A survey of patients' preferences on treatment effects among head and neck cancer patients receiving radiotherapy

Introduction: Head and neck cancer (HNC) is a heterogeneous group of subsites, with differing natural histories. Its management is complex and it may have a long-term effect on patients’ quality of life (QOL). The purpose of this survey was to assess patients’ preferences using a validated 12 point ‘Priority Assessment Tool’ developed by Sharp et al [1]. Materials and Methods: Sixty consecutive HNC patients being treated with radiotherapy at our centre were approached. Patients were asked to rank their priorities from 1 to 12 (1 = very important, 12 = least important). Results: 45 patients (75%) completed the survey. The most important, overwhelming priority for the cohort as a whole, was ‘being cured of my cancer’ which was first priority in 73% patients and within first three priorities for 96% of patients. Similarly, ‘living as long as possible’ was within the first three priorities for 67% of patients although for 13% patients, living longer was, surprisingly the least priority. For more than two third of patients (69%), ‘having no pain’ was within the first four important priorities. There is next, a group of six QOL priorities (voice, speech, chewing, swallowing, taste/smell, moist mouth), which have a much wider range and vary considerably in importance to individual patients, being very important to some and much less important to others. There then remains a group of three priorities that have a relatively low importance to patients, not absolutely, but in relation to their other priorities, with ‘keeping appearance unchanged’, being the lowest priority chosen by 40% patients. The other two least priorities were ‘returning to activities as soon as possible’ and ‘having a normal amount of energy’. Conclusions: Our survey has shown that most HNC patients markedly prioritise survival over function and other QOL measures. Having such information is crucial, to being able to make a valid decision with regard to the treatment options and the trade-offs between increased probability of cure or extending survival and loss of function, and late morbidity. This makes shared decision-making even more important in the present COVID-19 era, so that added information about the risks of infection and potential changes in risk benefit ratio may alter patients’ priorities and preferred outcomes.

Exposure to the COVID-19 pandemic environment and generosity.

We report data from an online experiment which allows us to study how generosity changed over a 6-day period during the initial explosive growth of the COVID-19 pandemic in Andalusia, Spain, while the country was under a strict lockdown. Participants (n = 969) could donate a fraction of a €100 prize to an unknown charity. Our data are particularly rich in the age distribution and we complement them with daily public information about COVID-19-related deaths, infections and hospital admissions. We find correlational evidence that donations decreased in the period under study, particularly among older individuals. Our analysis of the mechanisms behind the detected decrease in generosity suggests that expectations about others' behaviour, perceived mortality risk and (alarming) information play a key-but independent-role for behavioural adaptation. These results indicate that social behaviour is quickly adjusted in response to the pandemic environment, possibly reflecting some form of selective prosociality.

Angiotensin-Blockade and COVID-19: Hypotheses and clinical implications

The causative virus for the current COVID-19 pandemic, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) employs angiotensin converting enzyme-2 (ACE2) as a co-receptor for viral entry into host cells. Since ACE2 is also an important constituent of the renin-angiotensin-system (RAS), it has been argued that blockers of the RAS such as ACE-inhibitors (ACEi) or angiotensin-receptor blockers (ARBs) might modify ACE2 expression in host cells and thereby alter virus susceptibility beyond hypothetical effects of RAS blockers on the clinical course of viral disease. Here, we provide a detailed overview of both the classical RAS axis and the so-called alternative RAS axis that includes ACE2 and its end-product angiotensin-1-7 and how they might theoretically affect viral susceptibility and disease progression. From the models outlined it becomes clear that any clinical inferences such as to halt or convert established RAS-blocking regimens in patients with heart failure and chronic kidney disease is rather preemptive, thereby enforcing current recommendations from several national and international societies.