ABSTRACT
Background: One of WALCE's aims is to increase the awareness of people with lung cancer and provide them educational initiatives. It has been recently investigated patients' knowledge and attitudes towards clinical trials in order to gain better insights from their experience. Material(s) and Method(s): from January to April 2022, an anonymous questionnaire with 22 multiple-choice and 4 open-ended questions was carried out by WALCE. Result(s): 109 patients from 7 Italian cancer centers have filled out the questionnaire. 58% were women and the average age was 62 years. 86% have heard about clinical trials and 90% said to be interested in knowing more about them, but only 46% acknowledged to have looked for information, using different top sources. The majority of patients prioritized their oncologists (44% of cases), over consulting websites (31%), magazines (11%), family and friends (9%) and social media (8%), they've got it during the news about COVID (7%), or by other medical specialists (6%) and patient associations (5%) and more than half of patients (83%) confirmed to have found the information they were looking for (even if 39% only "sometimes"). However, 66% believe their level of knowledge about it is still poor (i.e. 84% are not aware of the different trail phases). At the same time, 72%said to be more inclined to participate in a clinical trial after the COVID Vaccine and 88% were interested to know more about them. According to 97% of patients, clinical trials generate data about safety (47%), efficacy (40%) and prognosis (27%), only 6% answered that the objective is to evaluate the costs of clinical procedures. Only 26% participated in a trial, but 50% would have liked to and "hope" was the reason for half of them, while the remaining 50% preferred not to participate because of fear and lack of information (16% of cases). The collaboration between researchers and patients is considered beneficial by 73% of the respondents, mainly to bring out the needs of patients (41% of the cases). Finally, 85% are willing to receive more information about clinical trials by newsletters (54%) or through the oncologists (18%). Conclusion(s): the survey has highlighted the need of lung cancer patients to receive more comprehensive information about clinical trials and to cooperate with researchers to include the voice of patients.
ABSTRACT
United States community health centers address socioeconomic and environmental conditions and provide comprehensive primary care despite market forces that reinforce a medical model. Collaborating with 14 health center organizations, the RCHN Commu-nity Health Foundation promoted the original and broader health center vision of health, launching its population health management initiative in 2015. Although participating organizations were recognized as patient-centered medical homes and achieved rewards for quality, most identified gaps in their capacity for population health management. These challenges, addressed through peer learning and local initiatives, included engaging target populations, care coordination, socioeconomic and clinical data collection, and working with nontraditional local organizations. With relatively small funding, the zeal and enthusiasm for population health was revitalized among health center stall. The current pandemic and growing national concern for health disparities represents an opportunity to expand this broader vision of population health and to sustain it as the COVID-19 pandemic eventu-ally subsides.
ABSTRACT
The hazards and disasters field routinely emphasizes that there is no such thing as a natural disaster. This is a nod to the fact that environmental disasters are caused by the human actions or inactions intersecting with the occurrence of a natural hazard, e.g. hurricane, fire, earthquake. This essay argues that the disaster literature can help us understand the causes and consequences of the COVID-19 pandemic but only if we consider the pandemic as a disaster and its profound impacts as outcomes of racial capitalism. Through intersectional systemic forms of oppression that both devalue Black, Indigenous and Latinx people and extract labor from them, racial capitalism has rendered these communities vulnerable. Copyright © 2021 Fayola Jacobs
ABSTRACT
Background: Since Sars-Cov2 infection (COVID-19) has rapidly spread around the world, Italy has quickly become one of the most affected countries. Patients (pts) with thoracic malignancies had the highest frequency of severe complications. Healthcare systems introduced strict infection control measures to ensure optimal cancer care. This study aimed to investigate the efficacy of pre-procedure screening for COVID-19 and whether infection influenced the opportunity of patients to receive timely diagnosis and therapy. Material (patients) and methods: We retrospectively collected data of oncological procedures of pts with confirmed or suspected thoracic malignancies, treated at Oncology Dept or coming from Emergency Dept of San Luigi Gonzaga Hospital between Jun 2020 and Mar 2021 (from the end of the 1st wave until the middle of the 3rd one). Outpatients were evaluated by a nasopharyngeal swab (NPS) performed 24/48 hours before procedures. Inpatients were tested by NPS before and after hospitalization according to a predetermined schedule. 125 pts were included in this analysis. Median age was 72 years;males were 64%. ECOG Performance Status was 0-1 in 90% of pts. Histological types were: NSCLC (86.4%), SCLC (7.2%), mesothelioma (5.6%), amartochondroma (0.8%). Stages IV were 80%. 135 procedures were performed: 102 were diagnostic (75 lung biopsies, 21 bronchoscopies, 1 lumbar puncture, 2 thoracoscopies, 1 thoracentesis, 1 gastroscopy and 1 thoracic surgery), 25 palliative and 8 therapeutic. 89 and 46 procedures were performed in outpatients and inpatients, respectively. Of the 132 NPS performed, 8 were found to be positive. Positive pts were infected during the 2nd wave (from Nov 2020 to Jan 2021). One patient was infected during hospitalization, the other ones in community. Most of pts were asymptomatic, only 2 had mild symptoms. 6 procedures (4.4%) were postponed (5 diagnostic, 1 palliative), an explorative bronchoscopy was canceled and a diagnostic biopsy was performed even though the patient tested positive. The median time to resolution of the infection was 17 days (range 11-36). The median delay of the procedures was 36 days (range 14-55). 4 patients started systemic treatment in a median time of 40.5 days (range 21-57). Conclusions: Our analysis pointed out that Sars-Cov2 infection led to the postponement of a small but not negligible number of diagnostic and therapeutic procedures and that a structured screening for COVID19 is critical for the best management of scheduled procedures during pandemic.
ABSTRACT
Background: At the end of 2019, a novel viral pneumonia, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was described in China. Since then, Italy has soon become one of the most affected countries. In this challenging situation, the oncological community was called to protect cancer patients (pts), especially those affected by lung cancer, considered one of the most vulnerable population due to older age, multiple comorbidities and type of infection. This study aimed to investigate the clinical management of NSCLC pts, in order to provide a reliable picture of real-word practice during the COVID-19 outbreak. Materials and Methods: A 29-questions survey focusing on the clinical management and therapeutic indications for NSCLC pts during COVID-19 pandemic was sent to 95 medical/thoracic oncologists across different Italian regions. Results: From April 12th to May 2nd, 79 responses were received, with an overall response rate of 83%. The majority (77.3%) of oncologists declared a significant change in the outpatient management of NSCLC pts. The number of consultations in case of suspected NSCLC decreased in about half of cases (46.8%), with a major reduction when considering the number of pts coming from the emergency department for a first oncological evaluation (60% of cases). The total number of pts with any stage, newly diagnosed NSCLC, within the observational period, was reported to be lower than the pre-pandemic era by the 56% of oncologists. For pts candidates to adjuvant chemotherapy and concurrent chemoradiation, the therapeutic indications followed guidelines in 62% and 72% of cases, respectively. As regards the metastatic disease, the majority of oncologists confirmed their clinical indication to first-line treatment. The collected data revealed major changes in the second line therapeutic options, most related to timing and schedules of administration. Lung cancer pts' accrual in clinical trials dramatically has fallen for 79% of oncologists and follow-up consultations were mostly managed by telemedicine. Conclusions: This survey showed that Italian oncologists are determined to follow the available guidelines for the clinical management of NSCLC pts during this emergency time, while more complicate is to deal with clinical trials. In this tough landscape, telemedicine provides a valid support to facilitate patient-healthcare interactions.