Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario.

INTRODUCTION: COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. METHODS: Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS: A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% versus -3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). CONCLUSIONS: Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.

Covid-19 vaccination in cancer patients - the role of anxiety, depression and distress in the perception of vaccine efficacy

Background: Following the establishment of the vaccination plan to counter the spread of the SARS-CoV-2 virus, cancer patients were immediately included among the population groups most at risk. Despite the recommendations, many patients did not adhere to the vaccination plan, showing skepticism and low confidence in the vaccine. For this reason, this research was established, with the aim of investigating, from a multifactorial and multidimensional point of view, the variables that influenced the perception of trust in the anti-Covid-19 vaccine, in order to intervene on them and encourage vaccination membership. Material (patients) and methods: A questionnaire was created, containing the Anxiety and Depression Scale (Zigmond & Snaith, 1983), the Distress Thermometer (Roth et al., 1998) and four questions investigating the perception of vaccination efficacy or ineffectiveness, which can be evaluated on a simplified scale 1-4. This questionnaire was administered to cancer patients immediately before the inoculation of the anti-COVID-19 vaccine. This questionnaire was administered both during the first (T0) and during the second dose (T1) of the vaccine, so as to be able to detect the differences between the variables considered. Results: Preliminary data on a sample of 342 patients were analyzed: the average age was 66.22 and its composition was mostly female (57.9%). In both vaccine administrations, distress, anxiety and depression were found to be within normal and below threshold values, while the perceived efficacy of the vaccine was found to be slightly higher at T1 than at T0. Distress was found to affect all the variables considered;its reduction, therefore, involves the modification of the average values of anxiety, depression, efficacy and ineffectiveness of the anti-Covid-19 vaccine. Conclusions: The reduction in perceived distress and the related increase in overall confidence in the anti- Covid-19 vaccine can be explained by historical and contextual factors, given the high sensitivity of the Distress Thermometer in detecting perceived distress within the 7 days prior to its compilation. Further data will be presented, given the ideas that this research poses for future studies.

Pitfalls during COVID19 vaccination recruitment for oncology patients

Background: The purpose of this work is to analyse the pitfalls of recruitment during the COVID19 vaccine campaign for patients in active treatment for solid tumours in an Oncological Department. Every Oncology Department in Veneto developed a way to recruit patients in order to vaccinate them (and afterwards their caregivers). Here we report the Alta Padovana experience during the first month of COVID19 vaccination period. Methods: Patients in active treatment (or previous 6 months), for solid tumours, with chemotherapy, immunotherapy or target therapy were identified. Every single patient were evaluated: exclusion criteria for vaccination were a recent (last 3 months) COVID19 infection, previous COVID19 vaccination, a very poor Performance Status (PS), previous serious anaphylactic reactions, concomitant use of G-CSF and severe neutropenic situation. Every single patient was contacted and was offered a mRNA-1273 Moderna Inc. COVID19 vaccination. Each patient signed an informed consent, filled in a questionnaire about medical history, a psychological questionnaire regarding the vaccine and their relative side effects (the emotional distress (HADS) thermometer and the emotional status check list). Results: From 6/3/2021 and 13/3/2021 a total of 529 patients were evaluated: 349 (66%) patients received the first dose of vaccination by the oncologic units;180 patients were not vaccinated due to different reasons. Some (8,6%) have been previously vaccinated (mainly because health professionals or 80 years older). Some (4,7%) patients were not vaccinated due to a recent (last 3 months) COVID-19 infection. Due to important comorbidities, severe previous anaphylactic reactions or very poor PS, 12% of patients were not vaccinated. Initially 44 patients (8,3%) refused the vaccine: for the fear of side effects, for the very little trust in the vaccination or other personal opinion. After a couple of weeks, to all sceptic patients were proposed again the vaccination and 16 accepted the vaccination;8 “sceptic patients” had a COVID infection and two died due to it. Conclusions: Due also to the “social terrorism” created by the “AstraZeneca vaccine Affaire”, some patients initially refused;unfortunately some “sceptic patients” had infections and two of them, with advanced tumour disease, died due to COVID19. Oncology team should adequately educate cancer patients (and their care-givers) regarding COVID infection and the risk related to vaccine refuse.