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Clements K, Thapa A, Cowell A, Conway D, Douglas CM, Paterson C. Impact of the COVID-19 pandemic on stage and incidence of head and neck cancer: A rapid review and meta-analysis. Clin Otolaryngol 2024; 49:363-375. [PMID: 38514776 DOI: 10.1111/coa.14152] [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: 05/15/2023] [Revised: 09/24/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This rapid review aims to evaluate the impact of the COVID-19 pandemic on incidence of head and neck cancer (HNC) and stage distribution at diagnosis. DESIGN Rapid review and meta-analysis. PARTICIPANTS Comparative data for new HNC patients between a pre-pandemic cohort (before March 2020) and a pandemic cohort (after March 2020 during the lockdown period). MAIN OUTCOMES MEASURED Data on tumour stage, incidence, referral pathway (number of new patient referrals), or workload levels (number of HNC treatments). Data on stage were summarised as odds ratios (OR) with 95% confidence intervals (CI), and data related to changes in numbers of diagnoses, referrals, and workload levels were summarised as a narrative synthesis. RESULTS A total of 31 reports were included in this review. Individually 16 out of 23 studies did not show a significant impact on stage relative to the pre-pandemic period. However, the meta-analysis revealed that patients diagnosed with HNC during the pandemic were 16% more likely to have nodal involvement (OR = 1.16; 95% CI 1.00-1.35), 17% more likely to have a late overall stage (OR = 1.17; 95% CI 1.01-1.36), and 32% more likely to present with advanced tumour extent (T3 and T4 stage) (OR = 1.32; 95% CI 1.08-1.62). Data on incidence was extremely limited and not currently sufficient to assess trends in burden of disease. CONCLUSIONS This review indicates that during the COVID-19 pandemic, there was upstaging of HNC at diagnosis, suggesting the provision of care to HNC patients was significantly affected.
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Affiliation(s)
- Kelten Clements
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Alekh Thapa
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna Cowell
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - David Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
| | - Catriona M Douglas
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
- Department of ENT-Head and Neck Surgery, Glasgow Royal Infirmary and Queen Elizabeth University Hospital, Glasgow, UK
| | - Claire Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Glasgow Head and Neck Cancer (GLAHNC) Research Group, Glasgow, UK
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Marty S, Lamé G, Guével E, Priou S, Chatellier G, Tournigand C, Kempf E. Impact of the Sars-Cov-2 outbreak on the initial clinical presentation of new solid cancer diagnoses: a systematic review and meta-analysis. BMC Cancer 2024; 24:143. [PMID: 38287348 PMCID: PMC10823607 DOI: 10.1186/s12885-023-11795-1] [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: 07/18/2023] [Accepted: 12/25/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic might have delayed cancer diagnosis and management. The aim of this systematic review was to compare the initial tumor stage of new cancer diagnoses before and after the pandemic. METHODS We systematically reviewed articles that compared the tumor stage of new solid cancer diagnoses before and after the initial pandemic waves. We conducted a random-effects meta-analysis to compare the rate of metastatic tumors and the distribution of stages at diagnosis. Subgroup analyses were performed by primary tumor site and by country. RESULTS From 2,013 studies published between January 2020 and April 2022, we included 58 studies with 109,996 patients. The rate of metastatic tumors was higher after the COVID-19 outbreak than before (pooled OR: 1.29 (95% CI, 1.06-1.57), I2: 89% (95% CI, 86-91)). For specific cancers, common ORs reached statistical significance for breast (OR: 1.51 (95% CI 1.07-2.12)) and gynecologic (OR: 1.51 (95% CI 1.04-2.18)) cancers, but not for other cancer types. According to countries, common OR (95% CI) reached statistical significance only for Italy: 1.55 (1.01-2.39) and Spain:1.14 (1.02-1.29). Rates were comparable for stage I-II versus III-IV in studies for which that information was available, and for stages I-II versus stage III in studies that did not include metastatic patients. CONCLUSIONS Despite inter-study heterogeneity, our meta-analysis showed a higher rate of metastatic tumors at diagnosis after the pandemic. The burden of social distancing policies might explain those results, as patients may have delayed seeking care.
