Our People: Pursuing Positivity in the Pandemic - 'Pause Power up Push on'

Background The pandemic has highlighted the importance of wellbeing and supporting each other. A UK Parliament study showed that 50% of NHS staff felt their mental health declined during the first two months. The 'Pause Power Up, Push On' (PPP) initiative focuses on positivity and wellbeing, not only during the pandemic but in the recovery phase and beyond. Wellbeing research shows regular breaks are crucial for replenishing energy and when taken with others the wellbeing effects are heightened. Aims ////. To empower teams to take a break together. . To boost morale through promoting balanced working environments. Methods The PPP initiative was implemented using a Quality Improvement (QI) model. A 'Rooftop Rota' encouraged every specialty to take at least one break during the week using the 'Rooftop Garden' (in line with social-distancing guidance). Departments were able to 'tick' attendance and encouraged to take photos promoting inter-specialty competition. A logo and slogan were shared through posters screensavers and pin-badges. Presentations were delivered at forums including Senior Management Leadership Workforce Leads, Junior Doctor Forum and departmental meetings - encompassing different seniorities specialties and disciplines. This project did not require ethics approval but was endorsed by the senior leadership team following a risk assessment. Results An initial questionnaire demonstrated 27% of staff never take a break during the working day. The PPP initiative was piloted for two months to improve this evidenced by rooftop attendance. A follow-up questionnaire will be completed in September 2021 as part of the ongoing QI cycle. Discussion/Conclusion Feedback is unanimously positive. Staff report feeling 'enthusiastic and energised' by PPP and empowered to incorporate breaks into their day. The initiative has also highlighted departments which have not participated and can prompt investigation into why. Despite the challenges we face through supporting each other we can continue to shine together.

Sociodemographic trends in COVID-19 mortality in patients with cancer: A nationwide analysis

Background: The COVID-19 pandemic has caused unprecedented disruptions in medical care, especially in those with cancer. Prior studies have demonstrated a higher risk of mortality in patients with cancer and COVID-19, which could be due to factors such as immunosuppression and higher burden of co-morbidities. However, there are limited studies examining the impact of sociodemographic factors including race, gender, rurality, and region on mortality in patients with COVID-19 and cancer. This study aims to characterize and analyze sociodemographic trends in COVID-19 mortality in patients with cancer. Methods: Data on patients with COVID-19 and cancer listed on death certificates from the Multiple Cause of Death Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database were extracted. Age-adjusted mortality rates (AAMR) were calculated and compared across sociodemographic groups. Results: A total of 18,467 total deaths occurred in patients with COVID-19 and cancer listed on multiple cause of death certificates in 2020, with overall AAMR of 4.4 (95% CI: 4.4-4.5). AAMR for patients with COVID-19 and cancer was significantly higher in Non-Hispanic (NH) Black or African American (7, 95% CI: 6.8- 7.3), NH American Indian or Alaska Native (6.4, 95% CI: 5.4-7.3), and Hispanic or Latino (5.4, 95% CI: 5.2-5.7) groups than NH White (4, 95% CI: 3.9-4.1) and NH Asian or Pacific Islander (2.5, 95% CI: 2.3-2.7). AAMR was also higher in males (5.9, 95% CI: 5.8-6.1) and those in Northeast (5.6, 95% CI: 5.4-5.8) and Midwest (5.3, 95% CI: 5.2-5.5) census regions. Those in medium metro counties had significantly lower AAMR (3.8, 95% CI: 3.7-4) compared to other locations based on the NCHS Urban-Rural Classification Scheme for Counties. Conclusions: AAMR in patients with any cancer and COVID-19 was significantly higher in NH Black or African American, NH American Indian or Alaskan, and Hispanic or Latino race/ethnicity groups, as well as in males. Regional and rurality disparities also exist. This study highlights persistent disparities in COVID-19 and cancer outcomes and identifies groups at higher risk of mortality. Future studies examining sociodemographic trends in COVID-19 mortality in patients with specific cancers are necessary.

