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Antoni MH, Moreno PI, Penedo FJ. Stress Management Interventions to Facilitate Psychological and Physiological Adaptation and Optimal Health Outcomes in Cancer Patients and Survivors. Annu Rev Psychol 2023; 74:423-455. [PMID: 35961041 PMCID: PMC10358426 DOI: 10.1146/annurev-psych-030122-124119] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cancer diagnosis and treatment constitute profoundly stressful experiences involving unique and common challenges that generate uncertainty, fear, and emotional distress. Individuals with cancer must cope with multiple stressors, from the point of diagnosis through surgical and adjuvant treatments and into survivorship, that require substantial psychological and physiological adaptation. This can take a toll on quality of life and well-being and may also promote cellular and molecular changes that can exacerbate physical symptoms and facilitate tumor growth and metastasis, thereby contributing to negative long-term health outcomes. Since modifying responses tostressors might improve psychological and physiological adaptation, quality of life, and clinical health outcomes, several randomized controlled trials have tested interventions that aim to facilitate stress management. We review evidence for the effects of stress management interventions on psychological and physiological adaptation and health outcomes in cancer patients and survivors and summarize emerging research in the field to address unanswered questions.
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Affiliation(s)
- Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Patricia I Moreno
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, Florida, USA;
- Cancer Control Research Program, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
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Jabbal IS, Sabbagh S, Dominguez B, Itani M, Mohanna M, Samuel T, Nahleh Z. Impact of COVID-19 on Cancer-Related Care in the United States: An Overview. Curr Oncol 2023; 30:681-687. [PMID: 36661702 PMCID: PMC9858078 DOI: 10.3390/curroncol30010053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
COVID-19 impacted several health services, including cancer-related care. Its implications were significant due to the lapse in hospital resources, compounded by the delays stemming from the economic effects on patients' jobs and medical coverage. Furthermore, reports suggesting an increased risk for morbidity and mortality from COVID-19 in patients with cancer and those on active cancer treatment caused additional fear and potential delays in seeking medical services. This review provides an overview of the pandemic's impact on cancer care in the United States and suggests measures for tackling similar situations in the future.
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Affiliation(s)
| | | | | | | | | | | | - Zeina Nahleh
- Department of Hematology-Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL 33331, USA
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Assaad S, Zrounba P, Cropet C, Blay JY. Mortality of patients with solid and haematological cancers presenting with symptoms of COVID-19 with vs without detectable SARS-COV-2: a French nationwide prospective cohort study. Br J Cancer 2021; 125:658-671. [PMID: 34135471 PMCID: PMC8206183 DOI: 10.1038/s41416-021-01452-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/26/2021] [Accepted: 05/27/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Over 30 million COVID-19 cases have been diagnosed worldwide from late 2019. Among frail persons, cancer patients are at high risk of death from COVID-19. METHODS The French prospective cohort ONCOVID-19 enrolled patients with solid or haematological tumour, receiving anticancer treatment and presenting with clinical symptoms suggestive of COVID-19. COVID-19 was confirmed through detectable SARS-CoV2 by RT-PCR (repeated twice if negative first) and/or specific CT-scan. The study aims to assess the 28-day mortality rate after the first COVID test. RESULTS From March 1st to May 21st 2020, 23 French cancer centres and hospitals enrolled 1230 cancer patients with suspicion of COVID-19, including 1162 (94.5%) matching the inclusion criteria. We identified 425 (36.6%) COVID-19 positive patients including 155 (13.3%) diagnosed with CT-scan only, while 737 (63.4%) patients were COVID-19 negative. Death at day-28 occurred in 116/425 (27.8%) COVID-19 positive patients, and in 118/737 (16.3%) COVID-19 negative patients (p < 0·0001). With a median follow-up of 2.1 (1.6-2.4) months, 310 (26.7%) deaths were reported including 143 (33.6%) in the COVID-19 positive population, and 167 (22.7%) in the COVID-19 negative patients. Male gender, age, metastatic disease, immunosuppressive treatments, lymphopenia, COVID-19 diagnosis and diabetes were independent risk factors for death. CONCLUSION Patients with solid and haematological cancers presenting COVID-19 symptoms with SARS-CoV-2 RT-PCR confirmed or not are both at high-risk of early mortality. COVID-19 is reported as the cause of death in 50% of COVID-19 positive patients with cancer. CLINICAL TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, number NCT04363632.
