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Background: Patients with cancer are vulnerable population that suffered during the COVID-19 pandemic from SARS-CoV-2 infection and from the pandemic's impact on healthcare systems. We are presenting the findings of MENA Registry for COVID-19 and Cancer (MRCC) regarding the SARS-CoV-2 infection presentation, diagnosis, treatment, complications, and outcomes. Methods: MRCC was adapted from ASCO COVID-19 Registry and included patients with SARS-CoV-2 infection and underlying cancer diagnosis including a newly diagnosed cancer in the work-up phase or patients with active cancer receiving cancer therapy or supportive care, or within first year of adjuvant chemotherapy or after one year of curative therapy and receiving hormonal therapy. Registry included data on patients from 12 centers in eight countries in the MENA region, namely: Saudi Arabia, Jordan, Lebanon, Turkey, Egypt, Algeria, United Arab Emirates, and Morocco. The data included patient and disease characteristics, COVID-19 presentation, management, and outcomes. The follow up is differential as data get captured at different points of disease trajectory for each patient which may not reflect the final outcome. Results: Data on 1345 patients were captured in the study by December 7, 2021. Median age was 57.1 years (18-98), whereas 56.1% were females. The median follow-up was 98.5 days (0-554). The most common COVID-19 symptoms was fever (50.3%) and 26.8% of patients were asymptomatic. Out of the 959 patients with complete data on hospitalization, 554 (57.8%) were hospitalized and 126 of them (22.7%) were admitted to intensive care unit (ICU). The majority of hospitalized patients (60%) had respiratory complications and 13.9% had sepsis and 8.5% suffered acute renal injury. As shown in Table, more than quarter of the patients died with 47% of death from COVID-19 or related complication and 60.6% died at home. More than half of the patients were fully recovered from infection. Conclusions: Although more than half of the patients recovered form COVID-19 and more are expected to recover with a longer follow up, the death toll and complications remain high in this patient population. Future analysis of the impact of vaccination and better disease management as well as the impact of newer variants would provide a useful insight on managing this vulnerable population.
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Background: The COVID-19 pandemic disrupted all facets of healthcare delivery including cancer care. This study evaluates the disruptions to US medical oncology practice during the pandemic in terms of number and type of patients (pts) encounters to determine the impact on continuity of patient care. Methods: We conducted a retrospective cohort analysis using the CLQD electronic health record database, containing data from 2+ million pts from all 50 states. We assessed changes in the monthly proportions of visit encounter types (in-person outpatient [IPOP] and telehealth [TE]) for new and established patients (NP and EP) with an invasive malignancy, benign or in situ neoplasm, or benign hematology diagnosis having an encounter between 1/1/2018 and 9/30/2020. Results: 781,945 pts were studied. Median age on 1/1/2018 was 64 years (IQR: 53- 73), 38% were female, and 58% had an invasive malignancy. From 12/2019 to 9/2020, total monthly encounters dropped from 157,964 to 90,662. Monthly IPOP visits for NP dropped from 11.2% to 7.9%, an absolute drop of 3.3% and a relative drop of 30%;TE for NP increased by 1.1% (Table). Monthly IPOP visits for EP, as a percentage of all visits, dropped from 94.4% to 86.6% from 12/2019 to 6/2020 but rebounded to 90.4% by 9/2020. Fraction of TE increased substantially during the pandemic period reaching a peak in 6/2020 (13.8% for EP and 1.6% for NP) and decreased in 9/2020 to 9.6% and 1.1% for EP and NP, respectively. Compared to non-Hispanic patients, Hispanic patients had a larger reduction in IPOP and more TE during the study period. Percentage of monthly encounters, by type, from baseline. Conclusions: We observed a reduction in the absolute number and monthly percentage of IPOP encounters during the COVID-19 pandemic. For EP, increases in TE does not fully compensate for reductions in IPOP. The reduction in IPOP NP encounters is particularly concerning since it was not accompanied by a compensatory increase in TE. The reduction in NP is consistent with reported pandemicassociated reductions in cancer screening and suggest a notable delay in cancer diagnoses during the pandemic. Reduction in Hispanic IPOP encounters warrants further evaluation. (Table Presented).