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Affiliation(s)
- Simon Marty
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Guillaume Lamé
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Etienne Guével
- Assistance Publique - Hôpitaux de Paris, Innovation and Data, IT Department, Paris, France
| | - Sonia Priou
- Laboratoire Genie Industriel, CentraleSupélec, Paris Saclay University, Gif-sur-Yvette, France
| | - Gilles Chatellier
- Department of medical informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, F-75015, Paris, France
| | - Christophe Tournigand
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France
| | - Emmanuelle Kempf
- Department of medical oncology, Henri Mondor and Albert Chenevier Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 1 rue Gustave Eiffel, 94000, Créteil, France.
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France.
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Hussain ZS, Andoh JE, Loya A, Yousefi S, Boland MV. Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists. J Glaucoma 2024; 33:35-39. [PMID: 37523625 PMCID: PMC10796841 DOI: 10.1097/ijg.0000000000002269] [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: 03/26/2023] [Accepted: 06/18/2023] [Indexed: 08/02/2023]
Abstract
PRCIS The change in glaucoma surgical volumes due to the coronavirus disease 2019 pandemic was not uniform across procedure types and was unequal between rural and urban practice locations. PURPOSE To quantify the impact of the coronavirus disease 2019 pandemic on surgical volumes performed by fellowship-trained glaucoma subspecialists. MATERIALS AND METHODS This retrospective cohort analysis of the Centers for Medicare and Medicaid Services Medicare Public Use File extracted all glaucoma surgeries, including microinvasive glaucoma surgeries (MIGSs), trabeculectomy, goniotomy, lasers, and cataract surgery, performed by fellowship-trained glaucoma surgeons in rural and urban areas between 2016 and 2020. Predicted estimates of 2020 surgical volumes were created utilizing linear squares regression. Percentage change between predicted and observed 2020 surgical volume estimates was analyzed. Statistical significance was achieved at P <0.05. RESULTS In 2020, fellowship-trained glaucoma surgeons operated mostly in urban areas (N = 810, 95%). A 29% and 31% decrease in predicted cataract surgery volumes in urban and rural areas, respectively, was observed. Glaucoma surgeries experienced a 36% decrease from predicted estimates (N = 56,781). MIGS experienced an 86% and 75% decrease in rural and urban areas, respectively. Trabeculectomy in rural areas experienced a 16% increase relative to predicted estimates while urban areas experienced a decrease of 3% ( P > 0.05). The number of goniotomies decreased by 10% more in rural areas than in urban areas (-22% and -12%, respectively). Laser procedures decreased by 8% more in urban areas than in rural areas (-18% and -10%, respectively). CONCLUSIONS Among glaucoma-trained surgeons, glaucoma surgeries experienced a greater volume loss than cataract surgeries. In urban US areas, relative reductions in MIGS and goniotomy volumes in urban areas may have been compensated by greater laser and trabeculectomy volumes. Trabeculectomies in rural areas were the only group exceeding predicted estimates. Glaucoma subspecialists may utilize these findings when planning for future events and in overcoming any remaining unmet need in terms of glaucoma care.
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Affiliation(s)
- Zain S. Hussain
- Dean McGee Eye Institute, Oklahoma City, OK, USA
- University of Medicine and Health Sciences, Basseterre, Saint Kitts and Nevis
| | - Joana E. Andoh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asad Loya
- Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Siamak Yousefi
- Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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Kanicka M, Chabowski M, Rutkowska M. A Single-Center Study of the Impact of the COVID-19 Pandemic on the Organization of Healthcare Service Delivery to Patients with Head and Neck Cancer. Cancers (Basel) 2023; 15:4700. [PMID: 37835394 PMCID: PMC10571551 DOI: 10.3390/cancers15194700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
The aim of this study was to identify and assess the impact of the COVID-19 pandemic on the diagnosis and treatment of head and neck cancer (HNC) patients of the Department of Otolaryngology, Head and Neck Surgery of the 4th Military Teaching Hospital in Wroclaw for whom oncological treatment was planned by a cancer case board between March 2018 and February 2022. We analysed the medical records of 625 patients. In order to verify whether the relationships between the analysed features were statistically significant, the chi-square test of independence and the Student's t-test for independent samples were used (p < 0.05). Our analysis showed that the impact of the pandemic on the organization of health service delivery to HNC patients was not uniform. The largest difference in the number of formulated treatment plans was observed at the beginning of the pandemic (22.1% reduction compared with the year before the pandemic). During the pandemic, the proportion of patients admitted on the basis of a DILO (diagnosis and oncological treatment) card issued by a primary care physician, instead of a regular referral to hospital, issued also by a primary care physician, was significantly higher compared with the that during the pre-pandemic period. The majority of cancer patients with a oncological treatment planned during the pandemic lived in urban areas. During the pandemic, the number of patients with more-advanced-stage cancer, assessed on the basis of the type of planned treatment (radical vs. palliative), did not increase compared with that during the pre-pandemic period. However, our follow-up period was quite short. It is necessary to intensify activities aimed at promoting health and increasing health awareness in people living in rural areas and setting long-term priorities and objectives for health policies at the national, regional and local levels, with particular focus on this group of people.