Patient-reported disruptions to cancer care in the U.S. during the COVID-19 pandemic: A national cross-sectional study

Background: Disruptions to cancer care during the COVID-19 pandemic due to disease mitigation efforts, supply-chain issues, and fear of COVID-19 have all been reported, but study of their extent has been limited. The purpose of this study is to evaluate the extent and associations with patient reported disruptions to cancer treatment and other care during the COVID-19 pandemic using nationally representative data. Methods: This cross-sectional study uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey of US adults. Adults who reported requiring current cancer treatment or other care related to their cancer in the second half of 2020 were included. Rates of patients with self-reported changes, delays, or cancellations to cancer treatment or other cancer-related care due to the COVID-19 pandemic were calculated and their associations with demographic and other variables were analyzed. All data were adjusted using sample weights and specific variables to account for stratification and other survey characteristics using the Stata svy command. Chi-square testing was used to compare proportions across variable groups. Univariable logistic regression analysis was utilized to assess variable associations with change, delay, or cancellations to cancer care during the COVID-19 pandemic. Multivariable logistic regression analysis was used to create a model adjusted for select demographic variables. Results: A sample-weighted 2,867,326 adults (n=574) reported requiring cancer treatment and/or other cancer care since the start of the COVID-19 pandemic. Of these, 189 (32.1%) reported any change, delay, or cancellation due to the pandemic. On univariable analysis, patients who were younger, female, had comorbidities, and uninsured were significantly more likely to report care disruptions. On adjusted analysis, younger age and female sex remained significant predictors. In a sample-weighted subset of 1,600,587 patients (n=331), 291 (87.9%) reported virtual appointment use. There was no association with disruptions across breast, prostate, lung, and colorectal cancer groups. Conclusions: Approximately 1/3 of patients experienced disruptions to cancer care during the COVID-19 pandemic. Patients with younger age or female sex were more likely to have disruptions in care, which may reflect risk stratification strategies in the early stages of the pandemic. The longitudinal impact of these disruptions on outcomes merits further study.

DIGITALLY ENHANCED TREAT-TO-TARGET and SHARED DECISION-MAKING APPROACH with A DIGITAL HEALTH APPLICATION: INTERIM RESULTS from A RANDOMIZED CONTROLLED TRIAL

Background: Digital health applications (DHA) became indispensable patient companions accelerated by the current COVID pandemic [1]. In 2020, for the frst time worldwide, a regulatory framework to reimburse DHA was established in Germany. To get listed as a DHA, preliminary evidence needs to be generated-next to fulflling highest standards in quality and safety. The DHA ABATON RA consists of two parts;1) digital shared-decision-making (SDM) including choosing an appropriate electronic patient reported outcome (ePRO) instrument and the respective ePRO target for the next visit, 2) remote patient monitoring and ePRO tracking by the patient. Hereby, ABATON RA supports a digitally guided Treat-to-Target (T2T) approach. Objectives: The objective of this study is to evaluate a potentially benefcial effect for the patient by using ABATON RA. Methods: Three-armed, partially blinded multicenter trial (RCT) including RA patients who regularly use a smartphone. Patients attend 3 visits, 3 months apart (T0, T3, T6), with one follow-up visit (T9). Intervention group (IG): Patients use ABATON RA. Via SDM patients and rheumatologists choose a specifc ePRO and respective treatment target for the next visit in three months, e.g. RAID ≤4. Control group (CG): Standard of care treatment (no DHA). Placebo group (PG): Usage of a placebo version of ABATON RA providing only Regensburger Insomnie Skala (RIS) and Epworth Sleepiness Scale (ESS) as ePROs. No SDM is conducted and ePRO results are not presented to HCP. Results: This interim analysis evaluated the frst 38 patients that completed T3. IG: 13 patients (Av. age 55.9, 61.5% females);PG: 12 (Av. age 50.7, 66.7% females);CG: 13 (Av. age 56.1, 76.9% females). We observe a signifcant improvement in the mean over time in a pairwise comparison within the intervention group for the following: Pt-GA mean difference of 2.98 (p = 0.025, partial η2 = 0.353), pain mean difference of 1.46 (p = 0.049, partial η2 = 0.286) whereas all pairwise comparisons for the two parameters were non-signifcant in PG and CG. The patient reactions assessment (PRA) score, measuring patient perceived quality of the patient-provider relationship, increased by a mean of 4.15 points in IG, compared to a slight decrease of 1.92 for PG and 2.77 for CG. Conclusion: These preliminary fndings show benefcial differences among the groups in favor of IG: 1) for quality of life and 2) the physician-patient-relationship. A digitally enhanced therapy is non-inferior to the gold-standard of exclusive in-person treatment. Patients seem willing and able to get involved in an enhanced treat-to-target and shared decision-making approach.

