ABSTRACT
Background: Prior to the COVID-19 pandemic, oncology patients attended in-person educational sessions to understand the practicalities and side-effects of their planned systemic anti-cancer treatments (SACT). These were halted during the pandemic to minimise hospital attendances. Moreover, patients were unable to bring family or friends for support at consultations. Providing this key treatment information in a digital format using videos was proposed with these aims: 1. Improve accessibility of information. 2. Improve patient experience. 3. Improve staff experience and efficiency. Method(s): A network collaboration with the Royal Free London and North East London Cancer Alliance enabled consistency of information and increased exposure of the videos. A patient-centred approach was taken in developing the videos: 1. A baseline patient survey assessed current and proposed methods of communicating: patients received written and verbal information, but some felt they had been given 'too much' or 'not enough' information and 33% of patients reported a video would be helpful. 2. A patient focus group guided content: cannulation, real patient experiences and images of staff/facilities were identified as important. 3. The videos were translated into four languages to meet the needs of the local patient population. A multiprofessional team of doctors, nurses, managers and communications staff were involved in the development and production of the videos. Between November 2020 and September 2021, several Plan Do Study ACT (PDSA) cycles were undertaken to create, edit and review content in the production process, with patient and production team feedback throughout. Intervention(s): Three videos were produced covering an overview of treatment and the side-effects of chemotherapy and immunotherapy. These were disseminated via trust websites, YouTube and QR codes on posters. Learning outcomes of the videos were assessed by separate patient and staff feedback surveys. Result(s): 15 patients were approached prior to starting SACT to complete a questionnaire prior to and after watching the videos. Prior to watching the videos, 60% of patients felt they had not received enough SACT information, 73% were anxious about treatment. After watching the videos, 100% reported understanding of the common side-effects of treatment and how to contact the hospital for advice. 87% would recommend the videos to others, 73% would watch them again. 100% of staff surveyed agreed that the videos improved accessibility to key patient information. The videos answered common questions patients asked staff prior to starting treatment. Over six months, there have been >300 YouTube views. [Formula presented] Conclusion(s): Multilingual patient information videos are an effective way to deliver key information about SACT, improve patient experience and reduce anxiety. Next steps are to intensify signposting by increasing stakeholder exposure, and consider adapting the videos for national use. YouTube views will be counted to continue to monitor the use and sustainability of this intervention. Keywords: systemic anti-cancer therapy, digital, videos, patient education, patient experience, patient information, multilingual, staff experience, network collaboration, SACT, chemotherapy, immunotherapy Copyright © 2022
ABSTRACT
Background: The efficacy of SARS-COV-2 vaccination has been demonstrated in healthy individuals. Immune responses are less well characterised in cancer patient groups, especially those receiving anticancer therapy (e.g. immune therapy, chemotherapy and targeted therapies. We aim to assess the immune response to the SARS-COV-2 vaccination in patients with solid organ cancer on different systemic anti-cancer therapies. Methods: All patients received 2 doses of COVID-19 mRNA vaccination as part of the UK National vaccination programme;with the second booster dose administered within 12 weeks of the first dose. All patients received either BNT162b2 (Pfizer/BioNTech) or ChAdOx1 S (AstraZeneca) vaccines. Sequential serum samples were collected pre-booster dose vaccination (baseline/within -30 days) and after second dose SARS-COV-2 vaccination, at 14-35 days and 36-63 days. Presence and titres of serum Anti-SARS-CoV-2 Spike protein (S) antibody titres were measured. Seroconversion is defined as a response >0.8 U/ml, and maximum response to Anti-S is defined as >250 U/ml. Responses were measured in 3 patient groups according to the type of anti-cancer therapy: chemotherapy (CHT group), immune therapy (IO group) and targeted therapies, mainly VEGF TKI (TT group). Results: Overall, 61 patients were recruited: 45.9%(28/61) in CHT group, 32.8% (20/61) in IO group and 21.3% (13/61) in the TT group. Baseline characteristics were comparable between patient groups. In response to the booster dose vaccination at 14-35 days, the number of patients who seroconverted was 79.3% (23/29), 94.7% (18/19) and 84.6% (11/13) in the CHT, IO and TT groups, respectively. At this same time point, 51.7% (15/29) in the CHT group achieved maximum anti-S titre levels (>250 U/ml), compared with 78.9% (15/19) of patients in IO group and 69.2% (9/13) of patients in TT group. All 3 groups demonstrated a significant increase in Anti-S antibodies at 14-35 days after second dose vaccine when compared to pre-booster serum levels, with the largest increase seen in the IO group with a mean Anti-S increase of 149.1 U/ml (SD±105.0, p < 0.0001) followed by the TT group mean increase 120.2 U/ml (SD ±110.8, p < 0.01) and the CHT group, mean increase 83.0 U/ml (SD ±108.4, p < 0.001). Anti-S antibody levels were sustained at 36-63 days post-booster across all groups. However only IO patients had a sustained immune response to vaccination, with median Anti-S titres level of >250 U/ml and a significant drop was seen in the CHT group (median Anti-S level 138, p < 0.05). Conclusions: Anti-S titres increase following vaccination in all 3 groups but remain most sustained in the IO group at 36-63 days post-vaccination. Chemotherapy and other targeted therapy treated patients may benefit from early COVID-19 vaccine boosters, compared to patients receiving immune therapy.