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Background: The ASCO Registry was created to analyze the impact of COVID-19 (COVID) on treatment (Tx) and outcomes of patients (pts) with cancer. Methods: The Registry includes pts with 1) a confirmed COVID diagnosis (Dx) and 2) clinically evident cancer receiving Tx/supportive care or resected cancer on adjuvant Tx <12 mos since surgery. Practices report data on cancer Dx and Tx at COVID Dx, COVID symptoms, comorbidities, cancer/COVID Tx, and survival. Kaplan-Meier estimation provided 30- and 90- day mortality rate estimates for pts with COVID Dx before or since 6/1/20 within pt subgroups with 95% confidence intervals (CI). Data submission cutoff for all practices was 10/24/20, except one that was 11/16/20. Results: This analysis reports on 453 pts with COVID Dx 3/5/20 to 10/22/20 who were on anticancer drug Tx for regional (9%) or metastatic (53%) solid tumors or hematologic cancers (38%) at COVID Dx. 38 practices entered data: health system-owned 51% of pts, privately-owned 25%, academic 24%. 53% of pts have ≥30 days followup or died ≤30 days from COVID Dx. Median age is 64 years;53% of pts are female;28% of pts are asymptomatic at COVID Dx. Multiple myeloma was most frequent cancer (17%). Allcause mortality rates (30 and 90 days) increased with pts' age at COVID Dx [Table]. No mortality difference was seen based on sex, race, or comorbidities (hypertension, diabetes, pulmonary disease). Pts with COVID Dx before June 1 had worse survival than pts diagnosed on/after June 1. Pts with B-cell malignancies had higher mortality rates than pts with solid tumors. Conclusions: Severity of COVID illness and mortality were greater for patients with COVID Dx pre-June 1 than on/after June 1. Differences on/after June 1 may be attributed to improvements in COVID management, higher COVID testing rates, and more asymptomatic pts diagnosed. Variations in COVID-19 pt populations over time due to these changes should be considered when analyzing and interpreting pandemic data. Cancer pts with ed age and B-cell cancers are at greatest risk of death but mortality rates for all groups advanced age and B-cell cancers are at greatestrisk of death but mortality rates for all groups(except those admitted to ICU) improved after6/1/2020.
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Background: Burnout (BO) is a recognized challenge among oncology workforce. It affects both genders with a higher frequency among women. This study examined the factors contributing to the development of burnout among women in oncology from the Middle East and North Africa (MENA). Methods: An online crosssectional survey was distributed to oncology professionals from different countries in the MENA region. The validated Maslach Burnout Inventory (MBI) of emotional exhaustion (EE), Depersonalization (DE), and Personal Achievement (PA) plus questions about demography/work-related factors and attitudes toward oncology were included. Data were analyzed to measure BO prevalence and related factors. Results: Between February 10 and March 15, 2020, 545 responses were submitted by female professionals. The responses pre-dated the COVID-19 pandemic emergence in the region. BO prevalence was 71% among female professionals. Women aged < 44 years represented 85% of the cohort. Sixty-two percent were married, 52% with children and one-third practiced a hobby. Twothirds worked in medical oncology, worked for < 10 years and 35% worked in academia. The majority (73%) spent > 25% on administrative work daily. Nearly half of the respondents (49%) expressed a recurring thought of quitting oncology and 70% had no burnout support or education. Inability to deliver optimal care was reported as distressing for career development in 82%. Factors significantly influencing the BO risk are listed in Table. Marital status, having children, academia and years in practice did not impact the risk of BO among female oncologists form MENA. Conclusions: High BO prevalence was reported among female oncology professionals from MENA. The majority of women oncology workforce were young and early- to mid-career in this cohort. Younger age, practicing in North African countries, high administrative load and the recurring thought of quitting were associated with increased risk of burnout. Whereas, practicing a hobby and enjoying oncology communication decreased the BO risk. Burnout support and education specifically for women in oncology is needed.