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Affiliation(s)
- Souad Assaad
- Medical Oncology Department, Centre Léon Bérard, Lyon, France.
| | | | - Claire Cropet
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon Bérard, Lyon, France.
- Université Claude Bernard, Lyon, France & Unicancer, Paris, France.
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Bandinelli L, Ornell F, von Diemen L, Kessler FHP. The Sum of Fears in Cancer Patients Inside the Context of the COVID-19. Front Psychiatry 2021; 12:557834. [PMID: 33897477 PMCID: PMC8058213 DOI: 10.3389/fpsyt.2021.557834] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
The pandemic resulting from COVID-19 has led to the collapse of the health system in dozens of countries. Parallel to clinical risk, the appearance or intensification of psychiatric symptoms has also been documented. The identification of groups at risk is essential for the establishment of preventive and therapeutic strategies. Cancer patients appear to be especially vulnerable both from a clinical and psychiatric perspective. Problems related to contamination and the cancer treatments themselves are intertwined, causing a sum of patients' fears to arise, which can cause mental effects. This study aims to review and investigate the impact of COVID-19 on the mental health of cancer patients and indicate possible support strategies.
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Affiliation(s)
- Lucas Bandinelli
- Postgraduate Program in Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Ornell
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lisia von Diemen
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Queen's University Department of Psychiatry, Providence Care Hospital, Kingston, ON, Canada
| | - Felix Henrique Paim Kessler
- Center for Drug and Alcohol Research and Collaborating Center on Alcohol and Drugs, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Liu H, Yang D, Chen X, Sun Z, Zou Y, Chen C, Sun S. The effect of anticancer treatment on cancer patients with COVID-19: A systematic review and meta-analysis. Cancer Med 2021; 10:1043-1056. [PMID: 33381923 PMCID: PMC7897967 DOI: 10.1002/cam4.3692] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The relationship between cancer and COVID-19 has been revealed during the pandemic. Some anticancer treatments have been reported to have negative influences on COVID-19-infected patients while other studies did not support this hypothesis. METHODS A literature search was conducted in WOS, PubMed, Embase, Cochrane Library, CNKI and VIP between Dec 1, 2019 and Sept 23, 2020 for studies on anticancer treatments in patients with COVID-19. Cohort studies involving over 20 patients with cancer were included. The characteristics of the patients and studies, treatment types, mortality, and other additional outcomes were extracted and pooled for synthesis. RRs and forest plots were adopted to present the results. The literature quality and publication bias were assessed using NOS and Egger's test, respectively. RESULTS We analyzed the data from 29 studies, with 5121 cancer patients with COVID-19 meeting the inclusion criteria. There were no significant differences in mortality between patients receiving anticancer treatment and those not (RR 1.17, 95%CI: 0.96-1.43, I2 =66%, p = 0.12). Importantly, in patients with hematological malignancies, chemotherapy could markedly increase the mortality (RR 2.68, 95% CI: 1.90-3.78, I2 =0%, p < 0.00001). In patients with solid tumors, no significant differences in mortality were observed (RR 1.16, 95% CI: 0.57-2.36, I2 =72%, p = 0.67). In addition, our analysis revealed that anticancer therapies had no effects on the ICU admission rate (RR 0.87, 95% CI: 0.70-1.09, I2 =25%, p = 0.23), the severe rate (RR 1.04, 95% CI: 0.95-1.13, I2 =31%, p = 0.42), or respiratory support rate (RR 0.92, 95% CI: 0.70-1.21, I2 =32%, p = 0.55) in COVID-19-infected patients with cancer. Notably, patients receiving surgery had a higher rate of respiratory support than those without any antitumor treatment (RR 1.87, 95%CI: 1.02-3.46, I2 =0%, p = 0.04). CONCLUSIONS No significant difference was seen in any anticancer treatments in the solid tumor subgroup. Chemotherapy, however, will lead to higher mortality in patients with hematological malignancies. Multicenter, prospective studies are needed to re-evaluate the results.
