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Nguyen NP, Karlsson UL, Lehrman D, Mazibuko T, Saghatelyan T, Thariat J, Baumert BG, Vinh-Hung V, Gorobets O, Giap H, Singh S, Chi A, Alessandrini G, Ahluwalia A, Durosinmi-Etti F, Zegarra Cárdenas J, Diabate K, Oboite J, Oboite E, Mehmood T, Vuong T, Kim L, Page BR. Impact of COVID-19 pandemic on older cancer patients: Proposed solution by the International Geriatric Radiotherapy Group. Front Oncol 2023; 13:1091329. [PMID: 36959795 PMCID: PMC10027708 DOI: 10.3389/fonc.2023.1091329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/18/2023] [Indexed: 03/09/2023] Open
Abstract
Older cancer patients are disproportionally affected by the Coronavirus 19 (COVID-19) pandemic. A higher rate of death among the elderly and the potential for long-term disability have led to fear of contracting the virus in these patients. This fear can, paradoxically, cause delay in diagnosis and treatment that may lead to a poor outcome that could have been prevented. Thus, physicians should devise a policy that both supports the needs of older patients during cancer treatment, and serves to help them overcome their fear so they seek out to cancer diagnosis and treatment early. A combination of telemedicine and a holistic approach, involving prayers for older cancer patients with a high level of spirituality, may improve vaccination rates as well as quality of life during treatment. Collaboration between health care workers, social workers, faith-based leaders, and cancer survivors may be crucial to achieve this goal. Social media may be an important component, providing a means of sending the positive message to older cancer patients that chronological age is not an impediment to treatment.
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Affiliation(s)
- Nam Phong Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Ulf Lennart Karlsson
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - David Lehrman
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Thandeka Mazibuko
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Tatul Saghatelyan
- Department of Radiation Oncology, National Center of Oncology, Yerevan, Armenia
| | - Juliette Thariat
- Department of Radiation Oncology, Francois Baclesse Cancer Center, Cain, France
| | - Brigitta G. Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de La Polynesie Francaise, Tahiti, French Polynesia
| | - Olena Gorobets
- Department of Oral Surgery, Centre Hospitalier Universitaire de Martinique, Martinique, France
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Sankalp Singh
- Department of Radiation Oncology, Army Hospital (Research & Referral), New Delhi, India
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Beijing, China
| | | | - Abhinav Ahluwalia
- Department of Radiation Oncology, Advanced Care Oncology Center, Dubai, United Arab Emirates
| | | | - Jorge Zegarra Cárdenas
- Division of Medical Oncology, Regional Institute of Neoplastic Disease, Concepcion, Peru
| | | | - Joan Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, Washington, DC, United States
| | - Tahir Mehmood
- Department of Radiation Oncology, Northampton General Hospital, Northampton, United Kingdom
| | - Te Vuong
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY, United States
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, United States
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2
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Bhatia RK, Lichter KE, Gurram L, MacDuffie E, Lombe D, Sarria GR, Grover S. Gynecologic radiation therapy in low and middle income countries during the COVID-19 pandemic. Int J Gynecol Cancer 2022; 32:446-450. [PMID: 35256435 PMCID: PMC9997715 DOI: 10.1136/ijgc-2021-003039] [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: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic has forever affected healthcare and posed an incredible challenge to our society to care for our sick. Patients with cancer were found early on to have higher rates of complications with COVID-19. Radiation therapy is an integral part of treatment for many types of gynecologic cancer and adaptation on its utilization during the pandemic varied across the globe. In this review, we detail certain guidelines for the use of radiation in gynecologic cancers during the pandemic as well as real world accounts of how different countries adapted to these guidelines or created their own based on individualized resources, staffing, government restrictions, and societal norms. Critically, this review demonstrates the breadth of fractionation schemes and technologies used when resources were limited but highlights the importance of long term follow-up for many of our patients during this time.
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Affiliation(s)
- Rohini K Bhatia
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lavanya Gurram
- Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Emily MacDuffie
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Surbhi Grover
- Department of Radiation Oncology, Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Mare M, Colarossi L, Veschi V, Turdo A, Giuffrida D, Memeo L, Stassi G, Colarossi C. Cancer Stem Cell Biomarkers Predictive of Radiotherapy Response in Rectal Cancer: A Systematic Review. Genes (Basel) 2021; 12:genes12101502. [PMID: 34680897 PMCID: PMC8535834 DOI: 10.3390/genes12101502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rectal cancer (RC) is one of the most commonly diagnosed and particularly challenging tumours to treat due to its location in the pelvis and close proximity to critical genitourinary organs. Radiotherapy (RT) is recognised as a key component of therapeutic strategy to treat RC, promoting the downsizing and downstaging of large RCs in neoadjuvant settings, although its therapeutic effect is limited due to radioresistance. Evidence from experimental and clinical studies indicates that the likelihood of achieving local tumour control by RT depends on the complete eradication of cancer stem cells (CSC), a minority subset of tumour cells with stemness properties. METHODS A systematic literature review was conducted by querying two scientific databases (Pubmed and Scopus). The search was restricted to papers published from 2009 to 2021. RESULTS After assessing the quality and the risk of bias, a total of 11 studies were selected as they mainly focused on biomarkers predictive of RT-response in CSCs isolated from patients affected by RC. Specifically these studies showed that elevated levels of CD133, CD44, ALDH1, Lgr5 and G9a are associated with RT-resistance and poor prognosis. CONCLUSIONS This review aimed to provide an overview of the current scenario of in vitro and in vivo studies evaluating the biomarkers predictive of RT-response in CSCs derived from RC patients.
