ABSTRACT
Background: Allocation of resources towards the treatment of patients with Sars-CoV-2 may affect the quality of care of cancer patients. Medical societies have issued statements on priority setting in cancer care in the wake of the Sars-CoV-2 outbreak (1). However, there is a lack of empirical data on how resources are prioritized and which criteria these decisions are mainly based on by those involved in decision making. Method(s): 15 semi-structured interviews were conducted with oncologists in Germany between February and July 2021. Transcripts are analysed following principles of qualitative content analysis based on Kuckartz (2). Result(s): According to preliminary analysis three main topics emerge: 1. Experiences with scarcity regarding specific diagnostic procedures and treatment 2. Effects of priority setting on coping and psycho-social support 3. Criteria for priority setting and decisions on deviations of standards of care. Reported criteria could be further distinguished into three subcategories: a) criteria related to the health condition of the patient (e.g. diagnosis, urgency of the procedure), b) pandemic-related organizational issues (e.g. hygiene requirements), c) systemic aspects not related to the pandemic (e.g. priorisation of well-paid interventions). Discussion(s): Our data indicate that pandemic-related organizational issues influenced priority setting, which needs to be addressed. Furthermore, interviewees agree in posteriorising palliative and follow up care, which needs to be discussed regarding possible negative side effects. Conclusion(s): Data will be interpreted focussing on the possible contribution to an informed guidance for priority setting regarding cancer care in times of pandemic.
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Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Method(s): The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hamatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Result(s): The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusion(s): Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population.
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Purpose: CRC prognosis has improved through guideline-based care. COVID-19 pandemic lead to re-allocation of health care resources potentially putting sections of cancer care at a disadvantage. We compared enrollment and clinical subgroups into our registry before and during the first (fw) and second wave (sw) of the COVID-19 pandemic. Method(s): CPP assembles clinical, histo-pathological and molecular data of pts. with resected CRC. Prospectively enrolled pts. during the fw (4-6/2020) and the sw (10-12/2020) were analyzed, focusing on total numbers, age and sex compared to corresponding pre-pandemic intervals of 2019. Due to site expansion (70 to 161) of CPP we calculated quarterly counts per site and in relation to total enrollment. Result(s): 2221 pts. enrolled into CPP during 2019 and 2020 were included, 47 % female (F) /53 % male (M). Mean age in 2019 was 71.9 years (y) vs 71.6 y in 2020. Mean number of pts. enrolled in CPP with primary diagnosis of CRC per site 2019/2020: fw 8,5/6.9 and sw 6.2/5.8. Evaluation for age showed: 2019%/2020% fw >70 y was 52.5/53.5 and <=70 y 47.5/ 46.5 respectively;for the sw > 70 y was 45.6/ 53.5;<=70 y 54.4/46.5. M vs F in fw 2019%/2020% M 50.5/61;F 49.5/39;in sw M 57.6/56;F 42.4/44. Discussion(s): CPP did not detect substantial differences in total counts of enrolled patients or distribution of age and sex. We detected a slight dip in enrollment together with a small shift toward men in fw as well as to elderly pts. in sw. Enrollment of pts. into registries seems to be feasible even in pandemic situation. Potentially, a possible data bias as preference of registry enrollment over randomized controlled trials. Conclusion(s): Real world data from CPP must be complemented by additional data for comprehensive assessment of colon cancer care and will be complemented for final data presentation in 2022 with data collected during the third and omicron wave.
