ABSTRACT
Background: Patients with cancer are vulnerable population that suffered during the COVID-19 pandemic from SARS-CoV-2 infection and from the pandemic's impact on healthcare systems. We are presenting the findings of MENA Registry for COVID-19 and Cancer (MRCC) regarding the SARS-CoV-2 infection presentation, diagnosis, treatment, complications, and outcomes. Methods: MRCC was adapted from ASCO COVID-19 Registry and included patients with SARS-CoV-2 infection and underlying cancer diagnosis including a newly diagnosed cancer in the work-up phase or patients with active cancer receiving cancer therapy or supportive care, or within first year of adjuvant chemotherapy or after one year of curative therapy and receiving hormonal therapy. Registry included data on patients from 12 centers in eight countries in the MENA region, namely: Saudi Arabia, Jordan, Lebanon, Turkey, Egypt, Algeria, United Arab Emirates, and Morocco. The data included patient and disease characteristics, COVID-19 presentation, management, and outcomes. The follow up is differential as data get captured at different points of disease trajectory for each patient which may not reflect the final outcome. Results: Data on 1345 patients were captured in the study by December 7, 2021. Median age was 57.1 years (18-98), whereas 56.1% were females. The median follow-up was 98.5 days (0-554). The most common COVID-19 symptoms was fever (50.3%) and 26.8% of patients were asymptomatic. Out of the 959 patients with complete data on hospitalization, 554 (57.8%) were hospitalized and 126 of them (22.7%) were admitted to intensive care unit (ICU). The majority of hospitalized patients (60%) had respiratory complications and 13.9% had sepsis and 8.5% suffered acute renal injury. As shown in Table, more than quarter of the patients died with 47% of death from COVID-19 or related complication and 60.6% died at home. More than half of the patients were fully recovered from infection. Conclusions: Although more than half of the patients recovered form COVID-19 and more are expected to recover with a longer follow up, the death toll and complications remain high in this patient population. Future analysis of the impact of vaccination and better disease management as well as the impact of newer variants would provide a useful insight on managing this vulnerable population.
ABSTRACT
Background: Patients with terminal diseases frequently undergo procedures and interventions that are futile and maybe detrimental to the patients' quality of life. We conducted a quality improvement project aimed to reduce futile acute care services (ACS) for cancer patients treated with a palliative intent. Methods: A multidisciplinary team retrospectively reviewed the records of terminally ill cancer patients who died during in the hospital at our institution, King Abdulaziz Medical City, Riyadh, Saudi Arabia. We included all patients expired between November 2017 to May 2018. The review aimed to assess the magnitude of improper utilization of acute care services (ACS) such as: Critical care response team (CCRT), cardiopulmonary resuscitations (CPR) and admission to intensive care unit (ICU). A root cause analysis and process mapping were conducted to identify reasons for over utilization of these services. Timely documentation of goals of care was identified as a main reason for this problem. Then interventions were implemented to improve the practice. Post intervention data was captured and compared to the baseline data. Results: After delivery of staff education sessions and implementation of mandatory documentation of goals of care in the electronic healthcare record system, the timely documentation of goal of care for patients with palliative intent had significantly increased from 59% of cases in the baseline to 86% for the post intervention phase. As a result, admission to ICU decreased from 32% of cases in the pre intervention phase to 14% in the post intervention phase reducing monthly cost of admission to the ICU by 40% and estimated to be on average of $48,000 USD monthly ($576,000 USD annually). Conclusions: Our interventions resulted in improved documentation of the goal of care leading to decrease in the utilization of acute care services (ACS) including reduction of intensive care unit (ICU) admissions and cost. This outcome is even more relevant nowadays during COVID-19 pandemic and the pressure on critical care resources. Improvement is sustained by integrating the changes in the work process and electronic medical records.
ABSTRACT
Background: As frontline workers facing COVID-19 pandemic, healthcare providers should be well prepared to fight the disease and prevent harm to their patients and themselves. Our study aims to evaluate knowledge, attitude, and practice (KAP) of oncologists in response to COVID-19 pandemic and its impact on them. Methods: A cross-sectional study was conducted using a validated questionnaire disseminated to oncologists by SurveyMonkey©. The tool had 42 questions that captured participants’ KAP, their experiences and the impact of the pandemic. Country sub-investigators in Middle East and North Africa region, Brazil, and the Philippines distributed the survey to their contacts via emails and text messaging between April 24 and May 15, 2020. Results: Among 910 physicians that participated in the study, 55% were males, 67% medical or clinical oncologists and 58% worked in public hospitals. Only 213 (23%) reported being officially involved in COVID-19 control efforts. Level of knowledge regarding the prevention and transmission of the virus was good among 63% of participants. Majority (92%) were worried about contracting the virus either extremely (30%) or mildly (62%) and 85% were worried about transmitting the virus to their families. 77% reported they would take the COVID-19 vaccine once available, although only 38% got the flu vaccine regularly. Adherence to strict precautions was variable including social distancing outside work (68%), no hand shaking (58%), and hand washing (98%). Participation in virtual activities included clinics (54%), tumor boards (45%), administrative meetings (38%);and educational activities (68%) and majority reported plans to continue them after pandemic. Participants reported a negative impact of the pandemic on relations with coworkers (16%), relations with family (27%), their emotional and mental wellbeing (49%), research productivity (34%) and financial income (52%). Conclusions: COVID-19 pandemic has negative effects on various personal and professional aspects of oncologists. Interventions should be implemented to mitigate the negative impact and to prepare oncologists to manage future crises with more efficiency and resilience. Editorial acknowledgement: On behalf the International Research Network on COVID-19 Impact on Cancer Care (IRN-CICC). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.R. Jazieh: Research grant/Funding (self): MSD. All other authors have declared no conflicts of interest.