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Affiliation(s)
- Marzia Mare
- Medical Oncology Unit, Mediterranean Institute of Oncology, 95029 Viagrande, Italy; (M.M.); (D.G.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Lorenzo Colarossi
- Pathology Unit, Mediterranean Institute of Oncology, 95029 Viagrande, Italy; (L.C.); (L.M.); (C.C.)
| | - Veronica Veschi
- Department of Surgical Oncological and Stomatological Sciences (DICHIRONS), University of Palermo, 90127 Palermo, Italy;
| | - Alice Turdo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Dario Giuffrida
- Medical Oncology Unit, Mediterranean Institute of Oncology, 95029 Viagrande, Italy; (M.M.); (D.G.)
| | - Lorenzo Memeo
- Pathology Unit, Mediterranean Institute of Oncology, 95029 Viagrande, Italy; (L.C.); (L.M.); (C.C.)
| | - Giorgio Stassi
- Department of Surgical Oncological and Stomatological Sciences (DICHIRONS), University of Palermo, 90127 Palermo, Italy;
- Correspondence: ; Tel.: +39-091-2389-0813
| | - Cristina Colarossi
- Pathology Unit, Mediterranean Institute of Oncology, 95029 Viagrande, Italy; (L.C.); (L.M.); (C.C.)
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4
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Goenka A, Ma D, Teckie S, Alfano C, Bloom B, Hwang J, Potters L. Implementation of Telehealth in Radiation Oncology: Rapid Integration During COVID-19 and Its Future Role in Our Practice. Adv Radiat Oncol 2020; 6:100575. [PMID: 33073060 PMCID: PMC7546643 DOI: 10.1016/j.adro.2020.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose The widespread coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes in care delivery among radiation oncology practices and has demanded the rapid incorporation of telehealth. However, the impact of a large-scale transition to telehealth in radiation oncology on patient access to care and the viability of care delivery are largely unknown. In this manuscript, we review our implementation and report data on patient access to care and billing implications. Because telehealth is likely to continue after COVID-19, we propose a radiation oncology–specific algorithm for telehealth. Methods and Materials In March 2020, our department began to use telehealth for all new consults, posttreatment encounters, and follow-up appointments. Billable encounters from January to April 2020 were reviewed and categorized into 1 of the following visit types: in-person, telephonic, or 2-way audio-video. Logistic regression models tested whether visit type differed by patient age, income, or provider. Results There was a 35% decrease in billable activity from January to April. In-person visits decreased from 100% to 21%. Sixty percent of telehealth appointments in April were performed with 2-way audio-video and 40% by telephone only. In-person consultation visits were associated with higher billing codes compared with 2-way audio-video telehealth visits (P < .01). No difference was seen for follow-up visits. Univariate and multivariable analysis identified that older patient age was associated with reduced likelihood of 2-way audio-video encounters (P < .01). The physician conducting the telehealth appointment was also associated with the type of visit (P < .01). Patient income was not associated with the type of telehealth visit. Conclusions Since the onset of the COVID-19 pandemic, we have been able to move the majority of patient visits to telehealth but have observed inconsistent utilization of the audio-video telehealth platform. We present guidelines and quality metrics for incorporating telehealth into radiation oncology practice, based on type of encounter and disease subsite.
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Affiliation(s)
- Anuj Goenka
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Daniel Ma
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Sewit Teckie
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Catherine Alfano
- Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York
| | - Beatrice Bloom
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Jamie Hwang
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.,Cancer Care Management and Research, Northwell Health Cancer Institute, Lake Success, New York
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Thomson DJ, Yom SS, Saeed H, El Naqa I, Ballas L, Bentzen SM, Chao ST, Choudhury A, Coles CE, Dover L, Guadagnolo BA, Guckenberger M, Hoskin P, Jabbour SK, Katz MS, Mukherjee S, Rembielak A, Sebag-Montefiore D, Sher DJ, Terezakis SA, Thomas TV, Vogel J, Estes C. Radiation Fractionation Schedules Published During the COVID-19 Pandemic: A Systematic Review of the Quality of Evidence and Recommendations for Future Development. Int J Radiat Oncol Biol Phys 2020; 108:379-389. [PMID: 32798063 PMCID: PMC7834196 DOI: 10.1016/j.ijrobp.2020.06.054] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. METHODS AND MATERIALS Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. RESULTS From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. CONCLUSIONS A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.
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Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
| | - Hina Saeed
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Leslie Ballas
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Soren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Laura Dover
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Mount Vernon Cancer Centre, Northwood, and University of Manchester, Manchester, United Kingdom
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, Massachusetts
| | | | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | | | - David J Sher
- Department of Radiation Oncology, University of Texas - Southwestern, Dallas, Texas
| | | | - Toms V Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennifer Vogel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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