Virtual sarcoma disease multidisciplinary team: A jump into the future?

Background: Sarcomas are rare cancers with complex diagnoses, requiring multimodal management in referral Centers with a dedicated Disease Multidisciplinary Team (DMT). COVID-19 pandemic imposed a sudden revolution in care management leading to activation of digital health tools such as virtual DMT meetings. We investigated how transition from face-to-face (FTF) to virtual meetings (VM) impacted clinical practice in a Sarcoma referral Center in Italy. Method(s): An online survey was administered to the participants of the Sarcoma DMT meetings held between 2020 and 2022 at Regina Elena National Cancer Institute of Rome. The survey consisted of 40 questions inquiring the experience of professionals in DMT meetings, opinions about FTF/VM, future perspectives. Moreover, we retrospectively analyzed the registries of DMT meetings held from March 9th 2019 to March 8th 2022 and we defined three 12-months periods by using the date of National lockdown beginning in Italy (March 9th 2020) as cutoff: a pre-covid, a covid, a post-covid phase. Result(s): A total of 22 healthcare professionals answered the survey: 18 medical doctors, 1 psychologist and 3 data/case managers. The most important changes in VM were better quality of clinical approach and research (22%), technological innovation (50%), and better logistical setting (95%). Between participants, 90% were highly/moderately satisfied with the depth of discussion, 100% declared that attendance was similar (68%) or increased (32%) compared to FTF, 86% thought that decision-making process was not affected, and 95% were still able to interact adequately and access relevant patients' data. 91% thought that VM could be approved hereafter and 100% that would facilitate DMT expansion globally. The median participation rate in Institutional Sarcoma DMT meetings was 58% (95% confidence interval (CI) 55%-60%), 62% (95% CI 48%-71%), and 64% (95% CI 61%-68%) respectively in the pre-covid, covid, and post-covid periods (p 0.0159). Compared to the re-discussed cases, the new ones rose from 30.1% in the pre-covid to 37.9% in the covid and 42.3% in the post-covid period (p<0.0001). Conclusion(s): VM guarantees a great standard of effectiveness in health assistance and should be a suitable or additional tool for the management of patients in clinical practice. Legal entity responsible for the study: IRCCS Regina Elena National Cancer Institute (IRE). Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology

Effects of Covid19 Pandemic on Quality of Life in Patients with Newly Diagnosed Sarcoma in a Referral Centre in Italy: Results from the Sarcord Study (Cometa Project)

Background: Sarcomas are extremely rare and disabling tumours causing physical impairments as well as psychological issues. The Health-related quality of life (HRQoL) in these patients (pts) is impaired as a consequence of their illness and its treatments. It is widely demonstrated the harmful impact of covid19 pandemic and its effects on the HRQoL of the general population and especially on cancer pts. We investigated this important aspect in sarcoma pts. Material (patients) and Methods: We performed a retrospective observational study including pts with diagnosis of soft tissue (STS) and bone sarcoma (BS) referred to Regina Elena National Cancer Institute in Rome and with histological diagnosis obtained during the year preceding (Control group-Ctg) or following (Covid group-Covg) the start of covid19 lockdown in Italy (March 9th 2020). Patients were evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), with scores analysed as continuous scales, and with the Distress Thermometer (DT), where the pts were accounted for as having low/ absent (score 0-4) or high distress (5-10). Result(s): We enrolled a total of 115 pts, 76 in the Ctg and 39 in the Covg;43 women and 72 men. Median age was 55 years (range 94-21). In the Ctg and in the Covg respectively, the most common diagnosis was STS (N=52 vs 27) followed by BS (N=24 vs 12). Most pts had a localized disease at diagnosis (N=64 vs 34) and only 17 (N=12 vs 5) had distant metastasis. The first treatment received was surgery in 75 pts (N=52 vs 23), chemotherapy in 30 pts (N=18 vs 12), concomitant chemo-radiotherapy in 4 pts (N=3 vs 1), and 6 pts (N=3 vs 3) had a follow-up strategy. In the Covg, compared with the Ctg, we found a decline in Social functioning (average score (mu)=81,64;SD=30,54 vs 91,38;SD=16,24 respectively;p=0,027) as well as an increase in financial difficulties (mu=11,95;SD=22,31 vs 3,93;SD=13,29;p=0,017) and increased nausea (mu=5,13;SD=13,31 vs 1,12;SD=4,24;p=0,018). We also found a higher rate of patients with emotional distress in the Covg (50% vs 71,8% p=0,025). Worsening, although not statistically significant, was observed in almost all questionnaire domains. Conclusion(s): Our study suggests that the covid19 pandemic had a detrimental effect on HRQoL in sarcoma patients. This study makes an effort on the strong need of improvement psychological support for both emotional and physical effects in our pts.

