogyakarta, Indonesia
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Prasad M, Moulik NR. Supportive care in paediatric oncology during the pandemic: Lessons from a nationwide survey in India. Pediatr Blood Cancer 2023; 70:e30317. [PMID: 36965185 DOI: 10.1002/pbc.30317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Maya Prasad
- Division of Pediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nirmalya Roy Moulik
- Division of Pediatric Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Rykov MY, Dolgopolov IS. COVID-19 coronavirus infection in children: Clinical presentation, diagnosis, vaccination, and treatment. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2022-67-6-14-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In late 2019, a new subtype of coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19 SARS-CoV-2) rapidly spread around the world, causing a global pandemic. Initially, the proportion of confirmed cases among children was relatively small, and it was believed that children were rarely infected. Subsequent observations have shown that in children and adolescents, the infection is either asymptomatic or paucisymptomatic, and therefore the true incidence is underestimated due to the lack of testing. The article systematizes the results of studies on the prevalence, diagnosis, clinical features, vaccination, and treatment of children with a new coronavirus infection COVID-19 SARS-CoV-2. The SARS-CoV-2 positivity rate throughout the peak of the pandemic in children was low compared to adults. Children are not only less likely to become infected with the virus, but they also endure the infection more easily than adults. The mortality rate in children with COVID-19 was <0.5%. In most children, infection is either asymptomatic or paucisymptomatic. Vaccination of children and adolescents is recommended mainly to achieve herd immunity in all age groups. However, there are no convincing data on the duration of the immune response, the level of the required protective antibody titer, as well as on the long-term side effects of vaccination due to the insufficient follow-up period and the uncertainty of the immune response criteria. As information is accumulated on the viral load of children and adolescents, their role in the transmission of the virus, diagnostic approaches in this age group are optimized. The effectiveness of the treatment was tested on patients admitted to the hospital, and recommendations for treatment were developed. Currently, global research efforts are focused on the protection of particularly vulnerable children, the prospects for total childhood vaccination, its effectiveness and safety.
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Affiliation(s)
- M. Yu. Rykov
- Russian State Social University; Semashko National Research Institute of Public Health
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