ABSTRACT
Introduction: To ensure safe delivery of oncologic care in the COVID-19 pandemic, telemedicine has been rapidly adopted. We assessed accessibility and time to treatment initiation for thoracic oncology patients seen via telemedicine or in-person during the initial phase of the COVID-19 pandemic. Methods: We conducted a retrospective cohort study of patients with thoracic malignancies seen within a multidisciplinary team at the University of Pennsylvania Health System (UPHS) during the first surge of COVID-19 cases in Philadelphia (March 1 to June 30, 2020). Patients with an index visit for a new phase of care, defined as a new diagnosis, local recurrence, or newly discovered metastatic disease were included. Patients who did not receive subsequent oncologic care within the UPHS were excluded. Dates of referral, index visit, and treatment initiation were ed from the electronic medical record (EMR). Patients were divided into groups based on index visit type (in-person vs. telemedicine). Comparisons of time to care between groups were evaluated using the Wilcoxon rank-sum test. Results: Between March 1 and June 30, 2020, 241 distinct thoracic oncology patients were seen for a new phase of care and managed with surgery (n=78, 32.4%), radiation (including concurrent chemoradiation) (n=59, 24.5%), or systemic therapy (n=73, 30.3%). The majority of visits were for a diagnosis of a new thoracic cancer (87.1%). 133 patients (55.2%) were seen in-person and 108 (44.8%) were seen via telemedicine. Baseline characteristics of patients seen via telemedicine vs in-person were well balanced. As expected, the proportion of telemedicine to in-person visit types changed with the local phase of the pandemic with an initial increase of telemedicine during the lockdown period and a decrease during the re-opening phase. A higher proportion of visits were conducted via telemedicine when receiving systemic therapy or radiation as compared to surgery. Among patients with new diagnoses (n=210), the median time from referral to initial visit was significantly shorter amongst the patients seen via telemedicine vs. in-person (4.5 vs. 6.0 days, p=0.006), though only 67.1% had referral dates reported in the EMR. Time-to-treatment stratified by treatment modality received did not differ by type of initial visit (median values in-person vs. telemedicine: surgery 16 vs. 22 days, p= 0.48;radiation 26.5 vs. 28 days, p=0.90;systemic therapy 13.5 vs. 14 days, p=0.49). A sensitivity analysis limited to new diagnoses only (210/241) confirmed the same results. Conclusions: Rapid adoption of telemedicine sustained timely delivery of oncologic care during the initial surge of the COVID19 pandemic across a thoracic oncology multi-disciplinary clinic. While the full impact of telemedicine on long term clinical outcomes remains to be determined, faster times from referral to initial visit in the telemedicine group provide preliminary evidence that telemedicine could sustain or improve accessibility to oncologic care, especially during current and future pandemics.
ABSTRACT
Background: The ASCO Registry was created to analyze the impact of COVID-19 (COVID) on treatment (Tx) and outcomes of patients (pts) with cancer. Methods: The Registry includes pts with 1) a confirmed COVID diagnosis (Dx) and 2) clinically evident cancer receiving Tx/supportive care or resected cancer on adjuvant Tx <12 mos since surgery. Practices report data on cancer Dx and Tx at COVID Dx, COVID symptoms, comorbidities, cancer/COVID Tx, and survival. Kaplan-Meier estimation provided 30- and 90- day mortality rate estimates for pts with COVID Dx before or since 6/1/20 within pt subgroups with 95% confidence intervals (CI). Data submission cutoff for all practices was 10/24/20, except one that was 11/16/20. Results: This analysis reports on 453 pts with COVID Dx 3/5/20 to 10/22/20 who were on anticancer drug Tx for regional (9%) or metastatic (53%) solid tumors or hematologic cancers (38%) at COVID Dx. 38 practices entered data: health system-owned 51% of pts, privately-owned 25%, academic 24%. 53% of pts have ≥30 days followup or died ≤30 days from COVID Dx. Median age is 64 years;53% of pts are female;28% of pts are asymptomatic at COVID Dx. Multiple myeloma was most frequent cancer (17%). Allcause mortality rates (30 and 90 days) increased with pts' age at COVID Dx [Table]. No mortality difference was seen based on sex, race, or comorbidities (hypertension, diabetes, pulmonary disease). Pts with COVID Dx before June 1 had worse survival than pts diagnosed on/after June 1. Pts with B-cell malignancies had higher mortality rates than pts with solid tumors. Conclusions: Severity of COVID illness and mortality were greater for patients with COVID Dx pre-June 1 than on/after June 1. Differences on/after June 1 may be attributed to improvements in COVID management, higher COVID testing rates, and more asymptomatic pts diagnosed. Variations in COVID-19 pt populations over time due to these changes should be considered when analyzing and interpreting pandemic data. Cancer pts with ed age and B-cell cancers are at greatest risk of death but mortality rates for all groups advanced age and B-cell cancers are at greatestrisk of death but mortality rates for all groups(except those admitted to ICU) improved after6/1/2020.
ABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 utilizes the angiotensin-converting enzyme 2 (ACE-2) receptor of cells in order to gain entry and continue infection. Recent literature has focused on acute respiratory distress syndrome (ARDS) and other associated pulmonary complications;however, only a scarce amount of literature exists on neurological complications. Such complications also pose a high morbidity in these patients. The exact pathogenesis of nervous system involvement by COVID-19 still remains poorly understood. The aim of this article is to review the neurological symptoms seen in COVID-19 infection and discuss the probable pathogenesis, management and outcome of associated neurological complications.