The Cancer and Research Center of Marche Region (Corm): A New Instrument to Offer Opportunities for Diagnosis and Treatment to Cancer Patients

Following the new health needs emerged during the covid pandemic, in June 2021, the Cancer and Research Center of Marches Region, CORM (www.corm-marche.it) was instituted at the Department of Oncology of the Academic Hospital Ospedali Riuniti, Ancona (IT) with the Italian Ministry of Health patronage. The CORM includes:-The digital platform for telemedicine to offer the ability to admit de novo diagnosis of solid tumors, as well as provide second opinions and to promote continutiy of care between hospital and territory-The Molecular Tumor Board, a multidisciplinary board including clinicians, pathologists and biologists to recommend personalized therapy in the "Precision Medicine" era. High throughput genomic profiling tests may be indicated by MTB team: foundation one cdx/liquid biopsy/ heme, 16 genes DNA panel and other panels that are relevant in different types of tumors, NTRK evaluation and PDL1 test. The molecular profiles are useful to indicate new treatment strategies, but also to understand the mechanism of resistance otherwise not justificable with a standard approach.-The Clinical Trial Unit which performs about 40 interventional trials/year and includes a phase 1 unit, certified by AIFA. Every year, 100 patients are enrolled in clinical trials, about 10/year in phase 1 trials.-The Regional Center of High Specialization in Oncological Genetics. In December 2004, the Regional Center of High Specialization in Oncological Genetics was instituted and we developed an increasing expertise in genetic counseling and tests for hereditary syndrome (hereditary breast and ovarian cancer syndrome and Lynch syndrome). Last year, we conducted 3166 genetic counseling, consisting of collecting genetic information and drawing pedigree, making or validating diagnosis, communicating clinical and genetic information and supporting the family to reach a decision and take appropriate actions. From January 2022, we activate the telemedicine platform also for genetic counseling to select patients who deserve genetic testing and come from distant territories. We aim to create a technological network between the oncology departments and general practitioners, patient associations and all the other specialists to guarantee the continuity of care and to overcome the disparities in oncological health services, simplifying cancer clinical management.

Sars-Cov-2 Omicron (B11529) Variant Infection Leads to High Morbidity and Mortality in Unvaccinated Patients with Cancer

Background: The Omicron (B.1.1.529) SARS-CoV-2 variant is highly transmissible and escapes vaccinal immunity. Evidence is lacking as to the impact of Omicron in oncological patients. Method(s): Capitalizing on OnCovid study data (NCT04393974), we analysed COVID-19 morbidity and case fatality rate at 28 days (CFR28) of unvaccinated patients across 3 phases defined following the evolution of the pandemic in Europe, according to date of COVID-19 diagnosis: "Pre-vaccination" phase (27/02/2020-30/11/2020), "Alpha- Delta variant" phase (01/12/2020-14/12/2021), "Omicron variant" phase (15/12/2021-31/01/2022). Finding(s): By the data lock of 04/02/2022, 3820 patients from 37 institutions across 6 countries were entered. Out of 3473 eligible patients, 2033 (58.6%), 1075 (30.9%) and 365 (10.5%) were diagnosed during the Pre-vaccination, Alpha-Delta and Omicron phases. In total 659 (61.3%) and 42 (11.5%) were unvaccinated in the Alpha-Delta and Omicron. Unvaccinated patients across the Omicron, Alpha-Delta and Pre-vaccination phases experienced similar CFR28 (27.5%, 28%, 29%, respectively). Following propensity score matching, 42 unvaccinated Omicron patients were matched with 122 and 121 patients from the Pre-vaccination and Alpha-Delta phases respectively, based on country of origin, sex, age, comorbidity burden, primary tumour, cancer stage and status, and the receipt of systemic anticancer therapy at COVID-19. Unvaccinated Omicron patients experienced improved COVID-19 outcomes in comparison to patients diagnosed during the Prevaccination phase. Morbidity and mortality were comparable to those of unvaccinated patients diagnosed during the Alpha-Delta phase. Interpretation(s): Despite time-dependent improvements in outcomes reported in the Omicron phase, patients with cancer remain highly vulnerable to SARS-CoV-2 in absence of vaccinal protection. This study provides unequivocal evidence in support of universal vaccination of patients with cancer as a protective measure against morbidity and mortality from COVID-19.

