ABSTRACT
Introduction: People with multiple sclerosis (MS) are vulnerable to severe outcomes from COVID-19 infection and were prioritised for COVID-19 vaccination in Australia from March 2021. Despite this, vaccine hesitancy may hinder optimal vaccination uptake. Aim(s): This study explored COVID-19 vaccine uptake, beliefs, and hesitancy in people with MS. Method(s): People with MS receiving MS healthcare management at two Australian health services were invited to participate in an online survey, between September and October 2021. The survey collected sociodemographic and disease-specific characteristics, as well as vaccine status, vaccine hesitancy and beliefs towards COVID-19 vaccination using validated scales: the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six. Regression analyses were used. Result(s): Of the 281 people with MS (mean age 47.7 [SD 12.8] years;75.8% females) who participated, 82.9% had received >=1 COVID-19 vaccine dose. There were 17.1% who were unvaccinated, of which 51.2% reported they were likely to accept vaccination in future. Younger participants were less likely to be vaccinated (B[SE] 0.05[0.01]), as were those within 1-5 years disease duration (B[SE] -1.17[0.39]), all p<0.05. Compared to vaccinated participants, unvaccinated participants reported higher vaccine hesitancy (B[SE] 9.66 [0.72]), greater negative attitudes around vaccine complacency and confidence (B[SE] 13.36[1.40]), greater complacency toward COVID-19 in the context of MS (B[SE] 1.80[0.50]), and higher MS interaction concerns (B[SE] 3.38[0.52]), all p<0.001. Participants who reported no impact of MS on their daily life had lower concerns about the impact of COVID-19 vaccination on MS treatments or disease progression, compared with those reporting MS impacted their daily life all of the time (B[SE] -2.00[0.66], p=0.002). Conclusion(s): General and disease-specific COVID-19 vaccine concerns may influence uptake for people with MS. Understanding the reasons for hesitancy and how they correlate with MS disease and treatment interaction concerns may inform tailored education messages at individual and population levels that addresses these concerns, particularly for ongoing booster doses.
ABSTRACT
Aims: Vaccination uptake is the principal focus of the world-wide response to the COVID-19 pandemic. Vaccine hesitancy remains a critical issue. Our aim was to ascertain rates and reasons for vaccine hesitancy in people with breast cancer (BC) in Australia. Method(s): Between June and October 2021, an anonymous online survey was conducted among people with solid organ cancer treated at nine Australian treatment centres. Data collected included demographics and clinical characteristics. Vaccine hesitancy and related beliefs were assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale (OCVCCS), and the Disease Influenced Vaccine Acceptance Scale-Six. Descriptive statistics, chi-squared and linear regression were used. Results for the BC subgroup are reported. Result(s): The BC subgroup (N = 986, mean age 58.4 years, 99% female) comprised 36.6% of the responses in the solid cancer population (N = 2691). Most (76%) were treated at metropolitan centres and 64% were receiving ongoing treatment. Early BC was more commonly reported than metastatic BC (77% vs. 23%). Overall, 82% self-reported at least one COVID-19 vaccine dose. Unvaccinated participants were more likely to diagnosed with BC for a shorter time (<2 years (22.1%) vs >=2 years (14.5%), p = 0.003). Participants with metastatic BC were more likely to be unvaccinated and report greater disease-related vaccine concerns and hesitancy, when compared with participants with early BC (all p < 0.05). When compared with participants with all other solid cancers, participants with BC reported more negative attitudes towards COVID-19 vaccine side-effects (OCVCCS Side-Effects subscale mean scores: 5.19 (SD 1.91) vs. 5.46 (SD 1.82), p < 0.001). Conclusion(s):Despite a relatively high rate of self-reported vaccination, people with BC reported lower vaccine confidence when compared with all other solid cancers. A better understanding of these inequalities, and strategies to address vaccine confidence in people with BC, particularly those with metastatic BC, should be developed.