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Background: Patients with terminal diseases frequently undergo procedures and interventions that are futile and maybe detrimental to the patients' quality of life. We conducted a quality improvement project aimed to reduce futile acute care services (ACS) for cancer patients treated with a palliative intent. Methods: A multidisciplinary team retrospectively reviewed the records of terminally ill cancer patients who died during in the hospital at our institution, King Abdulaziz Medical City, Riyadh, Saudi Arabia. We included all patients expired between November 2017 to May 2018. The review aimed to assess the magnitude of improper utilization of acute care services (ACS) such as: Critical care response team (CCRT), cardiopulmonary resuscitations (CPR) and admission to intensive care unit (ICU). A root cause analysis and process mapping were conducted to identify reasons for over utilization of these services. Timely documentation of goals of care was identified as a main reason for this problem. Then interventions were implemented to improve the practice. Post intervention data was captured and compared to the baseline data. Results: After delivery of staff education sessions and implementation of mandatory documentation of goals of care in the electronic healthcare record system, the timely documentation of goal of care for patients with palliative intent had significantly increased from 59% of cases in the baseline to 86% for the post intervention phase. As a result, admission to ICU decreased from 32% of cases in the pre intervention phase to 14% in the post intervention phase reducing monthly cost of admission to the ICU by 40% and estimated to be on average of $48,000 USD monthly ($576,000 USD annually). Conclusions: Our interventions resulted in improved documentation of the goal of care leading to decrease in the utilization of acute care services (ACS) including reduction of intensive care unit (ICU) admissions and cost. This outcome is even more relevant nowadays during COVID-19 pandemic and the pressure on critical care resources. Improvement is sustained by integrating the changes in the work process and electronic medical records.
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Background: Implementation of precautionary measures in response to COVID-19 pandemic involve patients pre-visit screening of patients to detect any potential risk of infection and proper patient flow to the clinic and adherence to social distancing. Our study evaluates our center experience with the pre-visit screening calls and plans to optimize the process. Methods: As precautionary measure to COVID-19 pandemic, all patients scheduled for oncology outpatient visit were called by a nurse to screen them for any acute respiratory infection (ARI) and triage their visit into physical visit or virtual visit. Patients with high ARI score were directed for proper isolation and COVID-19 testing process and recommended to have virtual clinic visit with their oncologists. Those who have low ARI score and require in person clinic visit receive confirmation of appointment during the call with visit instructions. A tally of all responses and decision were maintained for process monitoring. Results:Between March 23, and June 13, 2020, 1,905 patients had pre-visit screening calls. Nurses could not reach 82 (4%) patients and 23 patients expired per family member report. Out of 1800 patients who responded to call, 1392 (77 %) had confirmed physical appointment, 179 (10%) switched to virtual appointments. Sixteen out of the 19 patients who have high ARI score have swab done. All patients were tracked to assure proper management of their symptoms and continuity of oncological care. A total of 229 (12.7%) patients refused to come due to COVID-19 concerns and all were rescheduled based on primary oncologists decision. A quality improvement project was initiated to understand the concerns of patients who refused to come and address them properly. Conclusions: Pre-visit screening call is a critical intervention, not just in assuring adherence to infection control measures, but in identifying patients concerns and addressing them. There is a need for implementation of updated patient education and awareness approach about the risk of COVID-19 infection and the importance of adherence to their cancer treatment plans.
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Background: Cancer care is heavily centered in health care facilities due to the requirements of providing complex multidisciplinary care with multiple testing and interventions. We describe our experience in implementing a new model of care to minimize cancer patients visit to health care facilities and to reduce the risk of infections and to decrease the pressure on the health care system. Methods: In response to the COVID-19 pandemic, we reengineered the cancer care process to reduce patients visit to the hospital by the implementation of a Care Near Home (CNH) Model, which comprises offour components: Virtual clinic, laboratory testing near home, shipping medications and supplies, and involving local health care facilities. The effectiveness and acceptance of this new model has been assessed by the delivery of timely care successfully and assessing the satisfaction patients and healthcare providers. Results: On March 18, 2020, we launched the virtual clinics followed by different components of the model. The number of virtual clinic visits has increased significantly from 399 visits in March to 1107 in April 2020. More the 90% of physicians and patients who responded to the survey expressed their acceptance and satisfaction with the virtual clinic services. Medications were shipped to total of 603 patients. Of those, 578 (96%) patients received their medications (378 patients outside city, 200 patients inside city of which, 95% received medications within 24 hours). Only 25 (4%) patients did not receive their medications and we arrange for alternative solutions. Laboratories in various regions were set up to perform the tests for our patients and to communicate the results through our electronic healthcare records system. The process of ordering and performing the test were piloted with success and now we are at the scaling up phase. Conclusions: Although the implementation of CNH Model was driven by COVID-19 pandemic, it will be integrated in our work process and utilized as a long term approach to manage many of our patients because it is more convenient to them and more cost effective to the health care system.
