ABSTRACT
Background: COVID-19 has had a significant impact on the provision of HCV treatment services within the National Health Service (NHS). As one of the largest HCV treatment centres in London, we adapted to the pandemic by instituting changes in the dispensing of medications, alongside provision of virtual consultations. We aimed to review this pathway and assess the impact on patient outcomes. Methods: Data was extracted from HCV treatment trackers and patient records, and correlated with clinical outcomes. Outcomes for patients treated from April 2020 to March 2021 were compared to the preceding year. For the purpose of continuity of documentation and consultation style, outcome data of those patients treated at a designated pharmacist led treatment clinic was reviewed to assess the impact on medication adherence. Results: 216 patients were treated for HCV in the year commencing April 2020 compared to 318 in the preceding year, with documented SVR rates of 90% compared with 92% respectively. A greater number of patients did not attend for SVR12 bloods post pandemic despite completing treatment (42% vs 27%). There was also a noticeable increase in patients treated without genotyping (16.6% vs 8.8%). The pharmacist led clinic treated 22 patients in 2020, all of whom received at least one telephone consultation as part of the 'on treatment review'. 91% (n=20) were adherent (defined by NHS England as taking >75% of intended course). Of those who had reached SVR12, cure rates were 100% (n=15) in treatment naïve and 75% (n=3) in patients receiving re-treatment, with the single relapse likely attributable to an active HCC. Conclusion: There was a noticeable increase in the number of patients who did not attend for SVR12 bloods post pandemic compared to 2019. Social issues, including the inability of some patients to access a telephone, make virtual consultations more difficult. This could account for the increased number of patients lost to follow up in patient cohorts who have additional needs. In the pharmacist led treatment clinic, remote access consultations did not impact on medication adherence or patient outcomes, demonstrating a less intensive approach to monitoring may work for specific patient cohorts with specific designated providers. We present our findings to aid the evolution of treatment pathways to support the WHO target for HCV elimination. As we continue to evolve our pathways, future analysis should include patient acceptability of consultations via virtual means.
ABSTRACT
Background: The COVID 19 Pandemic has been an unprecedented global health crisis. We undertook a retrospective observational study to evaluate its impact on the management of hepatocellular cancer (HCC) in a large tertiary referral service in the UK offering all treatment modalities: liver transplantation and resection through to locoregional, systemic therapy and specialist palliative care. HCC in adults is often diagnosed in advanced stages as symptoms are only apparent later in the disease, and recent reviews have highlighted more patients presenting later with decompensation and a backlog of deferred care1. This study reviews outcomes pre and post the first wave of the Pandemic, including disease presentation, time to treatment and loss to follow up. Methods: Retrospective study of consecutive new referrals to a tertiary treatment centre. These included patients discussed between Dec 2019-Feb 2020 ('pre-COVID';total referrals n=98 with 66 newly diagnosed HCC), and July-Sept 2020 ('post 1st wave COVID';total referrals n=81 with 51 newly diagnosed HCC). NHS Providers had been asked to maintain access to essential cancer treatment throughout the Pandemic with easing of lockdown on 11 May 2020. Patients were longitudinally followed up and analysed using electronic medical records. Descriptive results were expressed as median with IQR for continuous data and as frequency (%) for categorical data. Baseline characteristics of patients were compared between the two cohorts using the Mann-Whitney U test for continuous data, and χ2 test for qualitative data. Results: As shown in Table 1, post 1st wave there has been a reduction in total number of referrals. Median age, sex and aetiology were similar between groups. Differences were noted in patient characteristics of the 'post 1st wave' cohort with a greater proportion presenting with Child Pugh C (19% vs 4%, p=0.037) and BCLC stage D (25.5% vs 12% p=0.019). Among the group of patients presenting during the Pandemic none had a diagnosis of COVID 19 infection. While there were no significant differences in loss to follow up or the decision to treatment time interval (excluding transplant) between 2019 & 2020 (p=0.672), 3 patients in 2020 had treatment cancellations due to capacity. Conclusion: After the 1st wave there has been a reduction in external referrals and an increase in number of patients presenting with advanced chronic liver disease and untreatable HCC. Whilst these are likely to represent the effects of major service reconfiguration during the Pandemic at both a 1° and 2° care level our study suggests we need to better understand medium to longterm impact. We note local efforts to preserve cancer care avoided treatment delays post 1st wave but further analysis is underway to assess impact of the second wave on quality of care received and mortality.
ABSTRACT
Youth mental health is a rapidly developing field with a focus on prevention, early identification, treatment innovation and service development. In this perspective piece, we discuss the effects of COVID-19 on young people's mental health. The psychosocial effects of COVID-19 disproportionately affect young people. Both immediate and longer-term factors through which young people are affected include social isolation, changes to the delivery of therapeutic services and almost complete loss of all structured occupations (school, work and training) within this population group. Longer-term mechanisms include the effects of the predicted recession on young people's mental health. Opportunities within this crisis exist for service providers to scale up telehealth and digital services that may benefit service provision for young people's mental health in the future.