ABSTRACT
Aims: People with haematological malignancies (HM) are at increased risk of severeCOVID-19 infection and death due to underlying immune deficiency and impaired vaccine responses. FromMarch 2021,COVID- 19 vaccination was offered to patients with HM, as part of the Australian COVID-19 vaccination rollout program. This study sought to ascertain whether vaccine hesitancy was a barrier to optimal vaccine uptake and explored the attitudes of people with HM towards COVID-19 vaccination. Method(s): Between June and October 2021, an online survey was distributed to adults with HM at nine Australian health services. The survey collected sociodemographic and clinical characteristics, and attitudes towards COVID-19 and COVID-19 vaccination using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, and the Disease Influenced Vaccine Acceptance Scale-Six (DIVAS-6). Result(s): Of the 869 survey participants (mean age 64.2 years, 43.6% female), 741 (85.3%) reported receiving at least oneCOVID-19 vaccine dose. Unvaccinated status was significantly associated with younger age, English as a non-dominant language, and shorter duration since diagnosis. Participants who were female or spoke English as their nondominant language reported more negative attitudes towards vaccine side-effects. Unvaccinated participants were more likely to report greater concerns about the vaccine impacting on their HM and treatment (DIVAS-6 Vaccine Vulnerability subscale score: B (SE) = 2.71 (0.35), p < 0.001). They were also more likely to report greater vaccine complacency (DIVAS-6 Disease Complacency subscale score: B (SE) = 1.79 (0.28), p < 0.001). Conclusion(s): People with HM reported high vaccine uptake, however, participantswho are recently diagnosed with malignancy, female, younger age or for whom English is a non-dominant language may benefit from targeted education strategies to address their vaccine concerns. Clinicians are well-positioned to address their patients' specific vaccine concerns and support the decision-making process, particularly with the need for COVID-19 vaccine boosters.
ABSTRACT
Aims: Peoplewith cancer have increased morbidity and mortality associated with COVID-19 infection. The influence of a person's cancer diagnosis on COVID-19 vaccine uptake is not well understood. We undertook an in-depth exploration of factors influencing COVID-19 vaccine uptake among those with cancer. Method(s): Adults with cancer were recruited from nine Australian health services to undertake a cross-sectional online survey (June to October, 2021) covering COVID-19 vaccine uptake, vaccine hesitancy, confidence and complacency, and disease-related decision-making impact. Free-text responses were invited regarding thoughts and feelings about the interaction between the participant's cancer,COVID-19, and vaccination. Qualitative thematic analysiswas undertaken using an iterative process with representative verbatim quotes to illustrate the themes. Result(s): Of 3560 survey responses, 1248 (35.1%, mean age 62.7 (SD 11.8) years, 58.5% female) provided free-text comments for qualitative analysis. Participants who provided free-text comments were significantly less likely to have received a COVID-19 vaccination, compared to those who did not comment (31.4% and 68.6%, respectively). Five key themes were identified from qualitative analysis: (1) having a chronic illness heightened both perceived susceptibility to and severity ofCOVID-19;(2) disruption of cancer managementwas a significant perceived barrier to vaccination;(3) paucity of evidence on COVID-19 vaccine safety (for people with their cancer) compromised the perceived benefits;(4) fear of the unknown greatly reduced motivation to vaccine uptake and (5) many were left confused about COVID-19 and the vaccine. Conclusion(s): This analysis highlights the additional layer of complexity related to COVID-19 vaccination decision-making in people with cancer. An appreciation of higher susceptibility to severe COVID-19 outcomes is balanced against uncertain impact of the vaccine on disease progression and management. Clinician consultation that can address individualized concerns related to the person's cancer and treatments is important to alleviate concerns and maximize COVID-19 vaccine uptake in people with cancer.
ABSTRACT
Background: Adults and childrenwith cancer are susceptible to severe SARS-CoV-2 disease. Vaccination is protective;data beyond initial response and regarding effect of booster doses are lacking in cancer patients. Method(s): The SerOzNET study assesses SARS-CoV-2 vaccine response in haematological and solid cancer patients aged 5 and older. Patients are recruited pre dose 1 and receive standard BNT162b2 (Pfizer) or ChadOx1-S (AstraZeneca) vaccine. Blood is taken at baseline and after each dose. Neutralizing antibody (NAb) titre, absolute antibody titre (Abbott), T cell response (IFN-gamma) and epigenetics are analysed. Clinical data are collected. Patients are followed for up to 3 months beyond dose 5. Result(s): 105 children (64% haem, 36% solid cancers) and 399 adults (35% haem, 65% solid cancers) were enrolled. In adults, NAb response rate increased after dose 3 (Post 2: 40% haem, 87%solid;Post 3:70%haem,97%solid). Post dose 2, predictors of nonresponse were ChadOx1-S vaccine (OR 3 p = .02), haem cancer (OR 14 p < .001), ECOG >=1 (OR 2.6 p = .01) and steroids (OR 5 p = .01). Post dose 3, only haem cancer predicted non-response (OR 16). IFN-gamma response is available for a subset, detectable in 41/90 (46%) postdose 1, 78/96 (81%) post-dose 2 and 35/42 (83%) post-dose 3;without significant difference between haem and solid cancer. In children, NAb response post dose 2 is available for 50 patients. Response rate between haem (19/31, 61%) and solid patients (13/19, 68%) was similar. IFN-gamma response post dose 2 was also similar: (14/22, 63%) vs solid patients (12/14, 85%) (p = .25). Analysis is ongoing. Conclusion(s): Response to two doses of SARS-CoV-2 vaccine is suboptimal in patients with cancer. The third priming dose is integral, with significantly higher response rates observed. 36% of children did not develop neutralizing antibodies post dose 2;subsequent doses are likely to be important for young patients.
