COVID-19 vaccine uptake trends in SARS-CoV-2 previously infected cancer patients.

Purpose: Cancer patients are at high risk of developing severe illness from SARS-CoV-2 infection, but risk is lowered with receipt of COVID-19 vaccine. COVID-19 vaccination uptake among previously infected cancer patients may be influenced by an assumption of natural immunity, predicted weak immune response, or concerns about vaccine safety. The objective of this study was to evaluate COVID-19 vaccine uptake trends in cancer patients previously infected with SARS-CoV-2. Materials and Methods: Medical records of 579 sequential cancer patients undergoing active treatment at Levine Cancer Institute who tested positive for COVID-19 between January 2020 and January 2021 were evaluated. Patients who died prior to vaccine eligibility were excluded from the analysis. Demographic, clinical, and COVID-19 related characteristics were analyzed to identify prognostic factors for COVID-19 vaccine uptake as this information could be important for health policy design for future pandemics. Results: Eighty-one patients died prior to the availability of COVID-19 vaccines. The acceptance rate of COVID-19 vaccination among 498 previously infected cancer patients was 54.6%. Of the patients with known vaccination dates, 76.8% received their first vaccine by April 17th, 2021. As of November 30, 2021, 23.7.% of eligible patients were boosted. In univariate models, older age, female sex, higher income, solid tumor cancer type, and hormone therapy were significantly associated with higher vaccine uptake, while Hispanic/Latino ethnicity was significantly associated with lower vaccine uptake. In a multivariable model, age (OR 1.18, 95% CI 1.10-1.28; p < 0.001), female sex (OR 1.80, 95% CI 1.22-2.66; p = 0.003), and higher income (OR 1.11, 95% CI 1.01-1.22; p = 0.032), were predictive of COVID-19 vaccine uptake. Conclusions: Overall, vaccine uptake was low among our cohort of previously infected cancer patients. Older age, female sex, and higher income were the only variables associated with COVID-19 vaccine uptake within this vulnerable patient population.

ADT and COVID-19 - A therapeutic discussion

By way of background, I need to draw on my experience in genitourinary oncology - one of the genes involved in the genesis of prostate cancer is TMPRSS2, a serine protease located on the cell surface, which is involved in several biological functions including cellular invasion by viruses. In addition to the possibility that castration may reduce the risk for COVID-19 infection, Kantoff and his colleagues question whether specific gene targeting of TMPRSS2 may provide protection (that is, without the need for clinical castration) either from COVID-19 infection or perhaps the severity of pulmonary involvement (a major cause of COVID-19related death). In the interregnum, prior to this producing a defined clinical result and/or the introduction of either effective COVID-19 therapies or vaccines, any well-connected reader who wishes to help any national or locoregional leaders who have been captivated by the swirl (absent clear data) surrounding the chloroquine derivatives might offer them this more datadriven option that suggests that ADT may really protect against COVID-19 infection.

The accidental 'stupidpower' - It is what it is

Testing, population size and death rates When thinking about improving survival of the population, I am so irritated by the conflict between the rational majority of physicians and the inhabitants of the White House, a collection of random politicians of conservative bent, and a small group of flat-Earth physicians (apparently led by one who views demons as the purveyors of illness in the land), regarding science and real data. Populations with community participation in the simple strategies of routine masking and social distancing have COVID-19-related death rates vs. population size of less than 10% of the conservative U.S. states and the nation as a whole. Another influential constituency that has abrogated its responsibility is the CDC - having initially lost some of its formerly authoritative credibility in the botched introduction of testing, it has compounded the felony by consistently issuing misinformation, caving into the scientific mumbo-jumbo being quoted by the White House, and reversing sensible decisions whenever someone of influence frowns at them.

Implementation, adherence, and results of systematic SARS-CoV-2 testing for asymptomatic patients treated at a tertiary care regional radiation oncology network.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus is a current pandemic. We initiated a program of systematic SARS-CoV-2 polymerase chain reaction (PCR) testing in all asymptomatic patients receiving radiotherapy (RT) at a large radiation oncology network in the Charlotte, NC metropolitan region and report adherence and results of the testing program. METHODS: Patients undergoing simulation for RT between May 18, 2020 and July 10, 2020 within the Levine Cancer Institute radiation oncology network who were asymptomatic for COVID-19 associated symptoms, without previous positive SARS-CoV-2 testing, and without recent high-risk contacts were included. PCR testing was performed on nasal cavity or nasopharyngeal swab samples. Testing was performed within 2 weeks of RT start (pre-RT) and at least every 4 weeks during RT for patients with prolonged RT courses (intra-RT). An automated task based process using the oncology electronic medical record (EMR) was developed specifically for this purpose. RESULTS: A total of 604 unique patients were included in the cohort. Details on testing workflow and implementation are described herein. Pre-RT PCR testing was performed in 573 (94.9%) patients, of which 4 (0.7%) were positive. The adherence rate to intra-RT testing overall was 91.6%. Four additional patients (0.7%) tested positive during their RT course, of whom 3 were tested due to symptom development and 1 was asymptomatic and identified via systematic testing. A total of 8 (1.3%) patients tested positive overall. There were no known cases of SARS-CoV-2 transmission from infected patients to clinic staff and/or other patients. CONCLUSIONS: We detailed the workflows used to implement systematic SARS-CoV-2 for asymptomatic patients at a large radiation oncology network. Adherence rates for pre-RT and intra-RT testing were high using this process. This information allowed for appropriate delay in initiating RT, minimizing the occurrence of RT treatment interruptions, and no known cases of transmission from infected patients to clinic staff and/or other patients.

