ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
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.