Rowing Against Cancer: From a Support Project to a Research Program. Perspectives and Challenges of Rowing in Metastatic Lung Cancer Patients

Introduction: Lung cancer symptoms and secondary effects of cancer treatments impact quality of life and induce patients to excessive rest and lack of physical activity resulting in severe deconditioning. Exercise has been shown to increase performance status, strength, endurance and reduce emotional issues in lung cancer patients. Despite these benefit this approach is a poorly utilized strategy and several barriers must be overcome due to limited data, lack of awareness of the benefits of exercise, and limited patient motivation. Several programs of adapted physical activity are developing to support lung cancer patients during oncological treatments, adopting a personalized approaches. Rowing programs have been reported in cancer survivors to reduce risk factors and the impact of treatments complications, particularly lymphedema in breast cancer survivors. A pioneering program of adapted physical activity was developed by a multidisciplinary team in collaboration with an association for the support of cancer patients (Sicilian Association for Oncological Support), using rowing in patients with active metastatic cancer, to evaluate feasibility, response of patients, and to increase awareness of the benefits of physical activity in the fight against lung cancer. Methods: The program was launched in December 2019 from the idea of a young world rowing champion, but the advent of the COVID-19 pandemic led to the postponement of this project, which was subsequently developed from March 2021 to July 2021. The team was composed by oncologists, sports medicine specialists, two coaches specialised in adapted physical activity programs and a cardiologist. The voluntary logistic assistance was warranted by the rowing society “Canottieri Peloro”, which effectively allowed the project to be carried out, providing patients with equipment, a specialised team doctor and a well-equipped gym. In this preliminary experience we managed to include a small number of patients to assess the feasibility/validity of this approach and improve patients’ needs and satisfaction. Results: Four patients affected by metastatic lung adenocarcinoma with EGFR mutations joined the project (1 M/3 F;median age was 59.5, range 47-68;ECOG PS: 1). All patients presented well-controlled and mild symptoms related to the disease (cough, dyspnea, bone or chest pain) and were receiving active oncological treatments (first line EGFR-TKI: 2 patients;second line EGFR-TKI and maintenance chemotherapy). After a baseline clinical, oncological and cardiological evaluation personalized training program was developed. Briefly, indoor training and individual rowing sessions have been administered to patients. All patients reported full adherence to the training, developing a growing motivation and interest in improving physical performance. We did not recorded any worsening of symptoms or problems related to cancer treatments. The full contact with water and nature and the peculiar backwards motion of rowing had a positive impact on patients, that enjoyed the experience, reducing their anxiety for the future. Conclusions: This preliminary experience, previous developed as a support activity for lung cancer patients, might pave the way for further exploration of the role of rowing in this setting and promote a pivotal project to better define specific programs for metastatic cancer patients to improve compliance and response to cancer treatments. Keywords: Lung cancer, Adapted physical activity, Rowing

Virtual multi-institutional tumor board: Feasibility and physicians acceptance, a GSTU foundation project in Sicily

Introduction & Objectives: Multidisciplinary tumor boards (MTBs) play a pivotal role in patients’ clinical management and decision-making process. Main barriers to achieve efficient MTBs, are lack of time and geographical distance. COVID-19 pandemic represented an exceptionalobstacle. Telehealth practice has recently expanded including live video conferences and remote patient visit. The elaboration of an efficient virtual(v)MTB during COVID-19 pandemic is a need and a key-point to realize a successful oncology team and to increase a network among healthprofessionals and institutions. Objective of the study was to assess the mode of operating of our vTMB and to evaluate satisfaction and concernsof participating physicians through a dedicated survey.Materials & Methods: A project for a virtual multi-institutional uro-oncological MTB was activated in Sicily. The vMTB was structured according to aBowen framework method, employing a cloud-based virtual platform (Navify®). A 5-point Likert scale measured acceptability, appropriateness, andfeasibility of the instrument. Consensus on patients’management was voted electronically and approved if at least 75% of consensus was reached.Decisions were matched to recent medical literature and verified as adhering to the guidelines. After the first 3 months of activity a structured surveywas carried out among the members of the vMTB to investigate their satisfaction, adherence and concerns.Results: The vMTB started in September 2020. Up to the end of December 2020, 13 virtual meetings (60-90 min each) were holded and 77cases of urological tumors were discussed. Overall, 18 hospital units and 48 specialists joined the meetings. The survey conducted among the 48participating physicians, positively highlighted the impact of the project: 48 (100%) preferred virtual to in-person MTB, 44 (91%) were satisfied ofthe quality of clinical information;46 (96%) on equity of care;42 (88%) on collaboration among specialists;42 (88%) on method standardizationand 37 (77%) on data security, tracking, storage, and availability.Conclusions: vMTB represents a unique opportunity to optimize multidisciplinary patient management. Our experience shows a rapid adaptation of physicians to vMTB. However, legal and technical issues remain fields of concern and must be carefully checked. Acknowledgments: Thanks to the GSTU foundation for Technical and Editing support

Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario.

