Interprofessional Team Collaboration for Routine and Emergent Mental Health Concerns Among Collegiate Student-Athletes: A Case Series.

Collegiate student-athletes experience an increasing number of mental health concerns. To help address these concerns and provide high quality healthcare for student-athletes, institutions of higher education are being encouraged to create interprofessional healthcare teams that are specifically dedicated to managing mental health. We interviewed three interprofessional healthcare teams who collaborate to manage routine and emergency mental health conditions in collegiate student-athletes. Teams were representative across all three National Collegiate Athletics Association (NCAA) divisions and included athletic trainers, clinical psychologists, psychiatrists, dieticians and nutritionists, social workers, nurses, and physician assistants (associates). The interprofessional teams indicated the existing NCAA recommendations helped to solidify members and roles of the mental healthcare team; however they all indicated their teams would benefit from more counselors and psychiatrists. Teams shared different mechanisms for referral and accessing mental health resources on their campuses, which may make on-the-job training for new members of the team an organizational necessity.

Going Virtual During Covid with the NCI-Connect Cares (Coping, Advocacy, Resources, Education, Support) Group for Rare Brain and Spine Tumor (RBST) Patients and their Families

Background/Purpose: RBST patients have limited supportive care resources and feel secluded as few healthcare providers have expertise in these diseases. The NCI-CONNECT specialized clinic for adults with RBSTs created a multidisciplinary approach with a genetic counselor, knowledgeable healthcare team, and group sessions with a health and wellness counselor (CARES). The CARES sessions created an educational and supportive space for patients to share their unique experiences. We report the adaptation of the CARES group that evolved from in-person to virtual during COVID. Method(s): Patients with RBSTs and their families attended weekly (1 h) groups at their clinic appointments. The CARES group leaders (A.A, S.S) led wellness/coping presentations (15-20 min) and a guided discussion on the topic. In 2021, the COVID pandemic shifted the group to monthly virtual meetings, and educational content was shared via a closed-Facebook group and NCI-CONNECT website. Six groups included presenters within Neuro-Oncology, shortened prerecorded presentations (10 min) allowing for more engagement opportunities, and a coping activity concluded the meeting. Emailed survey feedback was requested (5 out of 13 completed). Result(s): On average, six patients attended each group. Topics included mindfulness, distress, relational challenges, body image, and an educational series on symptom management. All presentations can be found on the NCI-CONNECT website. Patients reported enjoyment in the ability to connect with others, with 80% preferring monthly virtual meetings. Open-ended comments noted that hearing other patients' stories created connections patients expressed they needed. Conclusions and Implications: The virtual CARES group created an accessible space for RBST patients to build relationships and gain support to manage the uncertainties of coping with a rare disease during a time of physical isolation. Patient responses capture the need to continue the group further. Future work will focus on expanding the group based on patient needs and building metrics to understand the overall group benefits in a virtual world.

The COVID-19 Pandemic Experience for Patients with Central Nervous System (CNS) Tumors: Differences in Patient- Reported Outcomes (PROs) and Practice Recommendations

Background/Purpose: The COVID-19 pandemic and associated mitigation procedures have significantly altered daily life in ways that may disproportionately affect patients with CNS tumors. This study aimed to explore differences in symptom burden and interference, mood disturbance, and health-related quality of life in the CNS tumor patient population during the COVID-19 pandemic, compared to a normative sample of pre-pandemic data. Method(s): Data from the Neuro-Oncology Branch (NOB) Natural History Study, including demographic and clinical data, as well as PROs including PROMIS Anxiety and Depression Short-Forms, EQ- 5D-3L, MDASI-Brain Tumor/Spine Tumor, and NeuroQOL-Cognition Function, were collected and compared across groups ('NOB normative sample' and 'COVID year' patients) using one-sample proportion tests. Result(s): 178 COVID year CNS tumor patients (55% male, 82% Caucasian, median age 45 years) were compared with 678 NOB normative sample patients with similar demographic and clinical characteristics. Symptom burden remained comparably high during the COVID year compared to the NOB normative sample with the most common moderate-severe symptoms being fatigue (31% vs. 35%), difficulty remembering (28% vs. 24%), drowsiness (22% vs. 25%), disturbed sleep (20% vs. 22%), and distress (20% for both). However, a significantly greater proportion of COVID year assessments endorsed moderate-severe depression on the PROMIS compared to the NOB normative sample (17% vs. 12%, p = 0.023, Cohen's h = 0.22) and moderate-severe depression/anxiety on the EQ-5D-3L was also more prevalent (53% vs. 43%, p = 0.009, Cohen's h = 0.28). There were no other significant differences in PROs between groups. Conclusions and Implications: These findings demonstrated that while objective symptom burden for CNS tumor patients was unchanged, there was an increase in depression reported during the COVID-19 pandemic. Future work should investigate potential pandemic-era interventions for screening, targeting, and improving both mood disturbance and other disease-specific symptoms to improve symptom burden and quality of life.