Fewer early stage breast cancer diagnoses after COVID-19 outbreak: Preliminary report from the Italian COVID-DELAY study

Background: The coronavirus disease (COVID-19) has imposed an unprecedented challenge on the Health Care System. With the reallocation of crucial health resources to effectively exit the crisis, the pandemic has profoundly affected cancer patients' (pts) management. Breast cancer (BC) diagnosis results, especially in the early stage, from screening programs temporarily paused during COVID-19 outbreak. The aim of our multicenter study is to investigate the impact of COVID-19 on the likelihood of receiving timely diagnosis, staging and treatment for BC pts compared to pre-pandemic period. Material (patients) and methods: Medical records of all consecutive newly diagnosed BC pts referred to 4 Italian Oncology Departments between March and December 2020 were assessed. Monthly access rate and temporal intervals between date of symptoms onset, radiological, cytohistological diagnosis and treatment start were analyzed and compared with those of the same period in 2019. Differences between the two years were analyzed using Fisher's exact or chi-square test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables. Results: A significant reduction (23%) in newly diagnosed BC pts was seen when compared with 2019 (552 vs 719). Newly BC pts in 2020 were less likely to be diagnosed with early stage (stage I-II) BC (77% vs 84%, p < 0.01), had a worsened ECOG PS (19% had PS > 0 in 2020 vs 16% in 2019, p = 0.15) and were more symptomatic at diagnosis (43% vs 23%, p < 0.01). Other clinical and tumor characteristics (such as histotype [p = 0.23] and molecular subtype [p = 0.71]) were similar regardless of the year. Looking at pts management, time intervals between symptom onset and radiological diagnosis (median 17 days in 2020 vs 21 in 2019, p = 0.04), symptom onset and cytohistological diagnosis (26 vs 35 days, p = 0.06), cytohistological diagnosis and treatment start (median 62 vs 76 days, p < 0.01) were maintained or even improved. However, less BC cases were discussed in multidisciplinary tumor meetings during the 2020 (52% vs 69%, p < 0.01). Conclusions: While the COVID-19 effects on cancer care will be likely felt for years to come, our data indicate a sharp decline in BC detection in 2020 with major impact on early stage diagnosis. Despite the upheaval generated by this global Health Care crisis, our study proves the effectiveness of the actions taken by Oncology Departments to guarantee diagnostic-therapeutic pathways.

Caregiving during COVID19 pandemic: the new challenge in oncology assistance?

Introduction: Coronavirus disease 2019 (COVID-19) outbreak has been declared a pandemic unprecedented. Italy has been one of the first and heavily affected countries. The hematologic toxicity due to chemotherapy is the main reason why cancer patients are considered fragile patients, due to the high risk of infection. This led to important restrictions and recommendations during first and even more during second peak of COVID-19 pandemic with the prohibition of caregivers admission. In the above scenario, our study has the aim of evaluating the impact of COVID19 pandemic in caregiving in oncology. Materials and Methods: Between 02/09 and 04/02 2021 our team conducted a cross-sectional study by submitting a survey to caregivers of patients with solid cancer undergoing active treatments in Oncologic Departments of Marche region. An anonymous, paper questionnaire regarding perception of patient safety and continuity of care was submitted. Results: A total of 112 caregivers responded to our survey. The majority of them were between 46 and 65 years old (46.4%), female (57%), declared to take care of the patient for 0-2 hours/day (36.6%) and declared to have increased assistance time during the pandemic (59.3%). Half of the participants declared there were no economic difficulties in assistance of their relatives and more than half (55.4 %, n=62) did not report major change in this setting. Almost all caregivers (99.1%) declared that the Oncology Departments has complied with the safety recommendations to limit virus spread. Although 86 (76.8%) of them confirmed that access has been restricted due to pandemic, only 10 caregivers (8.9%) perceived these precautions too restrictive, while 107 ( 95.5%) of the all sample defined them effective. Despite these constraints, approximately all respondents declared that they had the chance to dialogue with health care providers and had the possibility to access the oncologic department if necessary (respectively 106 subjects, 94.6% and 101, 90.1%). Moreover, more than half of caregivers (n=57, 50.9%) perceived that the quality of care has not been affected by the pandemic. Conclusions: Despite the COVID-19 pandemic has overwhelmed the Italian National Health System, maybe more than in other countries, Oncology Departments was considered worthy of the emergency care in terms of safety and care management by caregivers. Caregivers perceived and believed in an adequate quality of care for their relatives without economic implications.

