ABSTRACT
BACKGROUND: The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults. METHODS: A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire. RESULTS: Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F<sub>(2, 514)</sub> = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R<sup>2</sup>: 0.20). CONCLUSION: COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.
ABSTRACT
Introduction: Two prospective randomized trials, TARGIT-A and ELIOT, have shown intraoperative radiationtherapy (IORT) to be a safe alternative with a low-risk of local recurrence compared to whole breast radiationtherapy following breast conserving surgery for selected low-risk patients. We report the first 1200 tumors treatedwith this modality at our facility. Methods: 1200 distinct breast cancers in 1169 patients (31 bilateral) were treatedwith breast conserving surgery and X-ray IORT, using the Xoft Accent System from June 2010 to November 2018.Patients were enrolled in an IORT registry trial and data were collected at 1 week, 1 month, 6 months, 1 year, andyearly thereafter. The primary endpoint was local recurrence. Results: To date, there have been 61 events in 54patients: 50 ipsilateral local recurrences (14 DCIS and 36 invasive), 7 regional nodal recurrences and 4 distantrecurrences. Of local recurrences, 9 were within the IORT field, 21 outside of the IORT field but within the samequadrant as the index cancer, and 20 were new cancers in different quadrants. There has been no breast cancerrelated deaths and 27 non-breast cancer deaths. Currently, with a median follow-up of 52 months, Kaplan Meieranalysis projects 5.2 % local recurrence rate at 5 years. In the table below, the five-year probability of localrecurrence is analyzed by quadrant and/or type of recurrence (all recurrences or just invasive). Using the 2017,ASTRO Categories, 520 patients (43%) were suitable for IORT, 415 (35%) were cautionary, and 265 (22%) wereunsuitable for IORT after final histopathology was evaluated. Conclusion: IORT is profoundly convenient. Whenused as the only adjuvant breast irradiation, it eliminates approximately 15-35 outpatient visits. This has become increasingly important during the current COVID-19 pandemic. In the group of patients described here, more that100,000 patient-hours were saved. The local, regional, and distant recurrence rates observed in this trial wereslightly higher than those of the prospective randomized TARGIT-A and ELIOT Trials. This may be explained by22% of our patients being considered unsuitable for IORT by ASTRO Criteria. The low complication rates previouslyreported by our group as well as the low recurrence rates reported in this study support the cautious use andcontinued study of X-ray IORT in women with low-risk breast cancer.
ABSTRACT
Purpose: Massachusetts has been heavily impacted by the COVID-19 pandemic with new cases rising from 6,621in March to 55,584 in April and 34,760 in May 2020. Most clinics and hospitals stopped performing electiveprocedures and reduced the volume of patients seeking in-person care starting in mid-March. This abstractquantifies the rates of mammography and PSA testing, both for screening and diagnostic purposes, as well asbreast and prostate biopsies performed during the first five months of 2020 as compared to the same months in2019 for a large health care provider group in central Massachusetts. Methods: Men and women aged 30-85 without a history of breast or prostate cancer who were active patients ofthe provider group between January 2019 and May 2020 were included in this analysis. We compared the monthlyrates per 1,000 people of mammography, total PSA, and breast and prostate biopsy for the period of January-May2019 and January-May 2020 overall and by age and race/ethnicity. Procedures were identified by CPT codes in thegroup's electronic health record. Results: In total, 65,312 men and 80,629 women were included in the analysis of 2019 data and 66,396 men and82,695 women in 2020. About 70% of the population was non-Hispanic white, 3% non-Hispanic Black, 4% Hispanic,4% Asian, and 18% other/unknown. The median age was 53 for men and 52 for women. The monthly number ofmammograms declined significantly between January-May 2019 and the same months in 2020 from an average of13.6 mammograms per 1,000 women per month in 2019 to 6.1 in March, 0.25 in April and 1.1 per 1,000 women inMay 2020. Digital tomosynthesis also declined from an average of 34.7 per 1,000 women in 2019 to 14.6, 1.4, and1.5 across March through May of 2020. The level of decline increased with age and was greatest among the oldestwomen, aged 75-85. Parallel declines occurred among all racial/ethnic groups. Breast biopsies declined steadilyfrom an average of 0.9 per 1,000 women per month in 2019 to 0.8 in March, 0.4 in April and 0.1 per 1,000 women inMay 2020. PSA testing was conducted in 2019 with an average of 34.4 men tested per 1,000 per month. Declines inPSA were slightly less than mammography with 17.6 tests completed per 1,000 men in March, 6.1 in April, and 11.3in May 2020. Prostate biopsies were infrequent in 2019 with an average of 0.15 per 1,000 men per month and didnot decline in 2020. Declines were slightly greater in younger men aged 30-54 and similar across racial/ethnicgroups. The greatest single-month change in test rates occurred between April 2019 and April 2020 in both women(screening mammogram rate declined 98%, tomosynthesis 96%) and men (PSA testing rate declined 83%), reflecting the peak of the COVID-19 surge in Massachusetts. Conclusions: The observed decline in these common screening and diagnostic procedures reflects the impact ofthe COVID-19 pandemic on cancer prevention and early detection, signaling possible downstream effects on thetiming and staging of future cancer diagnoses.