ABSTRACT
Background: Cancer patients are vulnerable population that are exposed to different risks and harms during COVID-19 pandemic. Our study goal is to evaluate the behavioral response of cancer patients to the pandemic in countries of the Middle East and North Africa (MENA) region. Methods: A cross-sectional study was conducted using a validated questionnaire administered via SurveyMonkey© to cancer patients in 13 centers in 6 countries in the MENA region: namely, Saudi Arabia, Kuwait, Jordan, Egypt, Algeria, and Morocco. The tool included 45 questions inquiring about patients’ demographics and behavioral practices during the crisis. Results: 1,012 patients were enrolled in the study between April 21 and May 15, 2020. Median age was 50 years (14-92), 67% were females, 39% had a college degree, and 75% were married. Most common reported cancer was breast cancer (40%) followed by gastrointestinal malignancies (15%). Only 3% know someone who has COVID-19 infection. Patients were worried about contracting the infection strongly (33%) or mildly (48%). Reporting strict adherence to precautions included avoiding the following actions: hand shaking (83%%), hugging and kissing (91%), social gathering (98%), meeting friends (91%), and visiting markets (80%). On the other hand, they were doing the following: repeated hand washing (77%), keeping distance from others (67%), using masks in public areas (77%), hand sanitizer (69%) and soap (81%). Some of the patients reported adopting healthier diet (35%), using dietary supplement (18%), reciting Quran (61%) or supplications (75%). About 23% of them will choose not to show up for scheduled medical appointment and 43% had appointment cancellation per request from medical team (31%) or patients themselves (12%). However, treatment session cancellation occurred per request from medical team in (11%) or patients in (4%). Interestingly, 84% of participants prefer virtual appointments over regular visits. Conclusions: Majority of cancer patients in the study are adopting adequate precautions to prevent exposure to infection. Further studies are required to evaluate the patients’ emotional well-being and other harms resulted from the pandemic to prevent detrimental effect on patients outcome. Editorial acknowledgement: On behalf of the International Research Network on COVID-19 Impact on Cancer Care (IRN-CICC). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.R. Jazieh: Research grant/Funding (self): MSD. All other authors have declared no conflicts of interest.
ABSTRACT
Background: COVID-19 pandemic impacted healthcare systems globally and resulted in the interruption of usual care in many healthcare facilities exposing vulnerable cancer patients to significant risks. Our study aimed to evaluate the impact of this pandemic on cancer care worldwide. Methods: We conducted a cross-sectional study using validated electronic questionnaire of 51 items via SurveyMonkey©. The tool was distributed to leaders in oncology centers worldwide. The questionnaire obtained information on the capacity and services offered at these centers, magnitude of interruption of care, reasons for interruption, challenges faced, interventions implemented, and the estimation of patient harm during the pandemic. Results: 356 centers from 54 countries across six continents participated between April 21 and May 8, 2020. These centers serve about 700,000 new cancer patients a year. Most of them (88%) reported facing challenges in providing care during the pandemic. 54% and 45% of centers reported cases of COVID-19 infection among their patients and staff, respectively. Although 51% reduced services as part of a preemptive strategy, other common reasons included overwhelmed system (20%), lack of personal protective equipment (19%), staff shortage (18%), and restricted access to medications (9.7%). Missing at least one cycle of therapy by more than 10% of patients was reported in 46% of the centers. Most centers implemented virtual clinics (83.6%) and virtual tumor boards (93%) and participants believed these will persist beyond the pandemic (55.5% and 60%, respectively). Centers performed routine tests in laboratories near patients’ homes (76%) and shipped medications to patients (68.6%). Participants reported patients’ exposure to harm from interruption of cancer-specific care (36.5%) and non-cancer related care (39%) with some centers estimating up to 80% of their patients exposed to some harm. Only 16% of the centers reported services are back to baseline at the time of completing the survey. Conclusions: The detrimental impact of COVID-19 pandemic on cancer care is widespread with varying magnitude among centers worldwide. Further research to assess this impact at the patient level is required. A “new normal” of cancer care emerged with emphasis on telehealth and care delivery closer to home. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.R. Jazieh: Research grant/Funding (self): MSD. C.D. Rolfo: Speaker Bureau/Expert testimony: AstraZeneca;Advisory/Consultancy: Inivata;Archer;MD Serono;Mylan;Oncompass;Honoraria (self): Elsevier. All other authors have declared no conflicts of interest.