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Affiliation(s)
- Hanqing Liu
- Department of Thyroid and Breast SurgeryRenmin Hospital of Wuhan UniversityWuhanHubeiPR China
| | - Dan Yang
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanHubeiPR China
| | - Xinyue Chen
- Department of Thyroid and Breast SurgeryRenmin Hospital of Wuhan UniversityWuhanHubeiPR China
| | - Zhihong Sun
- Department of Thyroid and Breast SurgeryRenmin Hospital of Wuhan UniversityWuhanHubeiPR China
| | - Yutong Zou
- Department of Laboratory MedicinePeking Union Medical College HospitalChinese Academy of Medical SciencesDongcheng DistrictBeijingPR China
| | - Chuang Chen
- Department of Thyroid and Breast SurgeryRenmin Hospital of Wuhan UniversityWuhanHubeiPR China
| | - Shengrong Sun
- Department of Thyroid and Breast SurgeryRenmin Hospital of Wuhan UniversityWuhanHubeiPR China
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Bhogal T, Khan UT, Lee R, Stockdale A, Hesford C, Potti-Dhananjaya V, Jathanna A, Rahman S, Tivey A, Shotton R, Sundar R, Valerio C, Norouzi A, Walker P, Suckling R, Armstrong A, Brearton G, Pettitt A, Kalakonda N, Palmer DH, Jackson R, Turtle L, Palmieri C. Haematological malignancy and nosocomial transmission are associated with an increased risk of death from COVID-19: results of a multi-center UK cohort. Leuk Lymphoma 2021; 62:1682-1691. [PMID: 33508995 DOI: 10.1080/10428194.2021.1876865] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic has been a disruptive event for cancer patients, especially those with haematological malignancies (HM). They may experience a more severe clinical course due to impaired immune responses. This multi-center retrospective UK audit identified cancer patients who had SARS-CoV-2 infection between 1 March and 10 June 2020 and collected data pertaining to cancer history, COVID-19 presentation and outcomes. In total, 179 patients were identified with a median age of 72 (IQR 61, 81) and follow-up of 44 days (IQR 42, 45). Forty-one percent were female and the overall mortality was 37%. Twenty-nine percent had HM and of these, those treated with chemotherapy in the preceding 28 days to COVID-19 diagnosis had worse outcome compared with solid malignancy (SM): 62% versus 19% died [HR 8.33 (95% CI, 2.56-25), p < 0.001]. Definite or probable nosocomial SARS-CoV-2 transmission accounted for 16% of cases and was associated with increased risk of death (HR 2.47, 95% CI 1.43-4.29, p = 0.001). Patients with haematological malignancies and those who acquire nosocomial transmission are at increased risk of death. Therefore, there is an urgent need to reassess shielding advice, reinforce stringent infection control, and ensure regular patient and staff testing to prevent nosocomial transmission.
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Affiliation(s)
- Talvinder Bhogal
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Umair T Khan
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Rebecca Lee
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,The University of Manchester, Manchester, UK
| | - Alexander Stockdale
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust (Member of Liverpool Health Partners), Liverpool, UK
| | | | | | - Avith Jathanna
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Shaun Rahman
- IC1 Liverpool Science Park, North West Coast Clinical Research Network, Liverpool, UK
| | - Ann Tivey
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Rohan Shotton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Ram Sundar
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Amir Norouzi
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Philip Walker
- IC1 Liverpool Science Park, North West Coast Clinical Research Network, Liverpool, UK
| | - Ruth Suckling
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Anne Armstrong
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,The University of Manchester, Manchester, UK
| | - Gillian Brearton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Nagesh Kalakonda
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel H Palmer
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Richard Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Lance Turtle
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust (Member of Liverpool Health Partners), Liverpool, UK.,NIHR Health Protection Unit in Emerging and Zoonotic infections, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - Carlo Palmieri
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.,The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
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Elsabeeny WY, Abd El Dayem OY, Rabea A, Ibrahim RSM, Mahmoud HGM, Kamal E, Osman RA, Ghoneim A. Insights of COVID-19 pandemic impact on anesthetic management for patients undergoing cancer surgery in the National Cancer Institute, Egypt. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2020. [PMCID: PMC7656221 DOI: 10.1186/s42077-020-00110-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract New corona virus disease COVID-19 is a pandemic outbreak viral infection that is highly contagious. The disease can affect any age groups. Majority of patients show mild or no symptoms. Immunocompromised patients and patients with co-morbidities are more vulnerable to have more aggressive affection with higher rate of complications. Thus, cancer patients carry a higher risk of infection. Diseased patient can transmit infection throughout the disease course starting from the incubation period to clinical recovery. All healthcare workers contacting COVID-19-positive patients are at great risk of infection, especially the anesthesiologists who can be exposed to high viral load during airway manipulation. In the National Cancer Institute of Egypt, we apply a protocol to prioritize cases where elective cancer surgeries that would not affect patient prognosis and outcome are postponed during the early phase and peak of the pandemic till reaching a plateau. However, emergency and urgent surgeries that can compromise cancer patient’s life and prognosis take place after the proper assessment of the patient’s condition. Aim This review aims to spot the management of cancer patients undergoing surgery during the COVID-19 pandemic in the National Cancer Institute, Egypt.
