ABSTRACT
Background: The COVID-19 pandemic has led to deteriorated outcomes among immunocompromised patients, significantly impacting cancer patients. However, little is known about the impact of the COVID- 19 pandemic on cancer patients in low and middle-income countries. Therefore, we sought to investigate the characteristics and clinical outcomes of cancer patients with COVID-19 treated at a single institution. Methods: A retrospective chart review was performed for cancer patients treated at King Hussein Cancer Center. Patients who were diagnosed with laboratory-confirmed SARS-CoV-2 infection by Real-time Polymerase chain reaction test between April 2020 and October 2020 were identified. Results: Overall, 327 COVID-19-infected cancer patients were included. At the time of COVID- 19 diagnosis, the median age was 55 years (range, 18-87 years), 146 patients (45%) were males. The most common neoplasms were breast cancer (n = 90, 27.5%), gastrointestinal cancers (n = 60, 18.3%), and lymphoma (n = 36, 11%). The majority of patients had comorbidities (n = 200, 61%), of which hypertension and diabetes mellitus were the most common. Testing reason was presence of symptoms in 183 (56%) patients, previous exposure in 10 (3.1%), and before elective procedure in 142 (43.4%). 118 patients (56.5%) were hospitalized and 18 patients (5.5%) required admission to the intensive care unit (ICU). At the time of the last follow-up, 76% (n = 249) remained alive, and 24% (n = 78) died, among which death was considered to be COVID related in 41 (52.5% of deaths). Mortality was significantly increased in patients with comorbidities (29%, vs 15.7 %;p = 0.008), the use of cardiac medications (34.3% vs. 18.1%;p = 0.001), active cancer status vs. remission (28.2% vs 11.6% p = 0.002), receiving chemotherapy in the last four weeks (27.6% vs 16.4%, p = 0.028), and when testing reason was the presence of symptoms vs exposure and elective (37.7% vs. 10% and 7.7% p = < 0.001) respectively. Chemotherapy was delayed in 109 (33.4%) patients and permanently discontinued in 57 (17.5%) patients. Among patients required hospitalization and needed ICU admission, mortality rates were 55.1% and 88.9% respectively. Conclusions: COVID-19 infection is associated with significant mortality and negatively affects treatment plans in cancer patients. A follow-up study will be needed to evaluate the effect of vaccination on the outcomes.
ABSTRACT
Introduction: The COVID-19 infection has a devastating clinical outcome among individuals with immunocompromised states, particularly those with malignancies. The impact of the coronavirus pandemic on patients with hematological malignancies in low and middle-income countries is not well studied. Herein, we sought to report the clinical outcomes of the COVID-19 infection in patients with hematological malignancies treated at a single institution. Methods: Electronic medical record charts of patients diagnosed with hematological malignancies (leukemia, lymphoma, and multiple myeloma) were reviewed. Patients who were diagnosed with laboratory-confirmed SARS-CoV-2 infection by Real-Time Polymerase Chain Reaction test between April 2020 and October 2020 were identified as the subjects of this study. The demographic data, including tumor characteristics, laboratory results, anti-cancer treatments, patient outcomes (need for hospitalization, ICU admission, complications, and mortality), were extracted and analyzed. Results: We identified 89 patients diagnosed with hematological malignancies who were infected with COVID-19 during the eligibility period. The median age at the time of diagnosis was 54 years (range, 19-80 years). Fifty-two patients (58%) were male, and 37 patients (42%) were female. Of the 89 cases, 41 patients (46%) were diagnosed with lymphoma, 27 patients (30%) had leukemia, 21 patients (24%) had multiple myeloma. 84 patients (94%) received prior anti-cancer treatment, such as: chemotherapy (n=47, 53%), immunotherapy (n= 4, 4%), chemoimmunotherapy (n=26, 29%), and tyrosine kinase inhibitors (n=3, 3%). At the time of COVID-19 diagnosis, 52 patients (58%) had active malignancy, while 37 patients (42%) were in remission. Fifty-nine patients (66%) had comorbidities, with hypertension (n=32, 36%) being the most commonly reported comorbidity, followed by diabetes mellitus (n=25, 28%) and ischemic heart disease (n=8, 9%). The most encountered presentations were: fever (n=32, 36%) followed by cough (n=31, 35%), shortness of breath (n=21, 23%), aches (n=6, 7%), fatigue (n=6, 7%), and ageusia (n=6, 7%). Forty subjects (45%) were hospitalized, 11 patients (12%) were eventually admitted to the intensive care unit (ICU). Notably, the hospitalization and ICU admission rates were higher among the people aged more than 53 years (n= 24, 59%;n=9, 82%, respectively). Among the 89 patients, complications were recognized in 36% of the patients (n=32), with sepsis (n=12, 13%), acute kidney injury (n=11, 12%), and cardiovascular complications (n=3, 3%) being the most prevalent complications. The median time interval between the date of COVID-19 diagnosis and the last follow-up date was 3 months (range, 2 days-6.4 months). At the time of the last follow-up, 64 patients (72%) remained alive, and 25 patients (28%) succumbed to COVID-related complications. Conclusion: The COVID-19 infection has deteriorated clinical outcomes among patients with hematological malignancies, which could be attributed to the high incidence of infections, increased risk of hospitalizations/ICU admissions, and other COVID-related complications. Such high morbidity and mortality rates necessitate future studies to outline the potential risk factors for COVID-related complications and modifications in the plan of care, including evaluation of the effect of vaccination on the outcome of these patients. Disclosures: No relevant conflicts of interest to declare.
ABSTRACT
Background: Telepharmacy is a relatively recent advancement in healthcare services that enables providing high-quality pharmacy services to rural and remote areas. It gained increased attention during the COVID19 pandemic. Objectives: To assess the knowledge, perceptions, and readiness towards telepharmacy services among senior pharmacy students in a Malaysian public pharmacy school. Materials and Methods: A cross-sectional study was conducted using a self-developed, pre-tested, and validated 35-item questionnaire among penultimate and final year students in a Malaysian public pharmacy school. Ethical approval was obtained before beginning the online data collection between September and December 2020. Descriptive and inferential data analyses were performed using SPSS version 22. A p-value ≤ of 0.05 was considered statistically significant. Results: The study received a total of 178 responses to the questionnaire. The response rates of the third and fourth years were 50.6% and 49.4%, respectively. Overall, 67% had high knowledge, and 68% showed high readiness level. Meanwhile, 61% of the responses had positive perceptions of telepharmacy services. A notably excellent knowledge was demonstrated in items related to the telepharmacy role during the pandemic (93.8%) and the technical competencies required for the service provider (96.1%). The beneficial role of telepharmacy to save patients’ resources was perceived positively with a 91% agreement level among study participants. The readiness items related to the lack of incentive and the excessive workload were associated with less agreement levels of 33.7% and 45.5%, respectively. Overall, participants’ knowledge of telepharmacy significantly impacted their expressed readiness to implement telepharmacy services in their future practice. Conclusion: Most study participants had adequate knowledge, positive perceptions and demonstrated readiness to implement telepharmacy services in their future pharmacy practice. The potential increase in workload and lack of incentive were the main concerns associated with the widespread adoption of telepharmacy practice models.