ABSTRACT
Background: Anaemia and iron deficiency affect a high proportion of patients with cancer, especially when undergoing treatment with systemic anti-cancer therapies (SACT) and are associated with fatigue, reduced quality of life & reduced performance status. Over the past 4 years, the Oncology DTU has continuously reviewed the managment of patients with anaemia and in particular the need to diagnose iron deficiency at time of starting SACT and recently the same guidance were introduced for Haemato-Oncology patients. Routine blood testing of Transferrin Saturation (TSAT) and serum ferritin is performed on all patients at time of starting SACT, those diagnosed with iron deficiency anaemia are treated with an intravenous iron infusion. During this time, various logistical challenges, learning and updates to local guidance has led to a more robust process, now in place to manage this patient group. Methods: Cancer patients attending for cycle 1 day 1 SACT have their TSAT and serum ferritin levels measured, if diagnosed with iron deficiency (ie TSAT <20% and serum ferritin <100ug/L, patients will receive an intravenous iron infusion. In March 2022, an audit of 141 new oncology referrals for SACT and 11 patients who received a blood transfusion was conducted for compliance to local guidance. Results: Logistical challenges included: update and approval of local guidelines, education of all members of the Health Care Team re: prescribing, contraindications and side-effects of iron infusions, patient education. Wider issues, include: COVID, staffing. 129/141 patients had TSAT and serum ferritin levels checked, of these 57 patients were diagnosed as iron deficient, with 54 patients then receiving an iron infusion. Analysis of further results is still underway. Conclusions: Whilst this is a very small audit, it demonstrates the importance of considering iron deficiency as an underlying cause of anaemia in patients with cancer, who are starting SACT and can ensure patients receive the most appropriate supportive treatment for their needs. Through our experiences, with the support of our haematology consultant, this service is predominantly nurse led and continues to develop. Legal entity responsible for the study: The author. Funding: Has not received any funding. Disclosure: The author has declared no conflicts of interest.
ABSTRACT
Background: The negative impacts of COVID-19 are higher in Blacks compared to Whites in the United States (US). Systemic inequities and differences in health behaviors may contribute to COVID-19 disparities. The aim of this study was to examine the impact of COVID-19 stay-at- home orders on health behaviors and anxiety in Blacks and Whites with overweight or obesity (OW/OB). Methods: In April 2020, the COVID-19 Health Behaviors Survey collected demographic information and changes to employment, income, diet (Rapid Eating Assessment for Participants), physical activity (PA;MET-minutes/ week), sleep patterns, and anxiety (General Anxiety Disorder-7) through an online survey. Of the 7753 respondents globally, adults residing in the US and BMI ≥25 kg/m2 were analyzed. Data presented as proportion (%) or Mean ± SD. Analyses were adjusted for baseline characteristics. Significance was set at p < 0.05. Results: Overall, 4008 respondents identified as Black (6.4%) or White (93.6%). Blacks reported being younger (-3.5 years), weighing more (+5.2 kg), single (18.4% greater proportion), and a lower annual income (2.9% lower proportion earning ≥US$50,000/year) compared to Whites (p < 0.004 for all). A greater proportion of Blacks reported being laid off (+13.5%), working fewer hours (+6.7%), and working from home (+4.6%) during COVID-19 stay-at- home orders (p < 0.0001 for all). In the overall sample, eating behaviors improved (+0.1 ± 0.3), PA decreased (-72.0 ± 1417.4 MET-minutes/ week), sleep time extended (+0.3 ± 2.5 hours), and anxiety heightened (+8.9 ± 13.2) during COVID-19 stay-at- home orders (p < 0.01 for all). These findings were universal between Blacks and Whites (p≥0.05 for all). Conclusions: This study highlights the disproportionate employment and income changes in Blacks compared to Whites with OW/OB, with no differential impact on health behaviors and anxiety. As the COVID-19 pandemic persists, disproportionate changes to employment and income may widen among Blacks and Whites, which may influence health behaviors and anxiety.