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Liu Y, Lu H, Wang W, Liu Q, Zhu C. Clinical risk factors for mortality in patients with cancer and COVID-19: a systematic review and meta-analysis of recent observational studies. Expert Rev Anticancer Ther 2020; 21:107-119. [PMID: 33054414 DOI: 10.1080/14737140.2021.1837628] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with cancer are more vulnerable to COVID-19 than the general population. Accordingly, it is necessary to identify the risk factors for death in patients with cancer and COVID-19. METHODS PubMed, Cochrane Library, and Embase Ovid databases were searched for relevant articles published before July 31st, 2020. Studies that explored the risk factors for mortality were included. The effect size was relative risk (RR) and 95% confidence interval (CI). RESULTS We included 17 observational studies involving 3268 patients. The pooled mortality was 24.8%. Male gender, age above 65 years, and comorbidities (especially hypertension and COPD) were risk factors for death (RR 1.16, 1.27, 1.12; 95% CI 0.7-1.95, 1.08-1.49, 1.04-1.2; P = 0.006, 0.004, and 0.002, respectively). Recent anti-cancer treatments did not increase mortality (P > 0.05). Dyspnea, cough, and sputum canused an elevated risk of death (P < 0.05). Antibiotics, glucocorticoids, interferons, invasive ventilation, and complications were associated with a high probability of death (P < 0.05). CONCLUSIONS Various demographic and clinical characteristics, such as male gender, advanced age, comorbidities, and symptoms, were risk factors for mortality in patients with cancer and COVID-19. Our findings suggest recent anti-cancer treatments do not increase mortality.
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Affiliation(s)
- Yang Liu
- Department of Radiotherapy Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital , Henan, China
| | - Huan Lu
- Department of Anesthesia and Intensive Care, Fudan University Shanghai Cancer Center , Shanghai, China
| | - Wei Wang
- Department of Clinical Evaluation, Henan Medical Association , Zhengzhou, Henan, China
| | - Qi Liu
- Department of Emergency Intensive Care, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan, China
| | - Changju Zhu
- Department of Emergency Intensive Care, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan, China
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Collateral effects of the coronavirus disease 2019 pandemic on lung cancer diagnosis in Korea. BMC Cancer 2020; 20:1040. [PMID: 33121456 PMCID: PMC7594984 DOI: 10.1186/s12885-020-07544-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022] Open
Abstract
Background The COVID-19 pandemic is predicted to significantly affect patients with lung cancer, owing to its rapid progression and high mortality. Studies on lung cancer diagnosis and treatment during an epidemic are lacking. We analyzed the impact of COVID-19 on lung cancer diagnosis in Korea, where lung cancer incidence continues to rise. Methods The number of newly diagnosed lung cancer cases in three university-affiliated hospitals during the pandemic and their clinical features were compared with lung cancer cases diagnosed during the same period in the past 3 years. The effectiveness of measures taken by the study hospitals to prevent nosocomial transmission was reviewed. Results A total of 612 patients were diagnosed with lung cancer from February through June, 2017–2020. During the pandemic, the number of patients who sought consultation at the division of pulmonology of study hospitals dropped by 16% from the previous year. Responding to the pandemic, the involved hospitals created physically isolated triage areas for patients with acute respiratory infection symptoms. Wide-range screening and preventive measures were implemented, thus minimizing the delay in lung cancer diagnosis. No patient acquired COVID-19 due to hospital exposure. The proportion of patients with stage III–IV non-small-cell lung cancer (NSCLC) significantly increased (2020: 74.7% vs. 2017: 57.9%, 2018: 66.7%, 2019: 62.7%, p = 0.011). The number of lung cancers diagnosed during this period and the previous year remained the same. Conclusions The proportion of patients with advanced NSCLC increased during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07544-3.