Systematic Review of Biologic Correlates of Frailty in Solid Tumors: Implications for Brain Tumors

BACKGROUND: Cancer and cancer treatments contribute to accelerated aging and frailty, which is present in over 50% of adult cancer survivors and increases vulnerability to poor outcomes. Biomarkers of frailty would allow for early identification and timely interventions. The purpose of this review is to synthesize the current literature examining biomarkers of frailty across solid tumor patients, including primary brain tumors (PBT). METHOD(S): The systematic review was conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. PubMed, Web of Science, and Embase, were searched by the medical librarian (D.C.) of all reports from the inception to December 08, 2021. Inclusion criteria were: a) English language, b) biomarkers of aging hallmarks, c) association between biomarkers and frailty. Studies were limited to human solid tumors. Two reviewers (D.S. and B.P.S.) independently screened titles, s, and full-text articles using Covidence platform with conflict resolution by the third researcher (T.S.A.). Included studies were independently evaluated for quality assessment using NIH tools for Observational Cohort, Cross-Sectional and Case-Control studies. RESULT(S): In total, 915 reports were screened and 15 full-text articles were included for the review. Studies were most commonly in breast tumors with no PBTs identified. Most were cross-sectional using small sample sizes. Fried, Balducci, and Leuven Oncogeriatric Frailty tools and cytokines (i.e. Interleukin-6 and C-reactive protein) were commonly used. Increased inflammatory response was the prevalent identified mechanism. Threats to internal validity of the studies were the use of unvalidated cut-off scores or modification of existing tools in about 50% of studies. Only six studies were rated as good using quality assessment ratings. CONCLUSION(S): Varied use of frailty measures and nonspecific blood biomarkers limited conclusions for mechanisms of frailty in cancer survivors. There are missed opportunities in neuro-oncology;inclusion of frailty assessment and biomarkers is instrumental to advancing science in PBTs.

Continuing fast-track (Expedited) pancreaticoduodenectomy service during the COVID-19 pandemic: Experience from an established pancreatic surgical centre

Aim: Avoiding preoperative Biliary drainage (PBD) can facilitate early curative Surgery for patients with periampullary tumours. However, The evidence over PBD is conflicting. This prospective re-audit aimed to assess compliance to NICE guidelines (NG85) and surgical outcomes at a well-established HpB Surgery unit after achieving additional theatre sessions following prior audit. Method(s): Prospective data collection and analysis for all patients undergoing pancreaticoduodenectomy with curative intent was performed as re-audit at a tertiary pancreatic centre between September 2020 to August 2021. Result(s): 64 or 71 patients received curative pancreaticoduodenectomy (43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduodenectomy, 7 inoperable). of 29 patients without PBD, 10 were jaundiced with median bilirubin levels of 138 Micromole/L (range 27-357 Mmol/L). Median time (range) from diagnostic imaging to Surgery with curative intent was 21 days (3-42) for patients without PBD compared to 62 days (22-305) for those with PBD (p=0.00028). No statistically significant difference in median HDU/ITU stay (4 Vs 3 days, p=0.849), postoperative complications (C-D>2) (30% Vs 27.8%, p=0.755), RO resection rates (42.8% Vs 75%, p=0.364), and median hospital stay (17 Vs 10 days, p=0.076) was observed for patients without or with PBD respectively. Interestingly, inoperable patients had shorter time delay from diagnostic imaging to Surgery (29 Vs 49 days, p=0.010) Conclusion(s): Fast-track (expedited) pancreaticoduodenectomy is feasible and safe for selected group of jaundiced patients without PBD. The constraints and challenges posed by COVID-19 pandemic are likely reflected in higher number of patients receiving PBD (42/71) despite clear referral pathway established following prior work at our institute.