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Background: As frontline workers facing COVID-19 pandemic, healthcare providers should be well prepared to fight the disease and prevent harm to their patients and themselves. Our study aims to evaluate knowledge, attitude, and practice (KAP) of oncologists in response to COVID-19 pandemic and its impact on them. Methods: A cross-sectional study was conducted using a validated questionnaire disseminated to oncologists by SurveyMonkey©. The tool had 42 questions that captured participants’ KAP, their experiences and the impact of the pandemic. Country sub-investigators in Middle East and North Africa region, Brazil, and the Philippines distributed the survey to their contacts via emails and text messaging between April 24 and May 15, 2020. Results: Among 910 physicians that participated in the study, 55% were males, 67% medical or clinical oncologists and 58% worked in public hospitals. Only 213 (23%) reported being officially involved in COVID-19 control efforts. Level of knowledge regarding the prevention and transmission of the virus was good among 63% of participants. Majority (92%) were worried about contracting the virus either extremely (30%) or mildly (62%) and 85% were worried about transmitting the virus to their families. 77% reported they would take the COVID-19 vaccine once available, although only 38% got the flu vaccine regularly. Adherence to strict precautions was variable including social distancing outside work (68%), no hand shaking (58%), and hand washing (98%). Participation in virtual activities included clinics (54%), tumor boards (45%), administrative meetings (38%);and educational activities (68%) and majority reported plans to continue them after pandemic. Participants reported a negative impact of the pandemic on relations with coworkers (16%), relations with family (27%), their emotional and mental wellbeing (49%), research productivity (34%) and financial income (52%). Conclusions: COVID-19 pandemic has negative effects on various personal and professional aspects of oncologists. Interventions should be implemented to mitigate the negative impact and to prepare oncologists to manage future crises with more efficiency and resilience. Editorial acknowledgement: On behalf the International Research Network on COVID-19 Impact on Cancer Care (IRN-CICC). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.R. Jazieh: Research grant/Funding (self): MSD. All other authors have declared no conflicts of interest.
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Background: Cancer patients are vulnerable population that are exposed to different risks and harms during COVID-19 pandemic. Our study goal is to evaluate the behavioral response of cancer patients to the pandemic in countries of the Middle East and North Africa (MENA) region. Methods: A cross-sectional study was conducted using a validated questionnaire administered via SurveyMonkey© to cancer patients in 13 centers in 6 countries in the MENA region: namely, Saudi Arabia, Kuwait, Jordan, Egypt, Algeria, and Morocco. The tool included 45 questions inquiring about patients’ demographics and behavioral practices during the crisis. Results: 1,012 patients were enrolled in the study between April 21 and May 15, 2020. Median age was 50 years (14-92), 67% were females, 39% had a college degree, and 75% were married. Most common reported cancer was breast cancer (40%) followed by gastrointestinal malignancies (15%). Only 3% know someone who has COVID-19 infection. Patients were worried about contracting the infection strongly (33%) or mildly (48%). Reporting strict adherence to precautions included avoiding the following actions: hand shaking (83%%), hugging and kissing (91%), social gathering (98%), meeting friends (91%), and visiting markets (80%). On the other hand, they were doing the following: repeated hand washing (77%), keeping distance from others (67%), using masks in public areas (77%), hand sanitizer (69%) and soap (81%). Some of the patients reported adopting healthier diet (35%), using dietary supplement (18%), reciting Quran (61%) or supplications (75%). About 23% of them will choose not to show up for scheduled medical appointment and 43% had appointment cancellation per request from medical team (31%) or patients themselves (12%). However, treatment session cancellation occurred per request from medical team in (11%) or patients in (4%). Interestingly, 84% of participants prefer virtual appointments over regular visits. Conclusions: Majority of cancer patients in the study are adopting adequate precautions to prevent exposure to infection. Further studies are required to evaluate the patients’ emotional well-being and other harms resulted from the pandemic to prevent detrimental effect on patients outcome. Editorial acknowledgement: On behalf of the International Research Network on COVID-19 Impact on Cancer Care (IRN-CICC). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.R. Jazieh: Research grant/Funding (self): MSD. All other authors have declared no conflicts of interest.
