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The Impact of COVID-19 Pandemic on Surgical Treatment of Resectable Non-Small Cell Lung Cancer in Greece. Life (Basel) 2023; 13:life13010218. [PMID: 36676167 PMCID: PMC9864579 DOI: 10.3390/life13010218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Background: The coronavirus disease (COVID-19) pandemic has posed an unprecedented challenge to health systems, and has significantly affected the healthcare of lung cancer patients. The aim of our study was to assess the impact of COVID-19 on early lung cancer patients’ surgical treatment. Methods: All consecutive patients with early-stage non-small cell lung cancer eligible for surgical treatment stage I/II and resectable stage III, referred to our department during the first wave of COVID-19 between February to May 2020, were included and compared with those on the exact corresponding quarter in 2019, one year before the pandemic. Waiting time to surgical treatment, increase of tumor’s size and increase on lung cancer stage were recorded and compared. All subjects were followed up for 12 months. Multiple linear and logistic regression models were applied to assess the differences in the management of the studied groups adjusting for potential confounders. Results: Sixty-one patients with early-stage lung cancer were included in the study; 28 (median age 67 years, SD: 7.1) during the pandemic and 33 (median age 67.1 years, SD: 7.5) one year earlier. A significantly longer period of waiting for treatment and an increase in tumor size were observed during the pandemic compared to before the pandemic [median time 47 days, interquartile rate (IQR): 23−100] vs. [median time 18 days, IQR: 11−23], p < 0.001. No significant differences were detected in the increase of the stage of lung cancer between the subgroups. Conclusion: The COVID-19 pandemic had a significant impact on surgical and oncological care, leading to significant delays on treatment and an increase in tumor size in early-stage lung cancer patients.
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Smyrnakis E, Symintiridou D, Andreou M, Dandoulakis M, Theodoropoulos E, Kokkali S, Manolaki C, Papageorgiou DI, Birtsou C, Paganas A, Stachteas P, Vlachopoulos N, Pagkozidis I, Zeimbekis A, Roka V, Giakoumis A, Kotsani M, Avakian I, Makridou E, Gavana M, Haidich AB, Avgerinou C. Primary care professionals' experiences during the first wave of the COVID-19 pandemic in Greece: a qualitative study. BMC FAMILY PRACTICE 2021; 22:174. [PMID: 34474684 PMCID: PMC8412972 DOI: 10.1186/s12875-021-01522-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Background The coronavirus outbreak (COVID-19) tested health care systems worldwide. This qualitative study aimed to explore and understand the experiences, beliefs and concerns of Primary Care Professionals (PCPs) regarding the preparedness and response of primary care to the first wave of the pandemic in Greece, a country where a public structured primary care system has been developing. Methods We conducted semi-structured telephone interviews with 33 PCPs (General Practitioners, community General Internal Medicine Specialists, community Paediatricians and nurses) recruited from all regions of Greece after the first wave of the pandemic (June 2020). Interviews were transcribed verbatim, data were anonymised and analysed. Thematic analysis was applied developing a conceptual framework. Results Four main themes were identified: a) Primary care unit adaptation and issues faced during the pandemic; b) Management of suspected COVID-19 cases; c) Management of non-suspected cases; d) Consequences of the pandemic. In the first phase of the pandemic, remote management of suspected cases and their referral to the hospital were preferred as a result of a shortage of personal protective equipment and inaccessibility to coronavirus testing in primary care. Due to the discontinuation of regular medical services and the limited in-person contact between doctors and patients, chronic disease management and prevention programmes were left behind. Social and emotional consequences of the pandemic, such as workplace stigma, isolation and social seclusion, deriving from fear of viral transmission, as well as burnout symptoms and exhaustion were commonly experienced among PCPs. Positive consequences of the pandemic were considered to be the recognition of the importance of an empowered public healthcare system by citizens and the valuable insight, knowledge and experience professionals gained in times of crisis. Conclusions Primary care has a key role to play during and after the pandemic by using its information infrastructure to identify at-risk groups, detect new cases of COVID-19, provide care according to needs, and carry out vaccination programmes. Central coordination and empowerment of primary care will increase its effectiveness, via public awareness, holistic patient management, and unburdening of hospitals.