Risk of SARS-CoV-2 infection and outcome after infection: Experience from the day-care unit at CHU Liège in Belgium

Background: No specific safety data concerning systemic oncological treatments were available at time of COVID-19 outbreak in Belgium. In our hospital we decided to maintain adjuvant and early line treatments for metastatic disease in patients under 65 and without specific comorbidities and to apply a shared decision approach in other patients while following closely the safety of these treatments. Method(s): Real time safety monitoring was proposed to all patients treated for solid tumours in our day-care unit starting March 1st, 2020. After signing informed consent patients were asked questions concerning protective measures at home, signs of SARS-CoV-2 infection and hospitalisation. Patients' charts were reviewed for outcome, including death, after suspected or proven SARS-CoV-2 infection. Minimum follow-up was 5 weeks after day care unit attendance. Result(s): 387 patients were included in our registry between March 1st and March 31st, 2020. Median age was 64 years-old (range 27-90). Most patients suffered from lung (n=96), breast (n=93), gastrointestinal (n=87), gynaecological (n=38) or urological (n=33) cancers. 131 patients received (neo)adjuvant treatments, 256 patients were treated for metastatic disease. Patients received chemotherapy (n=170), immunotherapy (n=103), targeted therapy (n=68) or other combinations (n=46). Although Belgium had one of the highest infection rates in the world, safety data concerning risk of SARS-CoV-2 infection and outcomes were rather reassuring. A total of 11 patients had either suspected (n=5, 1.3%) or proven (n=6, 1.6%) SARS-CoV-2 infection. Only one 74 years old patient died of COVID-19, another 51 years old patient died of progressive disease but presented also suspicion of SARS-CoV-2 infection at the time of death. Conclusion(s): Analysis of our data for patients treated in March 2020 in the day-care unit are reassuring and suggest higher risk related to under-treatment compared to risk related to continuation of systemic therapy at time of COVID-19 outbreak. Patients' follow-up will be updated and additional analyses and data in particular for April 2020, when the infection rate was still extremely high in Belgium, will be presented. Legal entity responsible for the study: The authors. Funding(s): Fondation Leon Fredericq. Disclosure: A. Rorive: Travel/Accommodation/Expenses: BMS;MSD. B. Sautois: Advisory/Consultancy, Travel/Accommodation/Expenses: Janssen;Advisory/Consultancy: Clovis;Sanofi;Astellas. J. Collignon: Advisory/Consultancy, Travel/Accommodation/Expenses: Roche;Amgen;Pfizer;Advisory/Consultancy: Servier;Bayer;Merck;Lilly;Sanofi;Sirtex;Celgene;Ipsen;Novartis. P. Freres: Advisory/Consultancy: Ipsen;Merck;BMS. C. Gennigens: Advisory/Consultancy, Research grant/Funding (institution): Astra-Zeneca;Advisory/Consultancy: BMS;GSK;Lilly;MSD;Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen;Pfizer;Pharmamar;Roche. G. Jerusalem: Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Roche;Pfizer;Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Lilly;Advisory/Consultancy, Research grant/Funding (institution): Amgen;Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;AstraZeneca;Daiichi Sankyo;Advisory/Consultancy: Abbvie;Travel/Accommodation/Expenses: Medimmune;MerckKGaA. All other authors have declared no conflicts of interest.Copyright © 2020

How do oncological patients perceive the COVID-19 pandemic? Experience from CHU Liège in Belgium

