ABSTRACT
Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Method(s): The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hamatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Result(s): The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusion(s): Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population.
ABSTRACT
Purpose: CRC prognosis has improved through guideline-based care. COVID-19 pandemic lead to re-allocation of health care resources potentially putting sections of cancer care at a disadvantage. We compared enrollment and clinical subgroups into our registry before and during the first (fw) and second wave (sw) of the COVID-19 pandemic. Method(s): CPP assembles clinical, histo-pathological and molecular data of pts. with resected CRC. Prospectively enrolled pts. during the fw (4-6/2020) and the sw (10-12/2020) were analyzed, focusing on total numbers, age and sex compared to corresponding pre-pandemic intervals of 2019. Due to site expansion (70 to 161) of CPP we calculated quarterly counts per site and in relation to total enrollment. Result(s): 2221 pts. enrolled into CPP during 2019 and 2020 were included, 47 % female (F) /53 % male (M). Mean age in 2019 was 71.9 years (y) vs 71.6 y in 2020. Mean number of pts. enrolled in CPP with primary diagnosis of CRC per site 2019/2020: fw 8,5/6.9 and sw 6.2/5.8. Evaluation for age showed: 2019%/2020% fw >70 y was 52.5/53.5 and <=70 y 47.5/ 46.5 respectively;for the sw > 70 y was 45.6/ 53.5;<=70 y 54.4/46.5. M vs F in fw 2019%/2020% M 50.5/61;F 49.5/39;in sw M 57.6/56;F 42.4/44. Discussion(s): CPP did not detect substantial differences in total counts of enrolled patients or distribution of age and sex. We detected a slight dip in enrollment together with a small shift toward men in fw as well as to elderly pts. in sw. Enrollment of pts. into registries seems to be feasible even in pandemic situation. Potentially, a possible data bias as preference of registry enrollment over randomized controlled trials. Conclusion(s): Real world data from CPP must be complemented by additional data for comprehensive assessment of colon cancer care and will be complemented for final data presentation in 2022 with data collected during the third and omicron wave.
ABSTRACT
Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Methods: The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hämatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Results: The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusions: Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population. Legal entity responsible for the study: The authors. Funding: Bundesministerium für Bildung und Forschung;Germany Förderkennzeichen: 01KI20521A-C. Disclosure: A. Reinacher-Schick: Financial Interests, Personal, Invited Speaker: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, MCI Group, AstraZeneca;Financial Interests, Personal, Advisory Board: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, AstraZeneca, Pierre Fabre;Financial Interests, Personal, Other, Travel support: Roche;Financial Interests, Institutional, Research Grant: BNT, Roche, Ipsen. O. Schoffer: Financial Interests, Personal, Advisory Role: Novartis. A. Kraeft: Financial Interests, Personal, Writing Engagements: Astra. A. Tannapfel: Financial Interests, Institutional, Research Grant: Roche, Biontech. J. Schmitt: Financial Interests, Institutional, Funding: Sanofi, Pfizer, Novartis. All other authors have declared no conflicts of interest.