ABSTRACT
Background: Immune checkpoint inhibitors (ICIs) can cause a variety of inflammatory autoimmune tissue damage, referred to as immune-related adverse events (irAEs). COVID-19 is associated with increased amounts of proinflammatory cytokines, which may synergistically affect the outcome of irAEs. Data are limited regarding the impact of COVID-19 on irAEs in ICI-treated cancer patients. Methods: We retrospectively analyzed adult patients with malignant solid tumors treated with ICIs at AdventHealth Orlando between August 2020 and August 2021. All COVID-19 infections were confirmed by PCR. Patients who had the most recent ICI treatment over one month before or after the positive COVID- 19 test were excluded from the study. For COVID-19 positive group, only the irAEs that developed after COVID-19 infection were considered as events. Results: A total of 579 patients were included in our study, with 46 (7.9%) in COVID-19 positive group, and 533 (92.1%) in COVID-19 negative group. The baseline characteristics of patients in the two groups were similar in terms of age, ethnicity, ECOG, cancer histology, and type of ICI. With a median follow-up of 10 months (1-73 months), no differences in the time from ICI initiation to irAE onset, corticosteroid use, or additional immunosuppressant use were seen. A trend in higher incidence of all-grade diarrhea/colitis (8.7% vs. 3.0%, p=0.07) and grade 3 and 4 hepatitis (4.3% vs. 0.8%, p=0.08) was noted in the COVID-19 positive group, however the difference was not statistically significant. No significant difference in the incidence of pneumonitis (2.2% vs. 1.1%, p=0.44), nephritis (2.2% vs. 0.8%, p=0.34) or dermatitis (6.5% vs. 6.4%, p=1.00) were noted between COVID-19 positive and negative groups. We noticed a higher incidence of all-grade irAEs in the COVID-19 positive group (30.4% vs. 19.9%, p=0.18), but the difference was not statistically significant. The incidence of grade 3 and 4 irAEs was significantly higher in the COVID- 19 positive group (10.9% vs. 3.2%, p=0.02). Nine COVID-19 related death occurred while no irAE-related death was noted in the entire cohort. Conclusions: Our study suggested that COVID-19 may pose a risk of severe irAEs in cancer patients receiving ICIs. Close monitoring and possible delaying ICI administration could be considered when cancer patients were infected with COVID-19. (Table Presented).
ABSTRACT
Background: The global spread of COVID-19, due to its pathogenesis and high mortality rate, has caused high levels of stress among various levels of societies. Hence, it is necessary to investigate social support interventions concerning their effectiveness and accessibility. Objectives: The study aimed to determine the association between coping strategies and social support in survivors of COVID-19. Methods: Following a descriptive-correlational design, using the census method, 158 discharged cases with a definitive diagnosis of COVID-19 in 2020 were recruited. Data collection tools included the demographic characteristics questionnaire, CISS-48 stress-coping methods, and Wax’s social support questionnaire. Data were analyzed using descriptive and inferential statistics of Pearson correlation coefficient and multivariate regression in SPSS version 22. Results: The most and least frequent stress coping strategies used by patients were problem-oriented (48.49 ±9.99) and avoidance-oriented stress strategies (24.48 ± 4.11), respectively. Family support (39.02 ± 4.20) was the major source of support. There was a significant correlation between the score of social support and the total score of stress, problem-oriented, and avoidance-oriented stress. According to the regression analysis, there was a significant association between the score of coping strategies and educational level. Conclusions: By increasing the awareness of COVID-19 patients about problem-based coping strategies, their stress can be reduced. Also, due to the high level of social support provided by the family, planning for family-centered nursing interventions and engaging family members in the care of COVID-19 patients are important.