6 years at the helm: A Decameron

Since 2014, when we took the helm of HemOnc Today as joint Chief Medical Editors, the overall progress in oncology has been spectacular. The challenges of setting a balance between speed to market and responsible scientific investigation are not new;while not wishing to repeat the fiasco of bone marrow transplantation for breast cancer, we also did not wish to see a delay in potentially life-saving therapies for the hematologic malignancies afforded by the use of chimeric antigen receptor T-cell therapy. In addition to the impact of checkpoint inhibition in the management of locally advanced and metastatic cancers of the kidney, bladder and prostate, a series of novel second-line agents that interfere with the hypothalamic-pituitary-end organ axis have been shown to improve outcomes in metastatic prostate cancer dramatically;in fact, some of these agents appear to be finding a place in adjuvant therapy. Not to be forgotten is the importance of survivorship issues, including the troubling paucity of pretreatment conversations about the impact of treatment on fertility, which we described in "Engaging in conversations about fertility' Of course, there has been dramatic progress in so many domains, and it may be easier to identify areas where the progress has been less substantial - metastatic pancreatic cancer and advanced brain tumors seem to be at the top of that list.

Out of the dark age

The batde of the PD-1/PD-L1 interface - with checkpoint inhibition having application in malignant melanoma and renal cell carcinoma, and now apparently being meaningfully applied in front-line treatment of metastatic bladder cancer, lung cancer and other malignancies - is a real step forward, notwithstanding occasional reports that are too premature for credibility. Powerful randomized trials have shown that second- and third-generation androgen-blocking therapies, when added to the front line, and perhaps as adjuvant therapy, for prostate cancer also seem to have increased survival by periods of months to years (rather than days to weeks). Nobody has jumped onto CAR-T for breast cancer, although cautious and structured early trials are in progress, and perhaps more interestingly in other solid tumors (kidney cancer, melanoma) where the biology of the disease may lend itself to this type of therapy.

Screwing up cancer care

[...]in my own academic work, I have complained about the number of urologists who fail to offer neoadjuvant chemotherapy - which is wellsupported by level-one data - citing insufficient robustness of the patient, while feeling comfortable to complete a radical cystectomy. [...]as reported by Crawford and colleagues, many health insurance companies have set standard operating procedures that do not allow reordering of the medications in a timely fashion, thus interfering with on-time delivery. The problem is much more widespread, and all of us involved in treatment of cancer are only too familiar with the delays created by payers - excessive documentation requirements, small-print rules that delay pre-approvals and approvals, requirements to secure approvals from family practitioners who have become the insurance gatekeepers, and obstructions to complaints and/or litigation.

How many errors to kill a population?

Maintaining power and control is never desirable in a government agency that really doesn't need that authority for its role. * Suggesting that masking is not necessary, when the driver was a fear regarding the absence of available masks. The Italians and Chinese showed the impact of masking and social distancing months ago, so what new fact led to the change in our country? * Deciding that civil rights and the Constitution should preclude a small number of states and cities from enacting social distancing rules, thus putting the rest of the nation at much greater risk. * Vouchsafing ad libitum that chloroquine derivatives probably work and have no potential toxic effects, leading at least to a false sense of security and possible harm. [...]you must attempt to please federal leadership, but be careful not to drop your testing standards so low as to allow test kits that have high false-positive or false-negative rates into our nation, and beware approving drugs that might not work and are potentially quite harmful for patients experiencing this viral explosion.

Management changes for patients with endocrine-related cancers in the COVID-19 pandemic.

Substantial management changes in endocrine-related malignancies have been required as a response to the COVID-19 pandemic, including a draconian reduction in the screening of asymptomatic subjects, delay in planned surgery and radiotherapy for primary tumors deemed to be indolent, and dose reductions and/or delays in initiation of some systemic therapies. An added key factor has been a patient-initiated delay in the presentation because of the fear of viral infection. Patterns of clinical consultation have changed, including a greater level of virtual visits, physical spacing, masking, staffing changes to ensure a COVID-free population and significant changes in patterns of family involvement. While this has occurred to improve safety from COVID-19 infection, the implications for cancer outcomes have not yet been defined. Based on prior epidemics and financial recessions, it is likely that delayed presentation and treatment of high-grade malignancy will be associated with worse cancer outcomes. Cancer patients are also at increased risk from COVID-19 infection compared to the general population. Pandemic management strategies for patients with tumors of breast, prostate, thyroid, parathyroid and adrenal gland are reviewed.