COVID-19 impact on colorectal cancer care in 2020: Preliminary data from the Italian COVID-DELAY study

Background: Since March 2020, Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide causing a massive Health Care crisis with Italy among the most affected countries. Oncology care has been widely derailed and cancer screening programs halted to effectively face the pandemic. Aim of our multicenter study is to assess how COVID-19 has impacted on the likelihood of receiving timely diagnosis, staging and treatment for colorectal cancer (CRC) patients (pts) during the 2020 compared to pre-pandemic period. Material (patients) and methods: All consecutive medical records of newly diagnosed CRC pts referred to 4 Italian Oncology Departments between March and December 2020 were evaluated. Monthly access rate and temporal intervals between date of symptoms onset, radiological and cytohistological diagnosis, treatment start and first radiological evaluation were analyzed and compared with the same months of 2019. Differences between the two years were evaluated using Fisher's exact or chisquare test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables. Results: A considerable drop (20%) in newly diagnosed CRC cases emerged compared to 2019 (214 vs 268). The lockdown period was more impacted by such decrease compared to the other months (percentage drop 40% vs 12%). New CRC diagnoses in 2020 were less likely to be diagnosed with early stage (stage I-II-III) CRC (67% vs 72%). Other clinical and tumor characteristics such as age, gender, sidedness and mutational status were similar regardless of the year. Looking at pts management, no differences were seen in terms of interval between symptom onset and radiological diagnosis (median 19 days in 2020 vs 28 days in 2019, p=0.88), symptom onset and cytohistological diagnosis (25 vs 36 days, p=0.27), symptom onset and treatment start (median 86 vs 100 days, p=0.79). However, less CRC were discussed in multidisciplinary tumor meetings during the 2020 (45% vs 54%, p=0.07). Conclusions: While COVID-19 effects on cancer pts' outcome might unfold in the years to come, our preliminary data show a remarkable drop in early stage CRC diagnoses throughout 2020. The Italian Oncology Departments managed to optimally tackle the quality care issue ensuring prompt diagnosis and treatment despite the pandemic evolving scenario. Further investigation, including larger case series, are warranted to offer a more exhaustive picture of the impact of COVID-19 emergency on cancer care.

Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy: Real-world evidence from the COVID-DELAY study

Background: The coronavirus disease 2019 (COVID-19) had an unprecedent impact on the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population, and diagnostic/therapeutic delays might affect the years to come. Aim of the multicenter, real-world, Italian COVID-DELAY study was to evaluate how the 2020 COVID-19 pandemic impacted on LC pts' access to diagnosis and treatment compared to pre-pandemic time. Patients and methods: All consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were reviewed. Monthly access rate and temporal intervals between date of symptom onset, diagnosis and treatment start were analyzed and compared to the same period of 2019. Differences between the two years were analyzed using Fisher's exact test or chi-square test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables. Results: Less LC cases (1523 vs 1637, -6.9%) were diagnosed during the 2020 pandemic compared to 2019. LC pts in 2020 were more likely to be diagnosed with stage IV disease (p < 0.01) and to be current smokers (p < 0.01). A major drop of new LC cases was seen during the lockdown period (percentage drop -13.2% vs -5.1%) compared to the other months included. Moreover, a geographic migration was observed with more LC patients referring to low/ medium volume hospital in 2020 compared to 2019 (p = 0.01). Looking at pts management, no differences emerged in terms of interval between symptom onset and radiological diagnosis (p = 0.94), symptom onset and cytohistological diagnosis (p = 0.92), symptoms onset and treatment start (p = 0.40), treatment start and first radiological revaluation (p = 0.36). However, less LC patients were treated in the context of clinical trials during 2020 (5% vs 7%, p = 0.07). Conclusions: Our study pointed out a decrease of new LC cases and a shift towards a higher stage at diagnosis in 2020. Despite this, the efforts put in place by the Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC patients.