PATIENT-REPORTED DELAYS IN TREATMENT FOR UROLOGIC CANCERS DURING THE COVID-19 PANDEMIC: A NATIONAL CROSS-SECTIONAL ANALYSIS

INTRODUCTION AND OBJECTIVE: The Covid-19 pandemic has disrupted every facet of medical care, without exception in urologic cancer care. Access to care and surgery rates significantly decreased during the initial period of the pandemic, but the overall impact on care and survival has not yet been fully appreciated. This study aims to characterize and analyze patient reported delays in treatment or ancillary care due to the pandemic for the two most common urologic cancers, prostate cancer (PC) and bladder cancer (BC) at the national level. METHODS: This retrospective, cross-sectional study used the National Health Interview Survey 2020, which consists of a nationally representative sample of 31,568 adults 18 or older. Data were then weighted to account for complex survey design and provide national estimates. Patients with a known history of PC or BC were included. Proportion of patients reporting changes, delays, or cancellations to cancer treatment or other ancillary care during the pandemic were analyzed and compared across cancer groups. RESULTS: A sample-weighted estimate of 1,720,245 patients with history of PC (n=1,439,867, 83.7%) or BC (n=280,379, 16.3%) of known treatment or other care status during Covid-19 were included. 282,929 (16.5%) reported receiving or supposed to be receiving treatment since the start of the pandemic, while 298,116 (17.3%) reported needing other care including lab visits, imaging, monitoring visits, rehabilitation, physical therapy, care for side-effects, or visits with medical specialists. Of those receiving or supposed to be receiving treatment, 76,984 (27.2%;95% CI 15.7-43.0%) reported their cancer treatment was changed, delayed, or cancelled due to the pandemic, with no significant difference between those with history of PC vs. BC (27.2% vs. 27.5%;P=.99). Of those needing other care, 73,189 (24.5%;95% CI 13.8-39.7%) reported change, delay, or cancellation due to the pandemic, again with no significant difference between patients with history of PC vs. BC (24.4% vs. 26.0%;P=0.93). CONCLUSIONS: Approximately 1/4 of PC and BC patients requiring treatment or other ancillary care during the pandemic reported change, delay, or cancellation. Delays in BC treatment have previously been shown to increase mortality, thus necessitating further study of the long-term implications of delays due to the Covid-19 pandemic on outcomes.

Use of remdesivir in a kidney transplant recipient suffering from covid-19 pneumonia

Introduction: Due to limited experience in the management of COVID-19 infection in the posttransplant population [1,2] we want to report a case of a kidney transplant recipient infected with SARS-CoV-2, undergoing a therapy with Remdesivir. Methods: The 38-year old kidney transplant recipient, who received a renal allograft in 10/2019 (unknown underlying kidney disease) was admitted to the emergency department with a history of intermittent fever, beginning oliguria, low blood pressure and somnolence. The laboratory results revealed a slight increase of acute phase reactants, hyponatremia and a low CD4+ T cell count. Results: A naso-and oropharyngeal swab specimen tested positive for SARSCoV-2;a chest CT scan revealed only minor changes. The patient was started on empirical broad-spectrum antibiotics. Maintenance immunosuppressive agents (mycophenolate mofetil and tacrolimus) were discontinued and hydrocortisone was initiated as a continuous i.v. infusion. Further, valganciclovir and prophylactic anticoagulation with low molecular weight heparin were initiated and ivIG were administered as supportive treatment. About 10 days after admission, the patient had persistent fever and gradually developed dyspnea. A second chest CT scan showed bilateral basal infiltrates with ground glass opacity. Oxygen was administered at 5-7 l/min. Due to acute clinical deterioration and the high risk of progression and significant mortality of SARS-CoV-2 pneumonia [3], a 5-day course of antiviral treatment with Remdesivir in emergency use was started. The patient improved with normalization of inflammatory parameters and fever disappeared. As of today day 25 after admission, the patient has normal blood gas analysis without oxygen supply, normal graft function, and had no rejection episode or CMV reactivation. Conclusion: Despite a few reported cases of COVID-19 infection in the transplant population additional data are needed to optimize management of this patient group [4]. This case report shows the delayed development of SARS-CoV-2 pneumonia in a kidney transplant recipient. The clinical improvement after a 5 day Remdesivir therapy underlines the encouraging results observed with use of Remdesivir in other patients [5].