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Affiliation(s)
- Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | | | | - Charis Birtsou
- Regional Practice of Lagadikia, Zagliveri Health Center, Prefecture of Thessaloniki, Greece
| | | | - Panagiotis Stachteas
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ilias Pagkozidis
- Aristotle University of Thessaloniki Primary Health Care Research Network, Thessaloniki, Greece
| | | | - Violeta Roka
- Farkadona Health Center, Prefecture of Trikala, Greece
| | | | - Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle "Maladies du Vieillissement, Gérontologie et Soins Palliatifs", F-54000, Nancy, France
| | - Ioanna Avakian
- Regional Practice of Zappeio, Farsala Health Center, Prefecture of Larissa, Greece
| | - Efthymia Makridou
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Magda Gavana
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Social and Preventive Medicine, and Medical Statistics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Avgerinou
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
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Liapikou A, Tzortzaki E, Hillas G, Markatos M, Papanikolaou IC, Kostikas K. Outpatient Management of COVID-19 Disease: A Holistic Patient-Centered Proposal Based on the Greek Experience. J Pers Med 2021; 11:709. [PMID: 34442353 PMCID: PMC8400346 DOI: 10.3390/jpm11080709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022] Open
Abstract
Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic and affected more than 227 countries or territories, resulting in more than 179 million cases with over 3.890.00 deaths, as of June 25, 2021. The Hellenic Thoracic Society (HTS) during the second wave of COVID-19 pandemic released a guidance document for the management of patients with COVID-19 in the community and in hospital setting. In this review, with guidance the HTS document, we are discussing the outpatient management of COVID-19 patients, including the preventive measures, the patients' isolation and quarantine criteria of close contacts, the severity and risk stratification, including the decisions for advanced hospitalization, and the disease management at home in patients with mild disease and after hospital discharge for those with more severe disease.
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Affiliation(s)
- Adamantia Liapikou
- 6th Respiratory Department, Sotiria Chest Diseases Hospital, 11527 Athens, Greece
| | - Eleni Tzortzaki
- Respiratory Outpatient Clinic, Heraklion, 71305 Crete, Greece; (E.T.); (M.M.)
| | - Georgios Hillas
- 5th Respiratory Department, Sotiria Chest Diseases Hospital, 11527 Athens, Greece;
| | - Miltiadis Markatos
- Respiratory Outpatient Clinic, Heraklion, 71305 Crete, Greece; (E.T.); (M.M.)
| | - Ilias C. Papanikolaou
- Pulmonary Department, Sarcoidosis Clinic, General Hospital of Corfu, 49100 Corfu, Greece;
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University Hospital of Ioannina, 45500 Ioannina, Greece;
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Symvoulakis EK, Anyfantakis D. Primary care and the COVID-19 pandemic: Schrödinger's cat. ERJ Open Res 2021; 7:00730-2020. [PMID: 33569496 PMCID: PMC7861024 DOI: 10.1183/23120541.00730-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022] Open
Abstract
We read with interest the article by Tomoset al. [1] reporting on the low death rates during the coronavirus disease 2019 (COVID-19) pandemic crisis in Greece. The authors underlined the importance of primary care in the management of suspected and mild cases and the reduction of inappropriate hospital referrals [1]. With good intentions, the authors offered their own view by stating that the key issue for the reported “Greek success story” is that the primary healthcare system is based on specialist doctors and not general practitioners [1]. They also suggested an algorithm that will help physicians to stratify the risk of infection, highlighting the importance of telemedicine [1]. We also support the usefulness of this conceptual framework. For large population groups that mainly benefit from rural primary care, limited access to private services can be an additional benefit. The #COVID19 pandemic crisis requires the collaboration of all healthcare providers. Every contribution is welcome to gain time during the phase of “system state” superposition.https://bit.ly/3m4SBxY
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Affiliation(s)
- Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece
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