Drop in early-stage colorectal cancer diagnoses after COVID-19: Preliminary report from the COVID-DELAY study

Background: By the end of 2020, coronavirus disease 2019 (COVID-19) would have indelibly marked the cancer care setting. With Italy at the forefront of pandemic, unprecedented measures were adopted to tackle the quality care issue. As a result of pausing screening programs, diagnostic delays might affect the years to come. Aim of our multicenter Italian study is to evaluate whether the COVID-19 outbreak has impacted on likelihood of receiving timely diagnosis, staging and treatment for colorectal cancer (CRC) patients (pts) after March 2020 compared to pre-pandemic time. Methods: Medical records of all consecutive newly diagnosed CRC pts referred to 4 Italian Oncology Departments between March and December 2020 were examined. Access rate (number of pts/days) and temporal intervals between date of symptoms onset, radiological and cytohistological diagnosis, treatment start and first radiological evaluation were analyzed and compared with the same months of 2019. Differences between the two years were evaluated using Fisher’s exact test or chi-square test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables. Results: A reduction (20%) in newly diagnosed CRC cases was seen when compared with 2019 (214 vs 268). The decline was greater in the lockdown period compared to the other months (percentage drop 40 % vs 12%). Newly CRC pts in 2020 were less likely to be diagnosed with early stage (stage I-II-III) CRC (67% vs 72%). Other clinical and tumor characteristics were similar regardless of the year. Looking at pts management, no differences emerged in terms of interval between symptom onset and radiological diagnosis (median 19 days in 2020 vs 28 days in 2019, p = 0.88), symptom onset and cytohistological diagnosis (25 vs 36 days, p = 0.27), symptom onset and treatment start (median 86 vs 100 days, p = 0.79). However, less CRC were discussed in multidisciplinary tumor meetings during the 2020 (45% vs 54%, p = 0.07). Conclusions: While COVID-19 repercussions will be likely felt for decades to come, our data suggest an alarming drop in early-stage CRC diagnoses during the first pandemic year. Conversely, our study draws the attention on the efforts made to ensure diagnostic-therapeutic pathways proper operation. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Prevalence and impact of COVID-19 sequelae on treatment pathways and survival of cancer patients who recovered from SARS-CoV-2 infection

Background: The long-term impact of COVID-19 in cancer patients (pts) is undefined. Methods: Among 2795 consecutive pts with COVID-19 and cancer registered to OnCovid between 01/2020 and 02/2021, we examined clinical outcomes of pts reassessed post COVID-19 recovery. Results: Among 1557 COVID-19 survivors, 234 (15%) reported sequelae including respiratory symptoms (49.6%), fatigue (41%) and cognitive/psychological dysfunction (4.3%). Persisting COVID-19 sequelae were more likely found in males (p=0.0407) aged ≥65 years (p=0.0489) with ≥2 comorbidities (p=0.0006) and positive smoking history (p=0.0004). Sequelae were associated with history of prior hospitalisation (p<0.0001), complicated disease (p<0.0001) and COVID-19 therapy (p=0.0002). With a median post-COVID-19 follow up of 128 days (95%CI 113-148), multivariable analysis of survival revealed COVID-19 sequelae to be associated with an increased risk of death (HR 1.76, 95%CI 1.16-2.66) after adjusting for sex, age, comorbidities, tumour characteristics, anticancer therapy and COVID-19 severity. Out of 473 patients who were on systemic anticancer therapy (SACT) at COVID-19 diagnosis;62 (13.1%) permanently discontinued therapy and 75 (15.8%) received SACT adjustments, respectively. Discontinuations were due to worsening performance status (45.1%), disease progression (16.1%) and residual organ disfunction (6.3%). SACT adjustments were pursued to avoid hospital attendance (40%), prevent immunosuppression (57.3%) or adverse events (20.3%). Multivariable analyses showed permanent discontinuation to be associated with an increased risk of death (HR 4.2, 95%CI: 1.62-10.7), whereas SACT adjustments did not adversely affect survival. Conclusions: Sequelae post-COVID-19 affect up to 15% of patients with cancer and adversely influence survival and oncological outcomes after recovery. SACT adjustments can be safely pursued to preserve oncological outcomes in patients who remain eligible to treatment. Clinical trial identification: NCT04393974. Legal entity responsible for the study: Imperial College London. Funding: Has not received any funding. Disclosure: A. Cortellini: Financial Interests, Personal, Advisory Board: MSD;Financial Interests, Personal, Advisory Board: BMS;Financial Interests, Personal, Advisory Board: Roche;Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Personal, Invited Speaker: Astellas;Financial Interests, Personal, Advisory Board: Sun Pharma. D.J. Pinato: Financial Interests, Personal, Advisory Board: ViiV Healthcare;Financial Interests, Personal, Invited Speaker: Bayer;Financial Interests, Personal, Advisory Board: Eisai;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: AstraZeneca. All other authors have declared no conflicts of interest.

