ABSTRACT
Background: High-grade glioma patients and their caregivers often suffer from psychological distress.1 Nevertheless, supportive services are lacking. This study investigates whether a mindfulness-based yoga intervention is feasible and affects anxiety, depression, quality of life, and stress-associated physiological parameters. Method(s): A monocentric on-site pilot study to test feasibility was started in 2020 and then adapted to an online format due to the COVID-19 pandemic. Participants were randomly assigned to immediate intervention and 8-weeks wait-list control groups. At randomization, immediately before and after the end of the 8-week intervention (1 h/week), which was performed by trained yoga teachers in a synchronous format, as well as another 3 months later, validated questionnaires were filled by participants and serum plus saliva samples were taken. In addition, participants were asked to rate their satisfaction with various course features. Result(s): A total of 43 participants with 27 donating biological samples and a drop-out of 14 were included. No significant changes in subjective criteria and physiological stress parameters were detected. Known disadvantages of online interventions were reported, e.g. technical difficulties. Overall course-satisfaction, with teachers guidance most positively rated, was reported. Discussion(s): High-grade glioma patients are very vulnerable due to their rapidly changing health status. Caregivers often have very limited time due to the care they provide. Therefore, recruitment is difficult and leads to dropouts. Validity of the results may be limited due to the small sample size and comparability of stress parameters due to circadian fluctuations in salivary cortisol. Conclusion(s): The online yoga course is feasible. Despite of lacking personal contact, supervision of participants is possible and satisfactory. To measure cortisol, more reliable hair samples will be taken in the upcoming multicenter study, starting in fall 2021.
ABSTRACT
Background: During the COVID-19 pandemic, many oncology practices began offering virtual visits via video and/or telephone. How such visits are perceived by Black adults receiving cancer care, a category of patients often facing access barriers and poorer outcomes, is not known. We elicited Black patients' perceptions of oncology virtual visits. Method(s): We conducted in-depth, semi-structured telephone interviews with Black adults aged >=21 years who received oncology care between 6/1/19 - 3/20/21 for head & neck cancer, prostate cancer, and multiple myeloma within two US-based academic health systems. The interview guide elicited perceptions within predefined themes (e.g., ease of use, usefulness, communication quality, appropriateness). Interviews were audio-recorded, transcribed verbatim, and coded for a priori themes and new ones identified during data immersion. One trained research assistant coded all transcripts, using Atlas.ti for data management. Result(s): Forty-nine Black adults diagnosed with cancer completed an interview between 9/2021 and 2/2022 (n = 16 head & neck, n = 16 prostate, n = 17 multiple myeloma);mean age 62 years (range: 26-79), 55% male, and 59% reported ever having a virtual visit (n = 21 experienced video virtual visit(s), n = 8 telephone only). Perceptions of virtual visits varied. Some expressed a desire for continued use and noted advantages, including factors associated with the comfort and convenience of being home and not needing to travel (e.g., not needing to get up and dressed;reduced time and gas/parking costs). Others emphatically indicated preferring in-person visits due to the face-to-face/one-on-one/person-to-person interaction. Those with positive perceptions endorsed similarities between information exchanges, communication, and physician knowledge in in-person compared to virtual visits, but often noted insurance coverage, working technology and the need for clinical appropriateness (e.g., it was just a follow up visit;I didn't need any labs) as foundational. Those expressing concerns discussed the inability for vital signs assessment/ physical exams/laboratory testing, and raised concerns regarding interpersonal communication, including the inability to be physically present with one another and assess each other's body language. For some respondents this led to concerns about trust/honesty and physicians being distracted and/or missing something during the visit. Technology-related obstacles (e.g., confidence and connectivity) when experienced were reported as overcome with assistance or via switching to telephone. Conclusion(s): We found Black adults with cancer generally receptive to virtual visits and that telephoneonly options increased access. Virtual visit acceptability among Black adults may be enhanced by improved interpersonal connectedness during visits, technology support, and patient-centered scheduling options.
ABSTRACT
Purpose: Disparities in COVID-19 outcomes have been widely reported, with disproportionate negative impacts onthe African American (AA) population. The purpose of this study was to evaluate the impact of race on COVID-19outcomes for cancer patients hospitalized in a large Michigan health care system. Methods: A cohort of hospitalized, laboratory-confirmed SARS-CoV-2 positive patients was identified through theHenry Ford Health System Institutional COVID prospective patient registry between March 1st-May 2020. Those with a diagnosis of cancer were identified using our institutional tumor registry and electronic health record (EHR).Patient self-reported race/ethnicity data were extracted from the system's centralized EHR, as were otherdemographic and clinical covariates. Racial differences in cumulative incidence of mortality and hospital discharge were tested. To further evaluate the effect of race on the mortality, Fine-Gray competing-risks model was performed with discharge alive as a competing event. A P<0.05 was considered statistically significant. Results: Out of the 204 COVID+ cancer patients hospitalized in our health care system, 69.6% were AA (N=142).AA patients were slightly younger than non-AA patients (70.35 v. 74.58, p=0.023). No difference in mean BMI wasdetected (30.33 AA v. 29.87 non-AA, p = 0.68). A smaller proportion of AA patients had active cancer (36.6% v.40.3%, p = 0.73). Outcomes were generally inferior in the AA cohort, although these differences were notstatistically significant. The rate of ICU admission was 41.5% in AA and 37.1% in non-AA (p=0.659). 34.5% of AApatients required intubation compared to 25.8% of non-AA patients (p=0.288). In our model, older age was the onlyvariable that significantly increased the risk of death (standard hazard ratio SHR 1.05, p = 0.002). The risk of death was higher for AA patients (SHR 1.92, p=0.068) and males (SHR 1.62, p = 0.078) but did not meet statisticalsignificance.