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Affiliation(s)
- Magdalena Kanicka
- Oncological Package Unit, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland;
| | - Mariusz Chabowski
- Department of Surgery, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland
- Department of Nursing and Obstetrics, Division of Anesthesiological and Surgical Nursing, Faculty of Health Science, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Monika Rutkowska
- Department of Otolaryngology, Head and Neck Surgery, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland;
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Rot P, Nicer J, Skrzypiec Ł, Nowocień J, Chloupek A, Jurkiewicz D, Sobol M. Health care system efficiency in otolaryngological surgeries during COVID-19 pandemic in years 2020-2021 compared to years 2018-2019: data from the Military Institute of Medicine in Warsaw. OTOLARYNGOLOGIA POLSKA 2023; 77:48-52. [PMID: 37772379 DOI: 10.5604/01.3001.0053.6709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<b>Introduction:</b> Coronavirus disease 19 (COVID-19) pandemic had a great impact on the health care system. This resulted not only from changes in the way medical facilities operated but also from the need to treat a huge number of patients. On the other hand, uninfected people feared visiting the doctor.</br></br> <b>Aim:</b> The aim of the study was to assess the impact of the COVID-19 pandemic on the diagnostics and treatment of patients with head and neck cancer.</br></br> <b>Materials and methods:</b> This retrospective study involved analysis of data of patients from a single hospital unit who underwent surgical procedures due to head and neck cancer during the COVID-19 pandemic in years 2020-2021 (pandemic group) compared to years 2018-2019 (pre-pandemic group).</br></br> <b>Results:</b> Patients in the pandemic group (n = 123) were older and were more likely to have grade 3 cancer than patients in the pre-pandemic group (n = 116). Cancer stages were similar in both groups. During the pandemic, time from the first outpatient visit to surgery was longer (median 1.6 vs. 0.8 months), while time to radiotherapy was shorter (median 50.5 vs. 63 days) than in the pre-pandemic period.</br></br> <b>Conclusion:</b> During the pandemic, patients had to wait slightly longer for surgery but not for radiotherapy when compared with the pre-pandemic period. Despite this, they did not have more advanced disease.
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Affiliation(s)
- Piotr Rot
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Jakub Nicer
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Łukasz Skrzypiec
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Jakub Nowocień
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Aldona Chloupek
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Maria Sobol
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
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Clements K, Cowell A, White G, Flynn W, Conway DI, Douglas CM, Paterson C. The COVID-19 pandemic has not changed stage at presentation nor treatment patterns of head and neck cancer: A retrospective cohort study. Clin Otolaryngol 2023; 48:587-594. [PMID: 36929626 PMCID: PMC10946702 DOI: 10.1111/coa.14048] [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: 09/22/2022] [Revised: 12/02/2022] [Accepted: 02/25/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES To evaluate the impact of the COVID-19 lockdown measures on HNC, by comparing the stage at presentation and treatment of HNC before and after the most severe COVID-19 restrictions. DESIGN A retrospective cohort study. SETTING A regional cancer network serving a patient population of 2.4 million. PARTICIPANTS Newly diagnosed patients with HNC between June and October 2019 (pre-pandemic) and June and October 2021 (post-pandemic). MAIN OUTCOME MEASURES Symptom duration before diagnosis, stage at diagnosis, patient performance status (PS) and intent of treatment delivered (palliative vs. curative). RESULTS Five hundred forty-five patients were evaluated-250 in the 2019 and 295 in the 2021 cohort. There were no significant differences in symptom duration between the cohorts (p = .359) or patient PS (p = .821). There were no increased odds of presenting with a late (Stage III or IV) AJCC cancer stage in 2021 compared with 2019 (odds ratio [OR] = 0.90; 95% confidence interval [CI]: 0.76-1.08); nor increased odds of receiving palliative rather than curative treatment in 2021 compared with 2019 (OR = 0.68; 95% CI: 0.45-1.03). CONCLUSION The predicted stage shift to more advanced disease at the time of diagnosis of HNC due to the COVID-19 pandemic has not been realised in the longer term. In keeping with this, there was no difference in symptom duration, patient PS, or treatment patterns between the 2019 and 2021 cohorts.