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10
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COVID-19 Outbreak and Oncological Surgery Practice. Indian J Surg Oncol 2020; 12:114-116. [PMID: 33013104 PMCID: PMC7519380 DOI: 10.1007/s13193-020-01239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 01/08/2023] Open
Abstract
The emergence of COVID-19 has caused a global public health emergency. With the World Health Organization (WHO) reporting the novel coronavirus outbreak a pandemic, the focus is needed on the influence of this rapidly spreading viral infection on cancer patients. In this study, we aimed to address cancer-related operations during the COVID-19 outbreak. We retrospectively reviewed 26 patients who had undergone cancer surgeries admitted from March 13 to May 13, 2020, during the COVID-19 epidemic at Istanbul Bagcilar Training and Research Hospital, as a pandemic hospital. A total of 26 cases of COVID-19 were enrolled in the study. Seventeen (65%) were female, and 9 (35%) were male. The mean age was 52.4 (range 28–74). The mean body mass index (BMI) is 27.8 kg/m2 (range 17.6–34.0). Eight of them had comorbidities. 7 patients needed an intensive care unit (ICU). Only one patient was COVID-19 positive in the PCR test, while the others were negative. In addition to this patient, 3 other patients were COVID-19 positive on computed tomography (CT). The patients included in this study underwent various oncologic surgery procedures. While 24 patients were discharged without any problems, 2 patients developed complications. Due to respiratory problems, the patient could not get out of intensive care and died on the sixth postoperative day. It is the obligation of the institutions and the medical staff to reassure patients by creating safe postoperative surgical environments free of COVID-19. Surgeon leaders need to synthesize actual data to make the best decisions for their cancer patients.
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Okoli GN, Lam OLT, Abdulwahid T, Neilson CJ, Mahmud SM, Abou-Setta AM. Seasonal influenza vaccination among cancer patients: A systematic review and meta-analysis of the determinants. Curr Probl Cancer 2020; 45:100646. [PMID: 32917396 DOI: 10.1016/j.currproblcancer.2020.100646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
Cancer patients are among high-risk individuals for whom seasonal influenza vaccine (SIV) is recommended, but rates of vaccination in this subpopulation remain suboptimal; even in jurisdictions with universal influenza vaccination programs. We sought to summarize the evidence to better understand the determinants of SIV uptake (vaccine receipt) among cancer patients. We searched MEDLINE, Embase, and CINAHL from 2000 to February 12, 2020, focusing on articles on the determinants of seasonal influenza vaccination among cancer patients, published in English. Study selection was conducted independently by 2 reviewers. One reviewer extracted data from the included studies and another reviewer checked the extracted data for errors. Outcomes were sociodemographic and health-related factors. We pooled adjusted results from studies using the inverse variance, random-effects method, and reported the odds ratios (OR) and their 95% confidence intervals (CI). Out of 2664 citations, 10 studies (mostly from USA and South Korea) met our eligibility criteria. Overall, being older (OR 2.23, 95% CI 1.46-3.38; I2 92.3%, [6 studies]), a nonsmoker (1.43, 1.32-1.51; I2 0%, [4 studies]), having a chronic illness (1.18, 1.07-1.29; I2 15.7%, [5 studies]), having had a medical check-up in the past year (1.75, 1.65-1.86; I2 0%, [2 studies]), and having health insurance (1.39, 1.13-1.72; I2 21.8%, [3 studies]) were associated with increased SIV uptake. Compared with being African-American, being Caucasian was also associated with increased SIV uptake (1.79, 1.47-2.13; I2 10.7%, [3 studies]). Limited evidence suggests seasonal influenza vaccination among cancer patients may be determined by some sociodemographic and health-related factors.