Seroprevalence of SARS-CoV-2-Specific Antibodies in Cancer Patients Undergoing Active Systemic Treatment: A Single-Center Experience from the Marche Region, Italy

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in cancer patients may vary widely dependent on the geographic area and this has significant implications for oncological care. The aim of this observational, prospective study was to assess the seroprevalence of SARS-CoV-2 IgM/IgG antibodies in solid cancer patients referred to the academic institution of the Marche Region, Italy, between 1 July and 26 October 2020 and to determine the accuracy of the rapid serological test. After performing 3767 GCCOV-402a rapid serological tests on a total of 949 patients, seroconversion was initially observed in 13 patients (1.4%). Ten (77% of the total positive) were IgG-positive, 1 (8%) were IgM-positive and 2 (15%) IgM-positive/IgG-positive. However, only 7 out of 13 were confirmed as positive at the reference serological test (true positives), thus seroprevalence after cross-checking was 0.7%. No false negatives were reported. The kappa value of the consistency analysis was 0.71. Due to rapid serological test high false positive rate, its role in assessing seroconversion rate is limited, and the standard serological tests should remain the gold standard. However, as rapid test negative predictive value is high, GCCOV-402a may instead be useful to monitor patient immunity over time, thus helping to assist ongoing vaccination programs.

Technology-mediated communication with patients is a challenge for oncologists in the digital and pandemic era. And the winner is whatsapp!

Background: Since December 2019, coronavirus disease 2019 (COVID-19) has spread to every Country taking on pandemic proportions in few months. Physicians were asked to redefine ordinary Hospital organization reprogramming clinically differentiable activities. Materials and Methods: During COVID pandemia our Institution was supported by a call-center (CC, named TOPS s.r.l.) to make a triage for cancer patients (pts) scheduled for follow up in our outpatient clinics: C1 (dedicated to female tumors), C2 (for gastrointestinal, urogenital and thoracic tumors) and D1 (for tumors in over 5 years follow up). We report preliminary data referred to the period 7th April-24th May 2020. The activity was divided into two phases (F): April (F1) and May (F2). In F2 pts were interviewed about their preferred visit modality. Physical examination was not postpone in case of clinical needs and first visits. Moreover, CC asked about programmed radiological examinations and collected patient's feedbacks about the service. Results: A total of 587 pts have been contacted: 341 during F1, and 246 in F2. 317/341 (93%) of the contacts in F1 were successful. A gender-stratified analysis showed a majority of female (72.4%). The CC was able to get in touch with 42.8% C1 pts, 34.6% C2 pts and 22.6% D1 pts. During F2 246 pts (96.5%) of 255 planned were efficiently contacted;female maintained the predominance (74.5%). 170 pts (69.1%) were scheduled in C1, 53 pts (21.5%) in C2 and 23 pts (9.4%) in D1. During F2, among the options provided 97 pts (39.4%) selected the phone call, 142 pts (57.7%) decided for video chat (whatsapp) and 2 (0.8%) for video conference with a dedicated platform (google.meet). Only 5 pts (2.1%) expressed their intention to come to the Hospital for examination. In 69.1% of cases (170 pts) the programmed radiological examinations were confirmed during the pandemic. According to some favorable reports, the service was helpful in preserving continuum of care and preventing cancer pts of being left aside in the emergence. Conclusions: This study show that cancer patients do appreciate technology-mediated follow up visits mainly including video chat (whatsapp) and therefore we should take this into consideration. Furthermore, a dedicated CC may be helpful to organize follow-up activities during COVID-19 and to strengthen doctor-patient relationship in such a critical moment.