Financial toxicity and distress during the COVID-19 pandemic in people living with primary brain tumors

Primary brain tumor (PBT) patients experience high symptom burden and functional limitations, which may be impacted by the economic strain and mood disturbance during the COVID-19 pandemic. We assessed financial toxicity and associated patient reported outcomes (PROs) after one year of lockdown in a cohort of PBT patients. Patient and disease characteristics and PROs including FACIT-COST, MDASI-Brain Tumor, PROMISAnxiety/ Depression short forms, and EQ-5D-3L were collected from 7/2020 to 5/2021 from participants in our Natural History Study. Descriptive statistics, Pearson correlations, and independent samples t-tests evaluated PRO relationships. The cohort included 112 PBT patients: 57% male, 87% white, mean age = 47 (range 25 - 80). Majority were married (65%), completed ≥ 4-year college degree (73%), earned annual family income ≥ $50,000 (68%) and living with a high-grade glioma (72%) complicated by recurrence (51%). Using FACIT-COST, 56% reported some financial hardship due to illness with a mean FACIT-COST of 28.3 (SD = 11.3, range: 0 - 44). Half of patients reported feeling moderately to extremely anxious or depressed. Non-Whites and Hispanics as well as those not currently working reported worse financial toxicity compared to White non- Hispanics and individuals currently working (21.4 vs 29.8 and 25.7 vs 30.4, respectively). Worse financial toxicity scores strongly correlated with worse overall symptom burden (r = -0.55) and interference (r = -0.42), worse anxiety (r = -0.39) and depression scores (r = -0.44), and worse overall HRQOL scores (r = -0.33)[all p< .01]. This is the first report of FACIT-COST in PBT patients to our knowledge and demonstrates that non-White individuals living with high grade glioma who are not currently working due to their tumor reported worse financial toxicity which was strongly correlated with higher symptom burden and interference with lower HRQOL. Future studies to assess financial toxicity longitudinally and post-pandemic using the FACIT-COST are needed.

An innovative virtual multi-institutional, multidisciplinary neuro-oncology tumor board: The Nih-Nob experience during the COVID-19 pandemic

BACKGROUND: The American Academy of Neurology Institute and Society for Neuro-Oncology recommend multidisciplinary tumor board (MTB) meetings as a quality metric in neuro-oncology. With the COVID-19 pandemic resulting in travel restrictions, we expanded our existing MTB by transitioning to a virtual format that maintained our commitment to providing consultation for primary CNS tumor cases. This transition permitted participation by neuro-oncology teams from over 30 Brain Tumor Trials Collaborative (BTTC)/National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) centers across the United States. Here, we describe results from opening our MTB remotely to these teams. METHODS: We retrospectively reviewed records from remote MTB meetings held between April 2020 and March 2021. To gauge the impact of our MTB on clinical management, we administered a brief survey querying BTTC members. RESULTS: Twenty-eight providers presented 41 cases during 24 virtual MTB meetings (range: 1-4 cases per meeting). Two cases (5%) were presented only for educational value. Approximately half (54%) of the cases discussed dealt with diagnosis/management of an NCI-CONNECT rare CNS tumor. During MTB discussions of the 39 cases seeking diagnosis/management recommendations, 32% received clinical trial recommendations, 10% were suggested to enroll in the NCI Neuro-Oncology Branch (NOB) Natural History Study (NCT02851706), 17% received a recommendation to obtain central neuropathology review, and 100% received recommendations for further disease management. Most BTTC survey respondents (83%) found these recommendations impactful in the management/treatment of their presented case or generally useful/ informative for their clinical practice. CONCLUSION: We describe the feasibility and utility of an innovative virtual multi-institutional MTB. These novel remote meetings allowed for discussion of complex neuro-oncology cases and recommendations from experts, particularly important for those with rare CNS tumors. Our study's findings during the COVID-19 pandemic of the value of providing remote access to MTBs should apply postpandemic.

