ABSTRACT
Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Method(s): The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hamatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Result(s): The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusion(s): Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population.
ABSTRACT
Background: The focus on treatment of COVID-19 patients during the Sars-CoV-2 outbreak, lockdown measures and individuals' anxiety regarding potential infection when seeing a healthcare provider have likely implications on the extent of diagnosis and quality of treatment of non-COVID-19 patients. This hypothesis has been evaluated exemplarily for the early detection, diagnosis and treatment of colorectal cancer in Saxony within the framework of the CancerCOVID project. Method(s): The situation during 2020 was compared with the situation before the Sars-CoV-2 pandemic (i.e., 2019). The evaluation is based on pseudonymised routine statutory health insurance data for Saxony including more than 50% of the population. Result(s): A main finding was the drop in the number of diagnosis of new colorectal cancer cases between 2019 and 2020 (i.e., 1797 versus 1352). Furthermore, the per-patient rate of surgeries for incident colorectal cancer cases increased slightly (2.4 to 2.5), as did the rate of intravenous (IV) cytostatics administration (2.2 to 2.4) and radiation therapy (1.1 to 1.4). The per-patient rate of surgeries for prevalent colorectal cancer patients remained constant (0.3), as did the rate of radiation therapy (0.2). However, the per-patient rate of IV cytostatics for prevalent colorectal cancer patients decreased from 1.7 to 1.4. The results of analyses pertaining to cancer screenings and mortality are available as well. Discussion(s): It is likely that reduced screenings and fewer contacts with healthcare providers due to the pandemic led to the drop in new diagnosis. The reasons for the small numeric increases in the rates of procedures per incident patient versus the largely flat trajectory in the rate of health care services for prevalent cases require further exploration. Conclusion(s): COVID-19 was associated with changes in the provision of health care especially for cancer patients, which should be taken into consideration in the resource planning when preparing for another pandemic or public health emergency.
ABSTRACT
The sixteen German states’ crisis communication has played a decisive role throughout the Corona pandemic. This article examines, in an analysis of over 27,000 press releases, tweets, and Facebook posts, the states’ public communication over the first year of this unique, global health crisis. Using (semi-) automated content analysis, it can be shown that content differs depending on the communication channel used: New infection statistics are quickly disseminated via social media while the economic consequences of the pandemic are more frequently addressed through press releases. Using topic modeling, it can also be shown that the state governments each have their own thematic priorities. Over the entire period of the study in 2020, it can be seen that some topics follow the wave-like course of the pandemic in Germany, while others tend to move in the opposite direction. © 2022, Nomos Verlagsgesellschaft mbH und Co KG. All rights reserved.
ABSTRACT
Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Methods: The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hämatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Results: The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusions: Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population. Legal entity responsible for the study: The authors. Funding: Bundesministerium für Bildung und Forschung;Germany Förderkennzeichen: 01KI20521A-C. Disclosure: A. Reinacher-Schick: Financial Interests, Personal, Invited Speaker: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, MCI Group, AstraZeneca;Financial Interests, Personal, Advisory Board: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, AstraZeneca, Pierre Fabre;Financial Interests, Personal, Other, Travel support: Roche;Financial Interests, Institutional, Research Grant: BNT, Roche, Ipsen. O. Schoffer: Financial Interests, Personal, Advisory Role: Novartis. A. Kraeft: Financial Interests, Personal, Writing Engagements: Astra. A. Tannapfel: Financial Interests, Institutional, Research Grant: Roche, Biontech. J. Schmitt: Financial Interests, Institutional, Funding: Sanofi, Pfizer, Novartis. All other authors have declared no conflicts of interest.