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Background: The focus on treatment of COVID-19 patients during the Sars-CoV-2 outbreak, lockdown measures and individuals' anxiety regarding potential infection when seeing a healthcare provider have likely implications on the extent of diagnosis and quality of treatment of non-COVID-19 patients. This hypothesis has been evaluated exemplarily for the early detection, diagnosis and treatment of colorectal cancer in Saxony within the framework of the CancerCOVID project. Method(s): The situation during 2020 was compared with the situation before the Sars-CoV-2 pandemic (i.e., 2019). The evaluation is based on pseudonymised routine statutory health insurance data for Saxony including more than 50% of the population. Result(s): A main finding was the drop in the number of diagnosis of new colorectal cancer cases between 2019 and 2020 (i.e., 1797 versus 1352). Furthermore, the per-patient rate of surgeries for incident colorectal cancer cases increased slightly (2.4 to 2.5), as did the rate of intravenous (IV) cytostatics administration (2.2 to 2.4) and radiation therapy (1.1 to 1.4). The per-patient rate of surgeries for prevalent colorectal cancer patients remained constant (0.3), as did the rate of radiation therapy (0.2). However, the per-patient rate of IV cytostatics for prevalent colorectal cancer patients decreased from 1.7 to 1.4. The results of analyses pertaining to cancer screenings and mortality are available as well. Discussion(s): It is likely that reduced screenings and fewer contacts with healthcare providers due to the pandemic led to the drop in new diagnosis. The reasons for the small numeric increases in the rates of procedures per incident patient versus the largely flat trajectory in the rate of health care services for prevalent cases require further exploration. Conclusion(s): COVID-19 was associated with changes in the provision of health care especially for cancer patients, which should be taken into consideration in the resource planning when preparing for another pandemic or public health emergency.
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Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Methods: The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hämatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Results: The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusions: Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population. Legal entity responsible for the study: The authors. Funding: Bundesministerium für Bildung und Forschung;Germany Förderkennzeichen: 01KI20521A-C. Disclosure: A. Reinacher-Schick: Financial Interests, Personal, Invited Speaker: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, MCI Group, AstraZeneca;Financial Interests, Personal, Advisory Board: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, AstraZeneca, Pierre Fabre;Financial Interests, Personal, Other, Travel support: Roche;Financial Interests, Institutional, Research Grant: BNT, Roche, Ipsen. O. Schoffer: Financial Interests, Personal, Advisory Role: Novartis. A. Kraeft: Financial Interests, Personal, Writing Engagements: Astra. A. Tannapfel: Financial Interests, Institutional, Research Grant: Roche, Biontech. J. Schmitt: Financial Interests, Institutional, Funding: Sanofi, Pfizer, Novartis. All other authors have declared no conflicts of interest.
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Background: Cancer patients (pts) were among the first to receive vaccination against SARS-CoV-2 (vac). However, their attitude towards as well as experience with vac remain unclear. Methods: Between 04-11/2021 cancer pts at our university cancer center completed a baseline (BL) and follow-up (FU) questionnaire (Q) containing multiple choice questions and ten eleven-level Likert items ranging from 1 (“totally disagree”) to 11 (“totally agree”). Data was analyzed using Student's t-test or Chi-square test. Results: 219 pts (43% female) completed BLQ (110 FUQ). Mean age was 64 (24-87) years. 82% had solid tumors, 93% were on active therapy (80% chemotherapy). 4% had history of COVID-19. 78% had already received at least one vac at BL, mainly BNT162b2 (91%) or ChAdOx1-S (8%). Only 1% refused vac. Most pts completely agreed to “definitely get vaccinated” (82%) and completely disagreed with “vac is dispensable due to COVID-19 being no serious threat” (82%;more dissent among men, p = 0.037) or “being against vaccination in general” (81%). Self-assessment as member of a risk group (p = 0.03) and fear of COVID-19 (p = 0.002) were more common among women. Every third patient (31%) completely agreed to “being afraid of COVID-19”, every second thinks “SARSCoV-2 infection would be very dangerous” (56%). Only 41% expressed “complete confidence in the vaccine being safe” and 37% “not being afraid of side effects”. Fear of side effects (SE) was more common among women (p = 0.0016), pts with solid tumors (p = 0.05), with GI tumors (p < 0.0001) and below mean age (p = 0.006). The latter expressed less “confidence in the vaccine being safe” (p = 0.0029). At FUQ, most pts (91%) reported their vac to be well tolerated, 44% reported no SE, especially men (p = 0.001) and pts above age average (p = 0.002). Most common SE was local pain at injection site (36%), which was more frequent among women (p = 0.002), younger pts (p = 0.024) and pts with solid tumors (p = 0.04). Other common SE included fatigue (18%) and myalgia (8%). No thromboembolic events occurred. Only 3 pts had their therapy postponed due to SE. Almost all pts felt retrospectively sufficiently informed about vac and possible SE (94%), would have it again (88%) and agree to get it yearly, if recommended (78%). After vac, pts felt safe meeting friends or family (91%) or shopping (62%). Vacation (32%), work (22%), public transport (21%) or sports (19%) were considered less safe (less frequent among men, p < 0.05). Most pts (70%) did not feel that the COVID-19 pandemic negatively influenced their treatment and regarded the hospitals protective measures as adequate (91%). Conclusions: Willingness to get vac is high among cancer pts and vac is well tolerated in this sensitive cohort. However, concerns about vac safety remain an issue. Those as well as gender differences need to be addressed to increase vac rates and tolerability. The present results may help identify pts that benefit from more detailed pre-vac consultation.