Mood disturbance in patients with central nervous system (CNS) tumors during the COVID-19 pandemic

BACKGROUND: Primary CNS tumors are associated with uncertainty likely contributing to mood disturbance that is common throughout the disease trajectory. The intersection of the COVID-19 pandemic with a CNS tumor diagnosis may further impact the anxiety/depression experienced in this population. This study assessed key anxiety/depression symptoms in patients with CNS tumors prior to and during the COVID year. METHODS: Patient reported outcomes (PROs), including the PROMIS Anxiety and Depression Short Forms and EQ-5D-3L, were collected at the time of clinical or telehealth evaluation from the COVID year (March 2020-February 2021) and were compared to assessments through February 2020 (a NOB-normative sample), reflecting what we would typically see in our regular clinic evaluations. RESULTS: The COVID sample (N = 178) was primarily White (82%), male (55%), median age of 45 (range 18-79), and KPS 3 90 (50%). The majority had high grade (70%) brain (83%) tumors with 3 1 prior recurrence (60%) and 25% were on active treatment. Visits were primarily conducted via telehealth (64%) and 20% had progression at assessment. Compared to the NOB-normative sample, patients reported significantly higher depression scores (moderate-severe, 17% vs. 12%, p < 0.05), but not anxiety (18% vs. 16%). Eleven percent reported both moderate-severe anxiety and depressive symptoms (8% pre-COVID). Overall health assessed by the EQ-5D-3L was similar to the normative sample in all dimensions, apart from impact of moderate/extreme mood disturbance, which was more prevalent in the COVID year (53% vs. 43%, p < 0.05%). CONCLUSION: Patients with CNS tumors are at risk for significant symptoms of depression and anxiety;this risk was heightened during the COVID year. Further evaluation of clinical factors associated with risk are underway. These findings highlight the need for assessments and interventions that can be administered via telehealth to address the mental health needs of this vulnerable population.

Patient-reported symptom burden and interference: A comparison between COVID-19 pandemic year and normative data in patients with central nervous system (CNS) tumors

CNS tumor patients are highly symptomatic causing interference with activity and worse quality of life. Social distancing due to the COVID-19 pandemic increased demands on the patient, caregivers, clinicians, and the health care system. The NCI's Neuro-Oncology Branch Natural History Study (NHS) systematically collected patient-reported outcomes (PROs) provide insight into how these challenges influenced symptom burden and interference during the COVID year. METHODS: Patient and disease characteristic as well as patient-reported symptoms and interference (MDASI-BT/-SP) and general health status (EQ-5D-3L) from 3/2020-2/2021) were compared to NHS normative sample collected prior to 3/2020. RESULTS: The sample (n = 178) was primarily White (82%), male (55%), median age of 45 (range 18 - 79) and KPS 3 90 (51%). The majority had high-grade (70%) brain (83%) tumors (BT) with ≥ 1 prior recurrence (60%) and 25% were on active treatment. Clinical visits were primarily conducted via telehealth (64%) and 20% of all patients were diagnosed with progression at the time of assessment. Most commonly reported moderate-severe symptoms among BT patients were fatigue (30%), difficulty remembering (28%), feeling drowsy (22%). Among spinal cord tumor patients, fatigue (39%), pain (35%) and numbness/tingling in arms/legs/trunk (35%) were most frequently reported. These symptoms were reported in similar frequencies by the normative sample. Nearly half of the COVID year sample (48%) reported moderatesevere activity-related interference. Reported problems with mobility (38%), self-care (19%), pain/discomfort (40%), and usual activities (50%) were similar in both groups except for increased mood disturbance (53%) was reported during the COVID year. CONCLUSION: These findings support CNS tumor patients remained highly symptomatic with significant impact on health-related quality of life during the COVID year. Clinicians should develop timely individual care plans to help BT patients navigate their disease course. Evaluation of risk associated with more severe symptoms and functional limitations are ongoing.