INTRODUCTION: COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. METHODS: Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS: A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% versus -3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). CONCLUSIONS: Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.

P39.09 Social Media Support of Lung Cancer Patient Associations During the Lockdown Restrictions in Italy: A Breath of Life During the COVID-19 Pandemic

Introduction: Unprecendented emergency measures applied in Italy, plagued by COVID-19 have determined the development of new patients associations strategies to support oncological patients, particularly lung cancer patients, experiencing increased fear and anxiety to contract COVID-19 for the higher risk of pulmonary complications. In this context, social networking platform have represented a privileged support tool, especially Facebook for the numbers of active users, patient communities and cancer advocacy and support activities. The objective of this study is to evaluate how Italian lung cancer patient associations have used Facebook to support patients during lockdown period in Italy. Methods: Data have been obtained by the analysis of posts inserted on Facebook pages by the Italian lung cancer patient associations between 31 January 2020 (first cases reported in Italy in Rome) and 4 May 2020 (start-up phase II after lockdown). The search of associations was conducted on Facebook and web search engines. Results: A total of eight Facebook pages of lung cancer patient associations have been analysed. Two associations have not updated their pages in the referred period. Published posts in all examined pages are in total 155, related to vademecum and guidelines for oncological patients (26,4%);information about the COVID-19 and indications to prevent trasmission (20%);updates on cancer treatments (5,2%);fundraising (7%) to donate medical devices for COVID-19 emergency. The most frequent hashtags have been: #covid19, #distantimauniti (Distant but United), #coronavirus. Several care emojis have been used in the different posts, including the virtual HUG, launched in the late April 2020 to help people to stay connected and express mutual love and support during the COVID-19 crisis (Figure 1). The most liked post, promoting a vademecum for caregivers to support lung cancer patients during lockdown period, has obtained 2700 like. Moreover, several initiatives have been carried out on Facebook such as the programs of digital solidarity, to share emotions, support and spend time together. [Formula presented] Conclusion: The use of Facebook during COVID-19 lockdown has represented for Italian lung cancer patient associations a new virtual space of meeting and supporting and a tool to reduce distances and the concerns related not only to cancer, but also to the danger of COVID-19. Keywords: lung cancer patient association, COVID-19, Facebook

The challenge of Italian cancer patient support associations in the era of social distancing, Quarantenee, and isolation: Social media networking to be. Far but near

Background: Unprecendented emergency measures applied in Italy due to coronavirus pandemic have determined the development of new strategies to support oncological patients. In this context, social networking has represented a privileged tool. The objective of this study is to evaluate how the national cancer patient support associations have used facebook to support oncological patients during lockdown period in Italy. Material and Methods: Data have been obtained by the analysis of posts inserted on Facebook pages by the Italian cancer patient associations between 31 January 2020 (first cases reported in Italy in Rome) and 4 May 2020 (start up phase II after lockdown).The search of associations was conducted on Facebook and web search engines. Results: A total of 64 pages of cancer patient associations, primarly residents in the Northern regions (50%), 26% in the center of Italy and 20% in the Southern regions, have been analyzed. A large proportion of the association (42.5%) deal with all tumor pathologies, 20.3% are specially dedicated to breast cancer and 7.4% to melanoma. Ten associations have not updated their pages in the referred period. Published posts in all examined pages are in total 931 and mainly referred to services and initiatives promoted by the associations (psychological support, streaming events, home care: 21,1%);information about the COVID-19 and indications to prevent trasmission (17.4%);update on cancer treatments (17.3%);surveys, vademecum and guidelines for oncological patients (13%);fundraising (6.4%) to donate medical devices for COVID-19 emergency;information about the activation of new clinical trials during the pandemic (5%). The most frequent hashtags have been: #covid19, #coronavirus, #iorestoacasa, #stopcoronavirus. Most liked post, promoting a fundraising to support cancer patients during lockdown period, has obtained 1800 like and 527 emoji heart. A new Care reaction, a virtual HUG launched in late April by Facebook to show support during the COVID-19 crisis has been used 38 times in the different posts. Moreover, several initiatives have been carried out on Facebook such as: home concerts, tutorials, webinar, to share emotions, support and spend time together. Conclusions: The use of Facebook during COVID-19 lockdown has represented for cancer patient associations a new virtual space of meeting and supporting and a tool to reduce distances and the concerns related not only to cancer, but also to the danger of COVID-19.