ABSTRACT
Background: Emilia Romagna recordered a very high percentage of hospitalized COVID-19 patients out of the total number of COVID-19 affected people. Data reveal cancer to be a major risk factor for adverse outcomes and death for patients with Sars CoV2 infection. This increased susceptibility could be due to the chronic immunosuppression, exerted by the cancer itself and exacerbated by cytotoxic therapies. Material(s) and Method(s): We retrospectively evaluated 93 oncological patients, followed for cancer at the Sant' Anna University Hospital in Ferrara, and diagnosed with COVID-19 infection in 3 different pandemic periods (February 2020- September 2020;October 2020-August 2021;September 2021- March 2022). We analyzed demographic and clinical features of the population: Age at diagnosis, gender, tobacco consumption, comorbidities (according to the Charlson Comorbidity Index), cancer subtype and stage, therapy ongoing and ECOG PS before and after COVID-19 infection. We also described the severity of the infection through the symptoms developed and need for eventual hospitalization. Result(s): The gender distribution of the cohort was broadly equivalent (Female/Male, 49/44), with a median age at COVID-19 diagnosis of 71 years (35-99). Current or previous smoking was reported by 28% and 14% of patients, respectively. The most common comorbidity was hypertension (79%) VS pulmonary disease (14%);the median CCI was 6. A symptomatic infection was observed in 38% of patients. A worse clinical outcome was associated to higher ECOG PS (2-3) (p 0,013) and to the first pandemic period (p<0,0001). A mortality rate of 36% has been observed among hospitalized patients due to severity of infection (p<0,0001). Increased age at cancer diagnosis (median age 66 years) was a significant risk factor for severe COVID-19 disease. Eighty-six percent of the study population had an active disease that correlated with high proportion (21%) of death (p<0,003). The most prevalent malignancies were breast (19,4%) and lung (15%), and the diagnosis of lung cancer was associated with a worse outcome;in contrast, cancer stage, ongoing anticancer therapies and treatment toxicities had no effect on clinical outcome. Conclusion(s): This study highlights a high mortality rate related to COVID-19 infection among cancer patients. Worse outcomes are driven by features such as pandemic period, cancer status and subtype, ECOG PS and median age at cancer diagnosis.
ABSTRACT
Background: Estrogen receptors (ER) are predictive of endocrine responsiveness. However, 30% of ER+ BC patients will relapse despite adjuvant ET and 10 to 20% of metastatic lesions loose the expression of ER. The early identification of endocrine resistant patients may help to improve treatment strategies, especially in the light of innovative drugs recently approved. In the ET-FES trial we evaluated 18F-FES CT/PET as a prediction tool for endocrine responsiveness in ER+ MBC. The ET-FES study was funded by the ERANET-Transcan project. Methods: MBC patients with ER+/HER2- disease, were eligible for the ET/FES study. All patients underwent a baseline [18]F-FES PET/CT in addition to conventional procedures. Patients were classified as endocrine sensitive if overall Standardized Uptake Value (SUV) ≥ 2 and received ET;patients with SUV <2 were randomized to receive ET or chemotherapy (CT). The prognostic role of [18]F-FES PET/CT was assessed for PFS and OS by univariate and multivariate analyses. The primary endpoint was disease progression rate (DPR) at 6 months. Results: From April 2015 to October 2020 146 patients, from 7 EU centers were enrolled: of them, 115 with a mean SUV >2 received ET and 30 with SUV <2 were included in the randomized study. Median follow up was 18.4 months (range 8.0 to 38.3 months) in endocrine sensitive patients (SUV > 2) versus 10.1 months (range 8.0 to 36.8) in patients with SUV <2. Overall, at the time of this analysis 67 patients (45.9%) had disease progression and 37 (25.3%) died. DPR at 6 months was 57% in patients with SUV >2 vs 50% in SUV <2 randomized to ET and 57% in case of CT. DPR at 12 months was 35% vs 17% and 14%, respectively. Median PFS was 7.3 months (IQR 3.8 – 17.3) vs 5.2 (IQR 3.1 – 9.4) vs 7.7 months (IQR 3.0 – 14.0), respectively. OS rate at 12 months was 31% versus 17% versus 14%. Conclusions: The ET-FES clinical trial was prematurely interrupted, due to COVID-19 pandemic. The discriminating ability of this assay was high, leading to a personalized endocrine approach;a considerable proportion of patients with a mean SUV >2 is still on ET. Clinical trial identification: EudraCT 2013-000287-29. Legal entity responsible for the study: Alessandra Gennari - Università del Piemonte Orientale. Funding: AIRC. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Background: Rectal cancer treatment has evolved during the past 40 years thanks to the advancements in imaging, pathology, surgical treatments, radiotherapy, and chemotherapy, within a multidisciplinary team approach providing an optimum health care. Many studies have demonstrated how the social environment can affect the treatment and outcome in neoplastic patients. The primary endpoint of this study was to compare the Health Equity Audit (HEA) before and after the establishment of a structured pathway for the management of neoplasms of the rectum. Methods: This was a retrospective study carried out at the University Hospital of Ferrara, Italy, on selected patients with rectal cancer stage < IIIb, who were diagnosed and treated in the year 2012 (Group 1:35 patients), before the start of the rectal cancer multidisciplinary team, and in the year 2020 (Group 2: 35 patients), after the setting up of the rectal cancer multidisciplinary team. For each patient we considered different social variables: age at time of diagnosis, gender, distance in km from the centre of treatment, level of education. We analysed the following indicators: Indicator 1: time between the first symptoms and diagnosis;Indicator 1b: % of patients coming from screening programs;Indicator 2: time between the communication of diagnosis and the beginning of the treatment;Indicator 3: adherence to treatment;Indicator 4: time between the end of neoadjuvant treatment and surgery. Results: The characteristics of the patients at baseline were well balanced between the two groups. Indicator 1 goal was achieved in 64% of the patients in group 1 and in 73,9% of the patients in group 2. Indicator 2 goal was achieved in 35,3% of group 1 and 55,6 % of group 2. In group 1, 71% of patients who lived less than 30 km away from our center met the indicator 2 criteria while only 33% of patients who lived more than 30 kms away had the same result. In group 2, 53% of patients who lived less than 30 km away from our center met the indicator 2 criteria while none of the patients who lived more than 30 kms away did. In addition, we found out that in group 1 the rate of patients who met indicator 2 goal increased with level of education. These preliminary results demonstrated that equality seems to have improved after 8 years despite the Covid pandemic in 2020. Conclusions: The introduction of a dedicated treatment pathway appears to have improved Health Equity for patients with rectal cancer.