Training and information during covid19 pandemic: The masterpiece in young oncologists

Background: COVID 19 pandemic was a health emergency that required a rapid response by the Italian National Health System. Healthcare professionals needed to be properly trained and informed about their patients' procedures and proper management. During an emergency, the information must be exhaustive, clear and timely to allow correct diagnostic and therapeutic continuity. It is also important that all health workers are promptly and homogeneously trained to guarantee the best treatment path even during pandemic. Our survey aimed to investigate the level of information and training of health workers in oncology during the pandemic and, in particular, the difference in perception between under and over 35 years operators. Material and Methods: An on-line multiple choices survey was submitted to oncology health workers during the pandemic to investigate individual perception of resources, information and staff training management by hospital centers. No open questions were included. Results: A total of 383 health workers replied to the survey (116 under 35 years versus 267 over 35 years). In the under 35s group a total of 65% declared they had been timely and sufficiently informed to understand the extent of the problem compared to 50% of over 35 (p=0.007). About 80% of young professionals were adequately informed and two thirds (63%) was formed about procedures/ recommendations to be followed during the pandemic. But in professionals over 35 only 56% declared to have the right information and over 65% did not feel adequately trained (p= <0.01). Furthermore, 44% of over 35 felt not sufficiently prepared for the management of the cancer patient during an epidemic compared to only 28% of the under 35 (p=0.015). Conclusions: The survey showed a different perception of information and training of healthcare professionals based on the age group. This could be determined by a different degree of task and responsibility but also by the greater and faster readiness of the younger operators to acquire new information and to draw a renewed ability to face an emergency by reorganizing themselves quickly and actively.

Covid19 pandemic: Patients' perspective during cancer treatment

Background: The coronavirus disease 2019 (COVID-19) outbreak has been declared global pandemic and Italy is one of the first and heavily affected countries. Cancer patients are a population at higher risk from COVID-19 both for intrinsic fragility bound to their underlying disease and oncologic treatment delay. Aim of our survey was to investigate how cancer patients perceived their health condition, their clinical management and information communication by their medical oncologists during the pandemic. Methods: Between 15th April and 1st May 2020 a survey was submitted to cancer patients under treatment at hospitals of Marche Region which had been invested by the pandemic. It consisted of questions regarding the perception of personal safety, continuity of cancer care and information quality provided by the Oncology Department and individual psychological distress. Results: A total of 661 patients participated in the survey;60.2% was female and 40.4% was aged between 46 and 65. Almost all of the attendees (97.7%) stated that the Oncologic Department complied with the appropriate safety standards and 78% was reassured about their concerns during the medical interview, but 41% was worried of being at higher risk of infection upon entry into the Oncology Department and 53.3% felt being at greater risk of infection because of chemotherapy treatment in general. The majority of the participants (62.2%) felt that postponing cancer treatment could reduce its efficacy, however 80% declared they did not feel abandoned at the time of treatment delay. 79.4% of the attendees felt more worried for their underlying disease in this emergency situation, but the mood worsened only for 34.2% of the participants. Conclusions: Our survey reveals that Oncology Departments have been considered worthy of the emergency in terms of safety standards and care management by cancer patients. However, the majority of attendees perceived the mutual negative influence between their underlying oncologic disease and risk of Sars-CoV-2 infection and manifested concerns about their health condition highlighting the need for special measures to ensure safe continuity of care.

Doctors and nurses during covid19 pandemic: A different perception of cancer care

