ABSTRACT
Background: Older patients with cancer remain at high risk for negative outcomes from COVID-19 infection, particularly those who have multimorbidities and on immunosuppressive therapy. These patients have been excluded or underrepresented in pivotal COVID-19 vaccine clinical trials and there are ongoing concerns that they may not acquire the same level of protection from the available vaccines as the immunocompetent adults. Moreover, the level of protection wanes over time making them more susceptible to emerging COVID-19 novel variants of concern. Despite the implementation of global vaccination campaigns which have successfully reduced COVID-related hospitalisations and deaths in many parts of the world, there remains many unresolved issues and challenges to address as the pandemic ensues. With aging, concerns for age-related dysregulation and immune dysfunctions called immunosenescence may lead to potentially lower immunogenicity to vaccines. Despite receiving the primary vaccination, real-world evidence showed that both patients aged > 65 years and those with cancer have a higher risk of developing breakthrough COVID-19 infections and related complications. Subsequent booster doses are found to be effective at improving immune response, particularly against the novel variants, and the vulnerable population should be given the priority in booster campaigns. Method(s): Since the beginning of the pandemic in 2020, The International Society of Geriatric Oncology set up a COVID-19 Working Group comprised of multidisciplinary specialists by developing recommendations, advocacy, and action plans based on expert opinion and evidence related to older adults with cancer. Result(s): The table below summarises the updated recommendations from the SIOG COVID-19 Working Group. Conclusion(s): The SIOG COVID-19 Working Group supports ongoing public health interventions, continued mass immunisations, and booster campaigns targeting the most vulnerable members of the society, including older adults with cancer (Table Presented).
ABSTRACT
Background: All aspects of healthcare have been challenged during the COVID-19 pandemic. Cancer services adapted to reduce disease transmission while maintaining essential services. International and national guidelines emerged rapidly to support optimal delivery of cancer care during the pandemic. This review aimed to identify the impact of COVID-19 on the delivery of hospital oncology pharmacy services. Method: We searched multiple databases: PubMed, Medline, EMBASE and CINAHL to March 2021. These were supplemented with manual searching. The key search terms used were 'oncology' OR 'cancer' AND 'COVID-19' AND 'pharmacy'. Full text guidelines or recommendations for service adaptations and papers focusing on the impact of the pandemic on hospital oncology pharmacy services published in English were included. s were excluded. We identified the strategies for service adaptations and grouped them into themes. Results: Weidentified four guidelines, two from France and one each from England and Saudi Arabia, that made recommendations for service adaptations due to COVID-19. A further two global surveys assessed the impact of the pandemic on oncology pharmacy practice.1-6 All included papers were published within the first 6 months of the World Health Organisation declaring a global pandemic. The common modifications to services focused on four themes: reducing frequency of patient visits, reducing healthcare practitioner exposure to COVID-19, increasing use of digital technology and maintaining the supply of essential medicines. Several approaches were used to reduce the frequency of patient visits to healthcare settings, and included delaying treatment, switching intravenous treatment to subcutaneous or oral routes, using extended dosing schedules, home administration and discontinuation of some treatment e.g., clinical trials. Pharmacy practitioners applied distancing and safety rules in the workplace in line with government recommendations. Some services introduced remote and/or flexible working patterns. Hospital pharmacy teams used digital technologies to maintain communication within the pharmacy team, e.g., through holding virtual meetings, and with patients through the use of telephone and video consultations. Medicine shortages due to disruption of supply chains were described. Shortages were reported for several medicines e.g., drugs used to treat COVID-19, e.g., remdesivir, systemic anti-cancer therapies and supportive care medicines. To ensure continuity of supplies, additional staff were deployed to facilitate sourcing and procurement of essential medicines. Discussion: We collated the impact of COVID-19 on hospital oncology pharmacy practice across different countries. Despite disparate healthcare services, the approaches for safeguarding patients and practitioners against COVID-19 transmission were common. However, the impact of treatment changes on patient outcomes and service re-configurations is yet to be evaluated. Unsurprisingly, this review identified a small number of studies, likely due to prioritization of service delivery. Despite the challenges to healthcare, the pandemic has created opportunities for hospital oncology pharmacy teams to embrace technology and innovative ways of working.
ABSTRACT
Background: Bisphosphonates are used to prevent skeletal-related events (SRE), such as pathological fracture and spinal cord compression1 in patients with multiple myeloma. Although intravenous bisphosphonates are generally well tolerated, potential serious complications include osteonecrosis of the jaw (ONJ) and hypocalcaemia. Monitoring, such as a dental review, and blood tests (creatinine, calcium and vitamin D) are important to detect early signs of ONJ.1 A suspected case of ONJ at the Haematology Day Care Unit (HDCU) highlighted that checks and monitoring before prescribing and administering bisphosphonate infusions was suboptimal. The aim of this quality improvement project was to improve bisphosphonate monitoring in the HDCU to identify and manage suspected cases of ONJ. Method: The Model for Improvement provided a framework to structure the project enabling small tests of change using plan-do-study-act (PDSA) cycles to improve patient safety.2 We planned three PDSA cycles, each conducted at four-week intervals. We recorded when blood tests (calcium, vitamin D, phosphate, PTH, creatinine) and dental checks were documented. To measure the scale of the problem, baseline measurements were recorded during November and December 2019. An education and training session for the multidisciplinary HDCU team was undertaken in January (PDSA cycle 1) to raise awareness of monitoring. PDSA cycle 2 (February) involved the inclusion of dental and blood monitoring on the HDCU referral checklist. A third PDSA cycle planned for March 2020 was to implement dental alert cards for patients.1 Results: A total of 71 patients received bisphosphonate infusions between November and December 2019. Of these, no records were found of patients having had a dental review and 10% of patients had all bloods tests done at baseline. After training (PDSA cycles 1) 70% of patients had dental reviews recorded and 71% of patients had all blood tests completed. This improved to 86% of patients having had dental reviews and 95% having all blood tests completed after introduction of monitoring parameters on the referral checklist (PDSA cycle 2). PDSA 3 was not completed. Discussion and conclusion: We demonstrated that simple interventions led to improvements in dental reviews and blood monitoring for patients on bisphosphonate infusions. Limitations of the project were the small sample size and short duration of data collection. Furthermore, PDSA cycle 3 was interrupted in March 2020 due to national guidelines3 mandating delay of non-urgent treatment during the COVID-19 pandemic. Staff training and the introduction of a monitoring checklist represent feasible methods to ensure safe prescribing and administration of bisphosphonate infusions. Since the project, there have been no reported cases of bisphosphonate-related ONJ in the HDCU. Further work is required to increase patient and healthcare team awareness of the need for regular dental reviews..