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Background: COVID-19 pandemic impacted healthcare systems globally and resulted in the interruption of usual care in many healthcare facilities exposing vulnerable cancer patients to significant risks. Our study aimed to evaluate the impact of this pandemic on cancer care worldwide. Methods: We conducted a cross-sectional study using validated electronic questionnaire of 51 items via SurveyMonkey©. The tool was distributed to leaders in oncology centers worldwide. The questionnaire obtained information on the capacity and services offered at these centers, magnitude of interruption of care, reasons for interruption, challenges faced, interventions implemented, and the estimation of patient harm during the pandemic. Results: 356 centers from 54 countries across six continents participated between April 21 and May 8, 2020. These centers serve about 700,000 new cancer patients a year. Most of them (88%) reported facing challenges in providing care during the pandemic. 54% and 45% of centers reported cases of COVID-19 infection among their patients and staff, respectively. Although 51% reduced services as part of a preemptive strategy, other common reasons included overwhelmed system (20%), lack of personal protective equipment (19%), staff shortage (18%), and restricted access to medications (9.7%). Missing at least one cycle of therapy by more than 10% of patients was reported in 46% of the centers. Most centers implemented virtual clinics (83.6%) and virtual tumor boards (93%) and participants believed these will persist beyond the pandemic (55.5% and 60%, respectively). Centers performed routine tests in laboratories near patients’ homes (76%) and shipped medications to patients (68.6%). Participants reported patients’ exposure to harm from interruption of cancer-specific care (36.5%) and non-cancer related care (39%) with some centers estimating up to 80% of their patients exposed to some harm. Only 16% of the centers reported services are back to baseline at the time of completing the survey. Conclusions: The detrimental impact of COVID-19 pandemic on cancer care is widespread with varying magnitude among centers worldwide. Further research to assess this impact at the patient level is required. A “new normal” of cancer care emerged with emphasis on telehealth and care delivery closer to home. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.R. Jazieh: Research grant/Funding (self): MSD. C.D. Rolfo: Speaker Bureau/Expert testimony: AstraZeneca;Advisory/Consultancy: Inivata;Archer;MD Serono;Mylan;Oncompass;Honoraria (self): Elsevier. All other authors have declared no conflicts of interest.
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Background: In response to COVID-19 pandemic, we launched VC to minimize hospital visits, decrease exposures to infection and ensure continuity of care to all cancer patients. Our project aimed to assess the value of VC in management of oncology patients and the level of patient and staff satisfaction with it. Methods: On March 18, 2020, we introduced VC to all specialties at the Oncology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Medical records were reviewed by the oncologists to identify patients who can be evaluated through VC, those who need to come personally, and those whose appointment can be deferred. Scheduled patients in VC were contacted through locally developed application (EIADATY) or by phone call. Performing laboratory testing near home and shipping medications were done when feasible. We reviewed the data of VC from March 18 to April 30, 2020 including satisfaction results of patients and staff using Likert scale from 1 to 5 with 1 being very dissatisfied and 5 being very satisfied). Results: A total of 29 clinic sessions/week were established for different oncology services. Out of 1319 scheduled patients, 1152 (87%) answered the call (90% via phone, 5% via application and 5% used both). Of the 149 patients surveyed, their overall satisfaction ( Score>3 out of 5) with punctuality was (92%), physician interaction (90%), duration of visit (90%), medication requesting (91%), medication shipping (79%) and satisfaction with whole experience (92%). Out of 89 involved physicians, 74 (83%) completed the survey with overall satisfaction with booking process (91%), communication tools (77%), and general satisfaction (93%). 93% of physicians believed that patients were satisfied with the experience and 81 % expected to continue VC beyond the pandemic. Survey of 44 support staff (nurses, coordinators, and pharmacists) revealed similar results. Conclusions: The transition to VC was well accepted by both patients and clinicians. Optimizing the video communication tool and the process of performing pre-visit laboratory and radiology tests closer to patients home and shipping medications are essential for the enhancement of the VC function. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: N. Almutairi: Research grant/Funding (self): MSD. All other authors have declared no conflicts of interest.