Background: The spread of Coronavirus disease brought the need to reorganize clinical activity in oncology. Cancer patients are very vulnerable and it is well known that their treatment has to be strictly planned. The most critical considerations still relate to the entry of the virus into hospitals, the heart of healthcare, where cancer patients are protected. Instead, during COVID19 pandemic the oncologic department had to limit access to care to protect patients from a more dangerous disease for them, witnessing a paradox of health care. This brought with it worries in oncologic healthcare professionals in replanning activities in order to guarantee therapeutic continuity and quality of care. It is well known that physicians and nurses have different role concepts and role expectations. The purpose of our study was to investigate doctors and nurses' perception on cancer patient reorganization during the COVID19 pandemic in a sample of Italian healthcare professionals in oncology. Methods: We submitted a survey to oncologic healthcare workers (physicians and nurses) of Italian National Health Care System during Pandemic to investigate clinical activity reorganization and cancer patient management through 12 closed questions. The survey promoted by Clinica Oncologica, AOU Riuniti di Ancona-Universita Politecnica delle Marche was electronic and anonymous. Results: A total of 383 oncology health workers completed the survey, 60 nurses (15%) and 323 physicians (85%). 60% of interviewed physicians perceived qualitatively lower than usual the therapeutic path of patients taken in charge in this historical moment, while 45% of nurses declared it was the same (p<0.01). The continuity of the multidisciplinary team was defined as guaranteed for 68% of oncologists, while almost 40% of nurses declared to not know it. Almost all physicians (95%) answered that their clinical activity was reorganized, compared to a lower portion of nurses (80%) that replanned their care role (p<0.01). Deferring treatments caused fear and anxiety in 62% of physicians and 46% of nurses (p=0.027). Conclusions: The survey underlined the need to integrate skills and involve all professional figures in planning cancer patients' treatment to guarantee optimal therapeutic strategies and a global take in charge in all its details, even during emergencies.

Scientia potentia est: How the Italian world of oncology changes in the covid19 pandemic

Background: After COVID-19 was declared a pandemic by the World Health Organization, a response from the Italian Health System to react to an unprecedented condition became necessary and sudden. COVID-19 pandemic required oncologists to redefine clinical organization and management of cancer patients. The aim of our study was to take a picture of the situation of Italian oncologies and to evaluate the difficulties in patients management. Methods: Between 18th March and 9th April 2020 we conducted an online survey (Google Forms). It consisted of 45 questions ranging from individual perception of pandemic management by oncological centers to physicians and nurses psychological distress and patient care. The survey was anonymous and broadcasted to oncology health workers by mailing contacts, word of mouth and social networks. Results: A total of 383 oncology health workers participated in the survey. The majority was female (72%) and from central Italy (46%). Impressively, a total of 357 (93%) participants declared the Oncologic Department reorganized routine clinical activity, but only 41% was adequately trained about the required procedures. 20% of the survey attendees think they have not received adequate and timely protective devices with respect to clinical needs and according to 58% the supply of these devices was only partial. 34% of professionals declared they do not have or know a defined common guideline to reschedule patients' treatments. More than 80% of interviewees declared to feel worry about being at greater risk of contagion than the general population, 92% feared to transmit virus to family members. Deferring treatments has caused fear / anxiety in 228 of the interviewed (60%). Symptoms of stressful situations emerged with a deterioration in sleep quality in 62% of professionals, worsening of mood (69%) and lower concentration ability (49%). Conclusions: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response quality has been heterogeneous, and several drawbacks emerged from this first analyses. Information, protection, testing and training of healthcare professionals are keywords that should be kept in mind to encourage recovery after this tragedy and to be ready to face a similar emergency in the next future.

Social distress among medical oncologists and other healthcare professionals during the first wave of COVID-19 pandemic in Italy.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has rapidly spread to every country around the world taking on pandemic proportions. Since 8 March 2020, the Italian government ordered a nationwide lockdown with unavoidable social isolation. Healthcare professionals (HCPs) represent the most physically and emotionally involved category. The aim of this study is to assess the social distress among HCPs in Italy. PATIENTS AND METHODS: In this online, totally anonymous survey, 24 multiple choice questions were posed to medical staff employed in the Italian Healthcare System during the COVID-19 pandemic. Data collection was performed from 30 March to 24 April 2020. RESULTS: A total of 600 HCPs completed the questionnaire. The majority of respondents expressed the fear of being at higher risk of contagion than the general population (83.3%) and the weighty concern of infecting their families (72.5%). An insufficient supply of personal protective equipment (PPE; P = 0.0003) and inadequate training about procedures to follow (P = 0.0092) were seen to significantly coincide with these worries. More than two-thirds declared a change in family organisation, which showed a significant correlation with the concern of infecting their relatives (P < 0.0001). CONCLUSIONS: This is the first Italian survey on social distress among HCPs during the COVID-19 pandemic. The unavailability of PPE, screening procedures and adequate training strongly affected HCPs' emotional status. Although there was a predominance of oncologists (especially from the North of Italy), which impairs the generalisation of our findings, this survey underlined the social impact that this health emergency has had on HCPs.