ABSTRACT
Background: CRC still is one of the leading causes of cancer related death though prognosis has improved through guideline based management. The COVID-19 pandemic lead to re-allocation of resources subordinating all sections of care for CRC patients. We present data on changes of CRC care during the pandemic from 22 German AIO CC and our high volume Institute of Pathology (pathology). Methods: Data was collected retrospectively comparing the months (mo) of the first wave (fw) (4-6/2020) and second wave (sw) (11-12/2020) of the pandemic with corresponding periods (cp) in 2019 focusing on the number of precancerous (ICD-O/0+2) and malignant (ICD-O/ 3+6) colorectal lesions (CRL) diagnosed by our pathology, the number/stage of primary diagnoses (PD) and the number of surgeries (surg) at AIO CC. There, quality criteria of CRC care were also assessed (number of PD discussed within a multidisciplinary tumor board (tb), received social service (soc)/ psychological (psy) counseling or recruited into a clinical trial). Statistical analysis was performed using students t-test for paired data. Results: Numbers of CRL detected upon histology (row 1-3), number of cases, surg and quality criteria from AIO CC (row 4-9) are displayed in the table. We saw a dip in diagnosed CRL and number of surg (p=0.007) only during fw, whereas PD dipped significantly in both waves. A significant reduction in diagnosis of stage III CRC was detected for 2019 vs. 2020 (p=0.001), not for other stages. Quality criteria showed a significant reduction in clinical trial inclusion, a small dip in soc/psy counseling and persistently high tb presentation. Conclusions: We detected a significant decrease of premalignant lesions and primary cancers during the first year of the pandemic which may impact cancer mortality in the future. Certified German CC provided CRC care with significant reduction in clinical trial inclusion only, suggesting high stability of established certified cancer care infrastructure.
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Introduction: Allocation of health resources towards the treatment of patients with Sars-CoV-2 may affect the quality of care of cancer patients. Several medical societies representing cancer health professionals have issued statements on priority setting in cancer care in the wake of the Sars-CoV-2 outbreak (1, 2). However, there is a lack of empirical data on how resources are prioritized and which criteria these decisions are mainly based on by those involved in decision making. Methods: Qualitative semi-structured interviews are conducted with oncologists in Germany between February and July 2021. Transcripts of interviews are analysed following principles of qualitative content analysis based on Kuckartz (3). Results: According to preliminary analysis of the first seven interviews conducted at the time of submission of this three topics emerge: 1. Experiences with scarcity regarding specific diagnostic procedures and treatment 2. Criteria for priority setting and decisions on deviations of standards of care 3. Effects of priority setting on coping and psycho-social support for patients and relatives. Conclusions: Data will be evaluated focussing on the possible contribution to an empirical and normative informed guidance for priority setting regarding cancer care in times of Sars-CoV-2 outbreak and further contexts. We will present and discuss findings from all interviews, which will be conducted till August 2021. References 1. Deutsche Gesellschaft fur Hamatologie und Onkologie. Coronavirus-Infektion (COVID- 19) bei Patienten mit Blut- und Krebserkrankungen. https://www.onkopedia.com/de/ onkopedia/guidelines/coronavirus-infektion- covid-19-bei-patienten-mit-blut-undkrebserkrankungen/@ guideline/html/index.html 2. Marron JM, Joffe S, Jagsi R et al. Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID19 Pandemic. J Clin Onc. April 28 2020, doi:10.1200/JCO.20.00960 3. Kuckartz, U. (2018). Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstutzung (4th ed.). Beltz Juventa.