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Affiliation(s)
- Kelten Clements
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
| | - Anna Cowell
- Beatson West of Scotland Cancer CentreGlasgowUK
| | - Gillian White
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
| | - William Flynn
- Department of Otolaryngology – Head and Neck SurgeryGlasgow Royal InfirmaryGlasgowUK
| | - David I. Conway
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
| | - Catriona M. Douglas
- Department of Otolaryngology – Head and Neck SurgeryGlasgow Royal InfirmaryGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
| | - Claire Paterson
- Beatson West of Scotland Cancer CentreGlasgowUK
- Glasgow Head and Neck Cancer (GLAHNC) Research GroupGlasgowUK
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Hirth V, Schopow N, Pfränger J, Roschke E, Heyde CE, Osterhoff G. Virtual versus in-person multidisciplinary musculoskeletal tumor conferences in times of COVID-19. Digit Health 2023; 9:20552076231179045. [PMID: 37456125 PMCID: PMC10338654 DOI: 10.1177/20552076231179045] [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] [Received: 09/21/2022] [Accepted: 05/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Multidisciplinary tumor conferences are a fundamental component in the treatment of oncological patients. The COVID-19 pandemic and its resulting social distancing restrictions offered the opportunity to compare in-person to virtual multidisciplinary tumor conferences. Methods Retrospective analysis of first-time presentations in tumor conferences at a university musculoskeletal tumor center in the time periods from September 2019 to February 2020 (in-person) and May 2020 to October 2020 (virtual). Results A total of 209 patients were first-time discussed in one of 52 analyzed musculoskeletal multidisciplinary tumor conferences (105 patients in 25 in-person, and 104 patients 27 virtual meetings). The total number of participants was slightly lower with virtual meetings (p < .001) and more disciplines were represented in virtual tumor conferences (p < .001). With median six consultants present in either, the level of available expertise did not differ between the conference formats (p = .606). Compared to in-person tumor meetings, the patients were discussed earlier in the virtual conferences (p = .028). The interval between first presentation to biopsy was significantly shorter after virtual tumor conferences (median 4 vs. 7 days, p < .001). There was no significant difference in the interval between initial presentation and resection (p = .544) among the two conference formats. Conclusions The implementation of virtual tumor conferences appears to have had a positive effect on timely diagnosis and multidisciplinarity during tumor conferences. This may result in better decision-making and treatment of patients with musculoskeletal tumors and could be routinely implemented into cancer care.