Scientia potentia est: How the Italianworld of oncology changes in the COVID19 pandemic

Background: After COVID-19 was declared a pandemic by the World Health Organization, a response from theItalian Health System to react to an unprecedented condition became necessary and sudden. COVID- 19 pandemicrequired oncologists to redefine clinical organization and management of cancer patients. The aim of our study wasto take a picture of the situation of Italian oncologies and to evaluate the difficulties in patients' management. Methods: Between 18th March and 9th April 2020 we conducted an online survey (Google Forms). It consisted of45 questions ranging from individual perception of pandemic management by oncologic centers to physicians' andnurses' psychological distress and patient care. The survey was anonymous and broadcast to oncology healthworkers by mailing contacts, word of mouth, and social networks. Results: A total of 383 oncology health workers participated in the survey. The majority was female (72%) and fromcentral Italy (46%). Impressively, a total of 357 (93%) participants declared the Oncologic Department reorganizedroutine clinical activity, but only 41% were adequately trained about the required procedures. 20% of the surveyattendees thought they had not received adequate and timely protective devices with respect to clinical needs, andaccording to 58% the supply of these devices was only partial. 34% of professionals declared that they did not haveor know a defined common guideline to reschedule patients' treatments. More than 80% of interviewees declaredfeeling worried about being at greater risk of contagion than the general population, and 92% feared to transmitvirus to family members. Deferring treatments has caused fear/anxiety in 228 of the interviewed (60%). Symptomsof stressful situations emerged with a deterioration in sleep quality in 62% of professionals, worsening of mood(69%), and lower concentration ability (49%). Conclusions: Our survey demonstrated the flexibility of oncologic teams. However, the emergency response qualityhas been heterogeneous, and several drawbacks emerged from this first analysis. Information, protection, testing, and training of health care professionals are keywords that should be kept in mind to encourage recovery after thistragedy and to be ready to face a similar emergency in the near future.

COVID-19 pandemic in Italy: Socialdistress and gender imbalance among health careprofessionals

Introduction: During the last months coronavirus disease 2019 (COVID-19) has spread abruptly to nearly everycountry, taking on pandemic proportions. The Italian government ordered a nationwide lockdown to hinder thespread of the contagion with unavoidable social isolation and substantial changes in lifestyle habits. Therefore, COVID-19 affected not only physical but also psychological health and well-being. Health care professionals fightingthe epidemic represent the most involved category, resulting in more physical and emotional involvement. The aimof this study is to assess the social stress level of health care workers in Italy. Materials and Methods: In this online, totally anonymous survey, 24 multiple-choice questions were broadcast tomedical staffs employed in the Italian health care system during COVID-19 pandemic. Data collection wasperformed from 30th March to 24th April 2020. Descriptive statistics have been applied to describe and summarizeour findings and the correlation analyses between categorical variables were performed using Pearson's Chi-Square. Results: A total of 600 health care professionals completed the questionnaire with a prevalence of young (32.3%between 36 and 45 years old), female (74.0%) oncologists (58.8%). Participants mainly belong to Lombardy (31.3%)and Marche (30.3%), two of the most affected regions, but almost all the Italian regions contributed to the survey. The majority of respondents expressed the fear of being at higher risk of contagion than the general population(83.3%) and the weighty concern of infecting their own families (72.5%). An insufficient supply of personal protectiveequipment (p = 0.0003) and inadequate training about procedures to follow (p = 0.0092) significantly correlated withthese worries. Furthermore, more than two thirds declared a change in family organization and daily life, showing asignificant correlation with worry about infecting their own relatives (p < 0.0001). Discussion: This is the first Italian survey on social distress among health care professionals during the COVID-19pandemic. The unavailability of personal protective equipment, periodic screening procedures, adequate training, and the correct spread of information strongly conditioned health care professionals' emotional status, familyorganization, and daily life. With this survey we underlined the social impact that this health emergency has onhealth care workers, especially on women, who deal with “caring” in the hospital as well as at home, juggling to fulfillmultiples roles of professionals, mothers, wives, and caregivers for elderly parents. We wish that institutions couldinvolve themselves concretely to guarantee that health care professionals safely perform their work in a contextappropriate to proper professional skills and with the adequate social and psychological support. Reducing workers'fear of contagion and psychological distress will certainly bring significant positive repercussions for the nationalhealth system.