Social Isolation and Social Support Among Young Adult Vs. Older Adult Cancer Survivors during One Year of the COVID-19 Pandemic: A Propensity Score Matched Analysis

Background/Purpose: Social isolation is associated with worse outcomes among cancer survivors, whereas social support is protective. Social factors are particularly important to evaluate among young adult (YA) cancer survivors aged 18-39 given the rapid social development that occurs during young adulthood, and social isolation may have been exacerbated during the COVID-19 pandemic. We examined differences in social isolation and social support among YA vs. older adult cancer survivors (aged >=40) across one year of the COVID-19 pandemic. Method(s): Participants were recruited to a large cohort study from 11/2020 to 02/2021. PROMIS short forms were used to assess social isolation at enrollment, 2-months, 6-months, and 10-months, and social support (i.e., emotional, instrumental, and informational support and companionship) at 2-months, 4-months, 6-months, 8-months, and 12-months. Propensity score matching to nearest neighbor was used to match YAs with older adult cancer survivors based on demographic and clinical characteristics. Multilevel models were used to evaluate the effects of age (YA vs. older adult), time (month), and the interaction of age and time on social isolation and social support. Result(s): In total, 504 participants were included (252 matched pairs). Most were female (70%), White (81%), and non-Hispanic (83%). YAs were M = 33.6 years (SD = 4.5) and older adults were M = 58.8 years (SD = 10.4). Across age groups and time, average scores for social isolation and social support were within normal ranges. YAs reported more social isolation than older adults (Mpooled = 48.7 and 45.8, respectively;Beta = 2.50, p < 0.01), and social isolation and companionship decreased similarly for YAs and older adults (Beta = -0.12, p = 0.04 and Beta = -0.12, p = 0.02, respectively). No other associations were observed. Conclusions and Implications: YA cancer survivors reported more social isolation than older adults during the COVID-19 pandemic, though differences were small and not clinically meaningful. Future studies should identify patient characteristics associated with high social isolation and low social support to identify subgroups that may benefit from intervention.

Medical care disruptions during the first six months of the COVID-19 pandemic: the experience of older breast cancer survivors.

PURPOSE: Older cancer survivors required medical care during the COVID-19 pandemic, but there are limited data on medical care in this age group. METHODS: We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors aged 60-98 from five US regions (n = 321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included interruptions in seeing or speaking to doctors, receiving medical treatment or supportive therapies, or filling prescriptions since the pandemic began. Logistic regression models evaluated associations between care disruptions and education, medical, psychosocial, and COVID-19-related factors. Multivariate models included age, county COVID-19 death rates, comorbidity, and post-diagnosis time. RESULTS: There was a high response rate (n = 262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were higher with each year of education (OR 1.22, 95% CI 1.08-1.37, p = < 0.001) and increased depression by CES-D score (OR 1.04, CI 1.003-1.08, p = 0.033) while increased tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99, p = 0.012). There was a trend between disruptions and comorbidities (unadjusted OR 1.13 per comorbidity, 95% CI 0.99-1.29, p = 0.07). Adjusting for covariates, higher education years (OR1.23, 95% CI 1.09-1.39, p = 0.001) and tangible social support (OR 0.98 95% CI 0.97-1.00, p = 0.006) remained significantly associated with having care disruptions. CONCLUSION: Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions. CLINICALTRIALS. GOV IDENTIFIER: NCT03451383.

Predictions of Systemic, Intracellular, and Lung Concentrations of Azithromycin With Different Dosing Regimens Used in COVID-19 Clinical Trials.

Azithromycin (AZ), a broad-spectrum macrolide antibiotic, is being investigated in patients with coronavirus disease 2019 (COVID-19). A population pharmacokinetic model was implemented to predict lung, intracellular poly/mononuclear cell (peripheral blood monocyte (PBM)/polymorphonuclear leukocyte (PML)), and alveolar macrophage (AM) concentrations using published data and compared against preclinical effective concentration 90% (EC90 ) for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The final model described the data reported in eight publications adequately. Consistent with its known properties, concentrations were higher in AM and PBM/PML, followed by lung tissue, and lowest systemically. Simulated PBM/PML concentrations exceeded EC90 following the first dose and for ~ 14 days following 500 mg q.d. for 3 days or 500 mg q.d. for 1 day/250 mg q.d. on days 2-5, 10 days following a single 1,000 mg dose, and for > 20 days with 500 mg q.d. for 10 days. AM concentrations exceeded the 90% inhibitory concentration for > 20 days for all regimens. These data will better inform optimization of dosing regimens for AZ clinical trials.