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Affiliation(s)
- Vanessa Hirth
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Nikolas Schopow
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Jan Pfränger
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Elisabeth Roschke
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Amin NB, Bridgham KM, Brown JP, Moyer KF, Taylor RJ, Wolf JS, Witek ME, Molitoris JK, Mehra R, Cullen KJ, Papadimitriou JC, Raghavan P, Hatten KM. Regionalization of Head and Neck Oncology Tumor Boards: Perspectives of Collaborating Physicians. OTO Open 2023; 7:e18. [PMID: 36998543 PMCID: PMC10046717 DOI: 10.1002/oto2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/15/2022] [Indexed: 03/05/2023] Open
Abstract
Objectives To survey academic and community physician preferences regarding the virtual multidisciplinary tumor board (MTB) for further improvement and expansion. Study Design This anonymous 14-question survey was sent to individuals that participated in the head and neck virtual MTBs. The survey was sent via email beginning August 3, 2021, through October 5, 2021. Setting The University of Maryland Medical Center and regional practices in the state of Maryland. Methods Survey responses were recorded and presented as percentages. Subset analysis was performed to obtain frequency distributions by facility and provider type. Results There were 50 survey responses obtained with a response rate of 56%. Survey participants included 11 surgeons (22%), 19 radiation oncologists (38%), and 8 medical oncologists (16%), amongst others. More than 96% of participants found the virtual MTB to be useful when discussing complex cases and impactful to future patient care. A majority of respondents perceived a reduction in time to adjuvant care (64%). Community and academic physician responses strongly agreed that the virtual MTB improved communication (82% vs 73%), provided patient-specific information for cancer care (82% vs 73%), and improved access to other specialties (66% vs 64%). Academic physicians, more so than community physicians, strongly agreed that the virtual MTB improves access to clinical trial enrollment (64% vs 29%) and can be useful in obtaining CME (64% vs 55%). Conclusion Academic and community physicians view the virtual MTB favorably. This platform can be adapted regionally and further expanded to improve communication between physicians and improve multidisciplinary care for patients.
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Affiliation(s)
- Neha B. Amin
- University of Maryland School of Medicine Baltimore Maryland USA
| | | | - Jessica P. Brown
- Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore Maryland USA
| | - Kelly F. Moyer
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Rodney J. Taylor
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Jeffrey S. Wolf
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Matthew E. Witek
- Department of Radiation Oncology University of Maryland School of Medicine, Maryland Proton Treatment Center Baltimore Maryland USA
| | - Jason K. Molitoris
- Department of Radiation Oncology University of Maryland School of Medicine, Maryland Proton Treatment Center Baltimore Maryland USA
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland School of Medicine Maryland Baltimore USA
| | - Kevin J. Cullen
- Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland School of Medicine Maryland Baltimore USA
| | - John C. Papadimitriou
- Department of Pathology University of Maryland School of Medicine Baltimore Maryland USA
| | - Prashant Raghavan
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
- Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine Baltimore Maryland USA
| | - Kyle M. Hatten
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
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Popovic M, Fiano V, Moirano G, Chiusa L, Conway DI, Garzino Demo P, Gilardetti M, Iorio GC, Moccia C, Ostellino O, Pecorari G, Ramieri G, Ricardi U, Riva G, Virani S, Richiardi L. The Impact of the COVID-19 Pandemic on Head and Neck Cancer Diagnosis in the Piedmont Region, Italy: Interrupted Time-Series Analysis. Front Public Health 2022; 10:809283. [PMID: 35265573 PMCID: PMC8899030 DOI: 10.3389/fpubh.2022.809283] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
Background The COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region. Methods This study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period. Results There were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62-0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89-1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76-1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84-1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80-0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave. Conclusions The COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.
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Affiliation(s)
- Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Valentina Fiano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Luigi Chiusa
- Pathology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - David I. Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Paolo Garzino Demo
- Maxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Gilardetti
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | | | - Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
| | - Oliviero Ostellino
- Oncology Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giancarlo Pecorari
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Maxillofacial Unit, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza Hospital, Turin, Italy
| | | | - Giuseppe Riva
- Division of Otorhinolaryngology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Shama Virani
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
- SC Epidemiologia dei Tumori CRPT U, Azienda Ospedaliero-Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte, Turin, Italy
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10
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Chang CWD, McCoul ED, Briggs SE, Guardiani EA, Durand ML, Hadlock TA, Hillel AT, Kattar N, Openshaw PJM, Osazuwa-Peters N, Poetker DM, Shin JJ, Chandrasekhar SS, Bradford CR, Brenner MJ. Corticosteroid Use in Otolaryngology: Current Considerations During the COVID-19 Era. Otolaryngol Head Neck Surg 2021; 167:803-820. [PMID: 34874793 DOI: 10.1177/01945998211064275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. DATA SOURCES PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. REVIEW METHODS Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell's palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19-specific findings. CONCLUSIONS Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell's palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. IMPLICATIONS FOR PRACTICE SCS use for SSNHL, Bell's palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.
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Affiliation(s)
- C W David Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Selena E Briggs
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC, USA
| | - Elizabeth A Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Marlene L Durand
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nrusheel Kattar
- Department of Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | | | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, USA
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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