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Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, MB, Canada; George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada.
| | - Otto L T Lam
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada
| | - Tiba Abdulwahid
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada
| | - Christine J Neilson
- Neil John Maclean Health Sciences Library, University of Manitoba, MB, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, MB, Canada; Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB, Canada; Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB, Canada
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Rossi D, Shadman M, Condoluci A, Brown JR, Byrd JC, Gaidano G, Hallek M, Hillmen P, Mato A, Montserrat E, Ghia P. How We Manage Patients With Chronic Lymphocytic Leukemia During the SARS-CoV-2 Pandemic. Hemasphere 2020; 4:e432. [PMID: 32803132 PMCID: PMC7410019 DOI: 10.1097/hs9.0000000000000432] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/15/2022] Open
Abstract
Infections are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). These can be exacerbated by anti-leukemic treatments. In addition, the typical patients with CLL already have fragilities and background risk factors that apply to the general population for severe COVID-19. On these bases, patients with CLL may experience COVID-19 morbidity and mortality. Recurrent seasonal epidemics of SARS-CoV-2 are expected, and doctors taking care of patients with CLL must be prepared for the possibility of substantial resurgences of infection and adapt their approach to CLL management accordingly. In this Guideline Article, we aim at providing clinicians with a literature-informed expert opinion on the management of patients with CLL during SARS-CoV-2 epidemic.
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Affiliation(s)
- Davide Rossi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Laboratory of Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Mazyar Shadman
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Adalgisa Condoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Jennifer R. Brown
- Chronic Lymphocytic Leukemia Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - John C. Byrd
- The Ohio State University Comprehensive Cancer Center and Division of Hematology, Columbus, Ohio, USA
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Michael Hallek
- Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Cologne, Germany
| | - Peter Hillmen
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
- Section of Experimental Haematology, University of Leeds, Leeds, United Kingdom
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emili Montserrat
- Hospital Clinic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Paolo Ghia
- Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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13
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Tuech JJ, Gangloff A, Di Fiore F, Benyoucef A, Michel P, Schwarz L. The Day after Tomorrow: How Should We Address Health System Organization to Treat Cancer Patients after the Peak of the COVID-19 Epidemic? Oncology 2020; 98:827-835. [PMID: 32683373 PMCID: PMC7445382 DOI: 10.1159/000509650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
On March 11, 2020, the WHO director general declared COVID-19 a pandemic. This pandemic evolves in successive phases, i.e., phase 1 (the start phase), phase 2 (“the storm”), and phase 3 (the recession). To date, oncology and surgery groups have only given instructions for addressing phases 1 and 2. To prevent excess cancer mortality, health care systems (HCS) need to be restructured. Our aim is to detail the specificities of each epidemic phase and discuss several methods of organization to optimize cancer patient flow during the COVID-19 pandemic, particularly during phase 3. Hospitals must be reorganized in order to create a cancer hub that is free of infection, allowing for the safe treatment of patients. Hospital structures are different, but all allow for the creation of virus-free areas. Screening programs are critical and need to be applied to all people entering the virus-free zone, including health care workers. Some reorganization proposals are internal to a hospital, while others require interhospital collaboration. The heterogeneity and complexity of HCS will make interhospital management difficult. The ministry of health has an important role in managing the cancer crisis. Cancer management should be declared a priority. Oncological and surgical societies must coordinate their efforts to facilitate this prioritization. The anticipation of oncological management during phase 3 of the pandemic is necessary because it requires a complete readjustment of HCS. This adaptation should allow for the continuation of cancer care to prevent excess cancer mortality, as the virus will still be present for a currently undetermined period of time.
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Affiliation(s)
- Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France, .,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France,
| | - Alice Gangloff
- Department of Digestive Oncology, Rouen University Hospital, Rouen, France
| | - Frederic Di Fiore
- UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France.,Department of Digestive Oncology, Rouen University Hospital, Rouen, France
| | - Ahmed Benyoucef
- Radiotherapy Department, Centre de Lutte Contre le Cancer Henri-Bequerel, Rouen, France
| | - Pierre Michel
- UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France.,Department of Digestive Oncology, Rouen University Hospital, Rouen, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France.,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France
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14
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Al‐Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, Wolff RA, Ibrahim NK, Chua ML, Hotte SJ, Meyers BM, Elfiki T, Curigliano G, Eng C, Grothey A, Xie C. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist 2020; 25:e936-e945. [PMID: 32243668 PMCID: PMC7288661 DOI: 10.1634/theoncologist.2020-0213] [Citation(s) in RCA: 431] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.