Developing a novel advanced clinical practitioner led severe COVID-19 follow-up service – a picture is not always worth a thousand words

During the COVID-19 pandemic the British Thoracic Society produced national guidance advising for all severe COVID-19 pneumonia (defining our inclusion criteria as clinico-radiological diagnosis, oxygen requirements >35%, continuous positive pressure ventilation or mechanical ventilation) to have 4–6-week follow-up with all COVID-19 patients having imaging at 12 weeks.1 To avoid duplication of work streams, the district general hospital developed a pathway liaising with ICU to ensure follow-up 4–6 weeks post discharge, chest x-ray at 12 weeks and follow-up telephone appointment at six months with the aim of discharging back to the community or referring for further investigations. In total we followed up 272 patients who were referred to our service.In the first wave (April 2020 - July 2020) we followed up 117 patients of whom 99 had a follow-up chest X-ray. Chest x-rays were performed on average 80.4 (43–140) days post discharge. Of these patients, 14% had residual changes, with 86% having a clinic normal chest X-ray, with 33 (28%) requiring referral for further investigation and respiratory physician follow-up due to breathlessness (quantified by Modified Medical Council Research dyspnoea score) identified at follow-up clinic appointments, on average 168.4 (91–209) days post discharge.In the second wave (October 2020 – April 2021) we followed up 155 patients of whom 133 had a chest x-ray and 51 (38%) had residual changes. Chest x-rays were performed on average 88.7 (32–120) days post discharge and follow-up clinic appointments were on average 150.9 (92–172) days post discharge. Only 35 patients have been followed up to date (the remaining having not reached 6-months post discharge). Of these 15 (42.8%) required onwards referral for further investigation.This data shows that we have run a robust follow-up service for severe COVID-19 pneumonia patients. It is important that we think carefully about who is referred for further respiratory investigations as our data shows that chest x-ray resolution does not necessarily correlate with resolution of symptoms, and the implication for NHS services.British Thoracic Society. British Thoracic Society Guidance on Respiratory Follow Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia [V1.2], 2020. https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidance-post-covid-pneumonia/

Telepsychology training in a public health crisis: A case example

ABSTRACT In early 2020, the world was thrust into a crisis with the advent of the COVID-19 pandemic. This resulted in the sudden expansion of telepractice in the mental health field for licensed mental health providers and trainees. Prior to the pandemic, few mental health training programs provided training opportunities in telehealth service delivery. The [name removed for blind review] (TBC) is one of a few telemental health training programs in the world. The TBC has provided telehealth services to rural and underserved populations since 2009 with a hub and spoke model of care, but due to constraints related to the pandemic has recently transitioned to an all in-home model of telehealth service delivery. The present paper highlights recent policy changes to in-home telepractice and the TBC methodology for transitioning to in-home service delivery. Results include solutions to common pitfalls in areas such as communication and logistics, clinical supervision and consultation, and boundary setting. Recommendations are also provided for the development of training programs throughout the world to equip mental health trainees in telehealth service delivery. Mental health practitioners are poised to thrive in the face of adversity during the COVID-19 pandemic and trainees should not be left behind. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

1,000,000 cases of COVID-19 outside of China: The date predicted by a simple heuristic.

We forecast 1,000,000 COVID-19 cases outside of China by March 31st, 2020 based on a heuristic and WHO situation reports. We do not model the COVID-19 pandemic; we model only the number of cases. The proposed heuristic is based on a simple observation that the plot of the given data is well approximated by an exponential curve. The exponential curve is used for forecasting the growth of new cases. It has been tested for the last situation report of the last day. Its accuracy has been 1.29% for the last day added and predicted by the 57 previous WHO situation reports (the date 18 March 2020). Prediction, forecast, pandemic, COVID-19, coronavirus, exponential growth curve parameter, heuristic, epidemiology, extrapolation, abductive reasoning, WHO situation report.