Background: No data concerning systemic oncological treatments' safety during COVID-19 outbreak were available in Belgium. The aim of this study is to analyse patients’ perception of both the risk of infection and the need for change in clinical practice in oncology. Methods: A 12-items questionnaire using the Likert scale for 11 of these questions concerning the patients’ perception of COVID-19 was distributed to patients admitted for systemic therapy of solid tumours in our day-care unit between April 14th and 30th, 2020 (4-6 weeks after lockdown in Belgium). Results: 237 patients were included in our research project after signing an informed consent. Median age was 63 years-old (range 26-90). Most patients suffered from lung (n=59), breast (n=54), gastrointestinal (n=47), gynaecological (n=34) or urological (n=16) cancers or melanoma (n=15). 87 patients received (neo)adjuvant treatments, 150 patients were treated for metastatic disease. Patients received chemotherapy (n=106), immunotherapy (n=60), targeted therapy (n=36) or combinations (n=35). The patients who estimated their risk of dying because of COVID-19 infections as <0.1%, 1%, 10%, 20%, 50% or 100% were respectively 9.7%, 15.2%, 13.5%, 6.3%, 32.4%, 11.4% (no opinion: 10.8%). Most patients agreed (21.5%) or strongly agreed (64.6%) that it is important for them to receive the best cancer treatment available even if this may increase the infection risk. Very few patients agreed (1.3%) or strongly agreed (2.5%) that they were considering stopping the ongoing therapy because of the COVID-19 outbreak. Most patients agreed (33.8%) or strongly agreed (49.4%) that the institution was doing everything possible for risk reduction of contamination while receiving the therapy in the day-care unit. Conclusions: Although patients evaluated the risk of dying due to COVID-19 infection as extremely high, they are still asking for the best oncological care available. The majority recognize the effort of the institution in minimizing infectious risk. Additional analyses will be reported at time of presentation. Questionnaires will be repeated 3 months after the peak of the COVID-19 outbreak. Legal entity responsible for the study: The authors. Funding: Fondation Leon Fredericq. Disclosure: A. Rorive: Travel/Accommodation/Expenses: MSD;Travel/Accommodation/Expenses: BMS. B. Sautois: Advisory/Consultancy, Travel/Accommodation/Expenses: Janssen;Advisory/Consultancy: Clovis;Advisory/Consultancy: Sanofi;Advisory/Consultancy: Astellas. A. Sibille: Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;MSD;Boehringer Ingelheim;Roche;Advisory/Consultancy: AstraZeneca;Takada. J. Collignon: Advisory/Consultancy, Travel/Accommodation/Expenses: Roche;Amgen;Pfizer;Advisory/Consultancy: Servier;Bayer;Merck;Lilly;Sanofi;Sirtex;Celgene;Ipsen;Novartis. C. Gennigens: Advisory/Consultancy, Research grant/Funding (institution): Astra-Zeneca;Advisory/Consultancy: BMS;GSK;Lilly;MSD;Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen;Pfizer;Pharmamar;Roche. P. Freres: Advisory/Consultancy: Ipsen;Merck;BMS. G. Jerusalem: Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Roche;Pfizer;Advisory/Consultancy, Travel/Accommodation/Expenses: Lilly;Amgen;BMS;AstraZeneca;Daiichi Sankyo;Advisory/Consultancy: Abbvie;Travel/Accommodation/Expenses: Medimmune;MerckKGaA. All other authors have declared no conflicts of interest.