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Affiliation(s)
- Humaid O. Al‐Shamsi
- Medical Oncology Department, Alzahra Hospital DubaiDubaiUnited Arab Emirates
- Department of Medicine, University of SharjahSharjahUnited Arab Emirates
- Emirates Oncology SocietyDubaiUnited Arab Emirates
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, Medicine, McMaster UniversityHamiltonOntarioCanada
- Medicine, McMaster UniversityHamiltonOntarioCanada
| | - Ahmad Alhuraiji
- Department of Hematology, Kuwait Cancer Control CenterKuwait
| | - Eric A. Coomes
- Division of Infectious Disease, Department of Medicine, University of TorontoTorontoOntarioCanada
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Robert A. Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Nuhad K. Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Melvin L.K. Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Center SingaporeSingapore
- Oncology Academic Program, Duke‐NUS Medical SchoolSingapore
- Cong Hua's InstituteSingapore
| | - Sebastien J. Hotte
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Brandon M. Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Tarek Elfiki
- Windsor Regional Cancer CenterWindsorOntarioCanada
- Department of Oncology, Schulich School of Medicine, University of Western OntarioLondonOntarioCanada
| | - Giuseppe Curigliano
- Department of Oncology and Hemato‐Oncology University of MilanMilanItaly
- Division of Early Drug Development for Innovative Therapy, University of MilanMilanItaly
- European Institute of OncologyMilanItaly
- IRCCS, University of MilanoMilanItaly
| | - Cathy Eng
- Vanderbilt‐Ingram Cancer CenterNashvilleTennesseeUSA
| | - Axel Grothey
- West Cancer Center, University of TennesseeMemphisTennesseeUSA
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan UniversityWuhanPeople's Republic of China
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15
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Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, Pradhan K, Thota R, Reissman S, Sparano JA, Gartrell BA, Smith RV, Ohri N, Garg M, Racine AD, Kalnicki S, Perez-Soler R, Halmos B, Verma A. Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discov 2020; 10:935-941. [PMID: 32357994 PMCID: PMC7334098 DOI: 10.1158/2159-8290.cd-20-0516] [Citation(s) in RCA: 558] [Impact Index Per Article: 139.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
Patients with cancer in a New York hospital system were much more vulnerable to COVID-19 death than the general population, with a case fatality rate that varied by cancer type and was 28% overall. Patients with cancer are presumed to be at increased risk from COVID-19 infection–related fatality due to underlying malignancy, treatment-related immunosuppression, or increased comorbidities. A total of 218 COVID-19–positive patients from March 18, 2020, to April 8, 2020, with a malignant diagnosis were identified. A total of 61 (28%) patients with cancer died from COVID-19 with a case fatality rate (CFR) of 37% (20/54) for hematologic malignancies and 25% (41/164) for solid malignancies. Six of 11 (55%) patients with lung cancer died from COVID-19 disease. Increased mortality was significantly associated with older age, multiple comorbidities, need for ICU support, and elevated levels of D-dimer, lactate dehydrogenase, and lactate in multivariate analysis. Age-adjusted CFRs in patients with cancer compared with noncancer patients at our institution and New York City reported a significant increase in case fatality for patients with cancer. These data suggest the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population. Significance: COVID-19 in patients with cancer is associated with a significantly increased risk of case fatality, suggesting the need for proactive strategies to reduce likelihood of infection and improve early identification in this vulnerable patient population. This article is highlighted in the In This Issue feature, p. 890
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Affiliation(s)
- Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Sanjay Goel
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Daniel Cole
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mendel Goldfinger
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Ana Acuna-Villaorduna
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Kith Pradhan
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Raja Thota
- Network Performance Group, Montefiore Medical Center, Bronx, New York
| | - Stan Reissman
- Network Performance Group, Montefiore Medical Center, Bronx, New York
| | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Benjamin A Gartrell
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Richard V Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Andrew D Racine
- Department of Pediatrics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Roman Perez-Soler
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Balazs Halmos
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
| | - Amit Verma
- Department of Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
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16
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Buchy P, Badur S. Who and when to vaccinate against influenza. Int J Infect Dis 2020; 93:375-387. [DOI: 10.1016/j.ijid.2020.02.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022] Open
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17
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Burke J, Soubani AO. Influenza and Pneumocystis jirovecii pneumonia in an allogeneic hematopoietic stem cell transplantation recipient: Coinfection or superinfection? Transpl Infect Dis 2017; 20. [PMID: 29111605 DOI: 10.1111/tid.12802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/28/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
Influenza infection and Pneumocystis jirovecii pneumonia (PJP) in hematopoietic stem cell transplant (HSCT) patients are well characterized; however, no dual infections have been reported in this patient population and little evidence of mechanisms of interaction between the two infections exists. We present a 53-year-old male allogeneic HSCT patient on immunosuppressive therapy for the treatment of graft versus host disease initially diagnosed with influenza A H3 and later PJP. Despite the development of acute respiratory distress syndrome, the patient was successfully treated with appropriate antimicrobial therapy and aggressive supportive care. This case demonstrates the necessity of maintaining a high index of suspicion for fungal (including PJP) coinfection or superinfection in the setting of worsening influenza infection.