Expected medium and long term impact of the COVID-19 outbreak in oncology

Background: The ongoing SARS-CoV-2 pandemic and ensuing coronavirus disease (COVID-19) is challenging cancer care and services worldwide. Methods: A 95 items survey was distributed worldwide by 20 oncologists from 10 of the most affected countries in order to evaluate the impact on organization of oncological care. Results: 109 representatives from oncology centers in 18 countries (62.4% academic hospitals) filled out the survey (June 17 – July 14, 2020). A swab or gargle test is systematically performed before day care unit or overnight stay admissions in 27.5% and 58.7% of the centers, respectively. A local registry (64.2%) and systematic tracing (77.1%) of infected patients was organized in many centers. Treatment modalities mostly affected by the pandemic (cancellation/delay) were surgery (44.1%) and chemotherapy (25.7%). Earlier cessation of palliative treatment was observed in 32.1% of centers, and 64.2 % of participants agree that under-treatment is a major concern. At the pandemic peak, teleconsultations were performed for follow-up (94.5%), for oral therapy (92.7%), but also for patients receiving immunotherapy (57.8%) or chemotherapy (55%). Approximately 82% of participants estimate that they will continue to use telemedicine. Most participants reported more frequent use of virtual tumor boards (82%) and oncological team meetings (92%), but 45% disagree that virtual meetings are an acceptable alternative to live international meetings. Although 60.9% report reduced clinical activity during the pandemic peak, only 28.4% had an increased scientific activity. Only 18% of participants estimate that their well-being will not recover to previous levels by the end of the year;63% indicate easily accessible psychological support for caregivers, but only 10% used or planned to use it. All clinical trial activities are or will soon be reactivated in 72.5% of the centers. Major study protocol violations/deviations were observed in 27.5% and significant reductions of clinical trial activities are expected by 37% of centers this year. Conclusions: COVID-19 has a major impact on organization of patient care, well-being of caregivers, continued medical education and clinical trial activities in oncology. Legal entity responsible for the study: The authors. Funding: Fondation Léon Fredericq. Disclosure: G. Jerusalem: Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Advisory/Consultancy, Travel/Accommodation/Expenses: Lilly;Advisory/Consultancy, Travel/Accommodation/Expenses: Amgen;Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;Advisory/Consultancy, Travel/Accommodation/Expenses: AstraZeneca;Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo;Advisory/Consultancy: AbbVie;Travel/Accommodation/Expenses: MedImmune;Travel/Accommodation/Expenses: Merck KGaA. G. Curigliano: Advisory/Consultancy, Speaker Bureau/Expert testimony: Roche;Advisory/Consultancy, Speaker Bureau/Expert testimony: Seattle Genetics;Speaker Bureau/Expert testimony, Writing engagement: Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony: Lilly;Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer;Advisory/Consultancy, Speaker Bureau/Expert testimony: Foundation Medicine;Advisory/Consultancy, Speaker Bureau/Expert testimony: Samsung;Advisory/Consultancy, Speaker Bureau/Expert testimony: Celltrion;Leadership role, Scientific Affairs Group: Ellipsis;Speaker Bureau/Expert testimony, Writing engagement: BMS;Speaker Bureau/Expert testimony: MSD;Advisory/Consultancy: Mylan. M. Campone: Honoraria (self), Advisory/Consultancy: GT1;Honoraria (institution), Advisory/Consultancy: Sanofi;Honoraria (institution), Advisory/Consultancy: Pierre-Favre;Honoraria (institution), Advisory/Consultancy: AstraZeneca;Honoraria (institution), Advisory/Consultancy: Servi r;Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis;Honoraria (institution), Advisory/Consultancy: AbbVie;Honoraria (institution), Advisory/Consultancy: Accord;Honoraria (institution), Advisory/Consultancy: Pfizer;Speaker Bureau/Expert testimony: Lilly. M. Martin: Advisory/Consultancy, Research grant/Funding (institution): Roche;Advisory/Consultancy, Research grant/Funding (institution): Novartis;Advisory/Consultancy, Research grant/Funding (institution): Puma;Advisory/Consultancy: AstraZeneca;Advisory/Consultancy: Amgen;Advisory/Consultancy: Taiho Oncology;Advisory/Consultancy: Daichii Sankyo;Advisory/Consultancy: PharmaMar;Advisory/Consultancy: Eli Lilly;Advisory/Consultancy: Pfizer. M. Cristofanilli: Advisory/Consultancy: CytoDyn;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution): Pfizer;Advisory/Consultancy: Lilly;Advisory/Consultancy: Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony: Foundation Medicine;Advisory/Consultancy: G1 Therapeutics;Advisory/Consultancy: Sermionexx;Advisory/Consultancy: Genentch. L. Pusztai: Honoraria (self), Research grant/Funding (institution), Clinical trial support: Merck;Honoraria (self), Research grant/Funding (institution), Clinical trial support: AstraZeneca;Honoraria (self), Research grant/Funding (institution), Clinical trial support: Seattle Genetics;Honoraria (self): Novartis;Honoraria (self), Research grant/Funding (institution), Clinical trial support: Roche Genentech;Honoraria (self): Eisai;Honoraria (self): Daiichi;Honoraria (self): Syndax;Honoraria (self): Immunomedics. R. Bartsch: Advisory/Consultancy: Accord;Honoraria (self): AstraZeneca;Advisory/Consultancy, Research grant/Funding (institution): Daiichi;Advisory/Consultancy, Travel/Accommodation/Expenses: Eli-Lilly;Advisory/Consultancy, Travel/Accommodation/Expenses: MSD;Advisory/Consultancy, Research grant/Funding (institution): Novartis;Advisory/Consultancy, Research grant/Funding (institution): Roche;Advisory/Consultancy: Puma;Advisory/Consultancy: Pierre-Favre;Advisory/Consultancy: Sandoz;Advisory/Consultancy: Eisai. M. Tagliamento: Travel/Accommodation/Expenses: Roche;Travel/Accommodation/Expenses: Bristol-Myers Squibb;Travel/Accommodation/Expenses: AstraZeneca;Travel/Accommodation/Expenses: Takeda;Travel/Accommodation/Expenses: Novartis;Travel/Accommodation/Expenses: Amgen. J. Cortés: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche;Honoraria (self), Advisory/Consultancy: Celgene;Advisory/Consultancy: Cellestia;Advisory/Consultancy, Research grant/Funding (institution): AstraZeneca;Advisory/Consultancy: Biothera Pharmaceutical;Advisory/Consultancy: Merus;Advisory/Consultancy: Seattle Genetics;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo;Advisory/Consultancy: Erytech;Advisory/Consultancy: Athenex + Polyphor;Advisory/Consultancy, Shareholder/Stockholder/Stock options: MedSIR;Honoraria (self), Advisory/Consultancy: Lilly;Advisory/Consultancy: Servier;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Merck Sharp Dome;Advisory/Consultancy: GSK;Advisory/Consultancy: Leuko;Advisory/Consultancy: Bioasis;Advisory/Consultancy: Clovis Oncology;Advisory/Consultancy: Boehringer Ingelheim;Honoraria (self), Travel/Accommodation/Expenses: Novartis;Honoraria (self), Travel/Accommodation/Expenses: Eisai;Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Honoraria (self): Samsung Bioepis;Research grant/Funding (institution): Ariad Pharmaceuticals;Research grant/Funding (institution): Baxalta GMBH/Servier Affaires;Research grant/Funding (institution): Bayer Healthcare;Research grant/Funding (institution): F. Hoffmann-La Roche;Research grant/Funding (institution): Guardanth Health;Research grant/Funding (institution): Piqur THerapeutics;Research grant/Funding (institution): Puma C;Research grant/ unding (institution): Queen Mary University of London. E.M. Ciruelos: Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;Advisory/Consultancy, Speaker Bureau/Expert testimony: Lilly;Advisory/Consultancy, Speaker Bureau/Expert testimony: Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Pfizer. H.S. Rugo: Research grant/Funding (institution): Eisai;Research grant/Funding (institution): Genentech;Research grant/Funding (institution): Lilly;Research grant/Funding (institution), Travel/Accommodation/Expenses: MacroGenics;Research grant/Funding (institution): Merck;Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Research grant/Funding (institution): Obi Pharma;Research grant/Funding (institution): Odonate Therapeutics;Research grant/Funding (institution): Immunomedics;Research grant/Funding (institution), Travel/Accommodation/Expenses: Daiichi-Sankyo;Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Advisory/Consultancy: Samsung;Advisory/Consultancy: Celtrion;Travel/Accommodation/Expenses: Mylan;Travel/Accommodation/Expenses: AstraZeneca. All other authors have declared no conflicts of interest.