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Affiliation(s)
- Jacob Burke
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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18
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A pilot randomized trial of adjuvanted influenza vaccine in adult allogeneic hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2017; 52:1016-1021. [PMID: 28263288 DOI: 10.1038/bmt.2017.24] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/26/2016] [Accepted: 01/12/2017] [Indexed: 11/08/2022]
Abstract
The annual influenza vaccine is recommended for hematopoietic stem cell transplant (HSCT) patients although studies have shown suboptimal immunogenicity. Influenza vaccine containing an oil-in-water emulsion adjuvant (MF59) may lead to greater immunogenicity in HSCT recipients. We randomized adult allogeneic HSCT patients to receive the 2015-2016 influenza vaccine with or without MF59 adjuvant. Preimmunization and 4-week post-immunization sera underwent strain-specific hemagglutination inhibition assay. We randomized 73 patients and 67 (35 adjuvanted; 32 non-adjuvanted) had paired samples available at follow-up. Median age was 54 years (range 22-74) and time from transplant was 380 days (range 85-8107). Concurrent graft-versus-host disease was seen in 42/73 (57.5%). Geometric mean titers increased significantly after vaccination in both groups. Seroconversion to at least one of three influenza antigens was present in 62.9% vs 53.1% in adjuvanted vs non-adjuvanted vaccine (P=0.42). Factors associated with lower seroconversion rates were use of calcineurin inhibitors (P<0.001) and shorter duration from transplantation (P=0.001). Seroconversion rates were greater in patients who got previous year influenza vaccination (82.6% vs 45.5%, P=0.03). Adjuvanted vaccine demonstrated similar immunogenicity to non-adjuvanted vaccine in the HSCT population and may be an option for some patients.
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19
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Yue MC, Collins JT, Subramoniapillai E, Kennedy GA. Successful use of oseltamivir prophylaxis in managing a nosocomial outbreak of influenza A in a hematology and allogeneic stem cell transplant unit. Asia Pac J Clin Oncol 2016; 13:37-43. [PMID: 27730741 DOI: 10.1111/ajco.12565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/31/2016] [Accepted: 04/20/2016] [Indexed: 01/08/2023]
Abstract
AIM To describe a nosocomial outbreak of H1N1 influenza A in an inpatient hematology and allogeneic stem cell transplant unit and outcomes of universal oseltamivir prophylaxis. METHODS Medical records of all patients admitted to the unit were reviewed to define the nosocomial outbreak, commencing 1 week prior to the index case until 4 weeks following institution of oseltamivir prophylaxis. Timelines for clinical symptoms, viral spread, management, patient outcomes and follow up testing were constructed. All cases of influenza were confirmed on nasopharyngeal swabs and/or bronchoalveolar lavages collected for polymerase chain reaction testing. RESULTS In addition to the index case, further 11 patients were diagnosed with influenza A during the outbreak. Six patients (50%) had influenza-like-illness, five (42%) had respiratory symptoms only and one (8%) was asymptomatic. In total, five patients died, including four (33%) patients who were admitted to intensive care. A clustering of seven cases led to recognition of the outbreak and subsequent commencement of universal prophylaxis with oseltamivir 75 mg/day in all inpatients within the unit. Strict infection control processes were reinforced concurrently. There were no further cases of influenza A linked to the outbreak after the implementation of universal oseltamivir prophylaxis. Three later cases were linked to H1N1 exposure during the original outbreak. CONCLUSION H1N1 influenza infection is associated with significant mortality in hematology patients. Universal prophylaxis with oseltamivir during a nosocomial outbreak appeared to be effective in controlling spread of the virus. We recommend early institution of infection control and universal prophylaxis in any nosocomial outbreak of influenza.
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Affiliation(s)
- Mimi C Yue
- Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Joel T Collins
- Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elango Subramoniapillai
- Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Glen A Kennedy
- Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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