ABSTRACT
Background: COVID-19 disease is more severe in unvaccinated cancer patients compared with the general population. There is limited data regarding clinical efficacy of vaccination in these patients. Method(s): SerOzNET (ACTRN12621001004853) is a prospective observational cohort study of adults and children with cancer receiving COVID-19 vaccination. The primary endpoint is serological response. An important secondary endpoint is outcome of COVID-19 infection after vaccination. We report self- and clinician reported COVID-19 infections. Result(s): Of 395 adults (20 years +), 74 (19%) reported COVID-19 infection over mean duration on study of 259 days. 71 (97%) had received 2 vaccine doses, 51 (69%) received 3+ doses. 21 (28%) had antiviral treatment. 62 (84%) had symptoms, 7 (9%) required hospitalisation, 0 required ICU admission or died due to COVID-19. Of 113 children/adolescents (5-19 years), 31 (27%) reported COVID-19 infection over mean duration on study of 215 days. 28 (90%) had received 2 vaccination doses, and 12 (39%) received 3+ doses. 23 (74%) had symptoms, 8 (25%) required hospitalisation, 2 (6%) had antiviral therapy, 0 required ICU admission or died due to COVID-19. Pediatric pts with COVID-19 infection had increased risk of hospitalisation compared with adults (p=0.03). Hematological cancer pts had non-significant but numerically higher rates of hospitalisation (Table). [Formula presented] Conclusion(s): Pts with cancer are likely to be exposed to COVID-19, with infection rates similar to the wider population. Vaccination appears to protect against ICU admission in cancer patients. However, 9% of adults and 25% of children with cancer required hospitalisation for COVID-19, demonstrating increased severity of symptoms compared to the general population. Higher rates of infection and hospitalisation in pediatric pts may be partly attributable to the lower proportion of children who had received a 3rd vaccination dose at the time of infection. Clinical trial identification: ACTRN12621001004853. Legal entity responsible for the study: Monash Health. Funding(s): Cancer Australia (Australian Federal Government) Victorian Cancer Agency (Victorian State Government, Australia) Leukaemia Foundation (Foundation, Australia). Disclosure: All authors have declared no conflicts of interest. Copyright © 2022
ABSTRACT
Background: There is limited published data regarding safety and toxicity of Sars-CoV-2 vaccination in patients with cancer. This may contribute to vaccine hesitancy amongst some members of this vulnerable cohort (Nguyen 2022). Methods: SerOzNET (ACTRN12621001004853) is a large prospective cohort study of adults and children with cancer undergoing Sars-CoV-2 vaccination. Participants undertake surveys by text message link sent to their mobile phone, or on an iPad provided in clinic. A validated hesitancy survey is undertaken at enrolment (Oxford COVID-19 Vaccine Confidence and Complacency Scale), and prior to the 3rd vaccine dose. For children, a parental survey is also collected. Quality of life is assessed with serial EORTC QLQ-C30 (adults) or PedsQL (children, self- and parentreport) at baseline and serially throughout the study. Patient- reported vaccine toxicity is assessed by patient-reported CTCAE items for common vaccine related AEs and patient-reported impact of vaccination on cancer treatment (delays, hospitalisations). Medically ascertained vaccine toxicity is assessed by study investigators one month after the 3rd vaccination dose. Results: Five hundred and four participants have been enrolled (403 adults (80%) and 101 children (20%)). Hesitancy: At baseline, 351 adults (88%) and 56 children (55%) responded. The adult cohort was predominantly female (67.2%) with an average age of 53.8 years. Preliminary analysis showed similar levels of vaccination concerns between baseline (mean score = 18.4, SD = 5.1) and follow-up pre-3rd dose (mean score = 17.9, SD = 5.7) in adults. We will present results regarding whether self-reported COVID-19 vaccine toxicity after the first dose was related to change in hesitancy scores at follow-up, which may have implications for COVID-19 vaccine booster willingness. Patient toxicity surveys have been returned post dose 1 for 445/497 (91%), post dose 2 for 417/457 (91%) and post dose 3 for 280/334 (84%). Incidence of any AEs was high (77-100% depending on age and dose), however the incidence of severe AEs (patient reported) was low (0-10% depending on age and dose). Interruptions to cancer treatment after vaccination were uncommon (2-12%). Pain at the injection site was the most commonly reported AE for all ages and doses. Hospital admissions (any reason) were reported post dose 1 in 4/15 children aged 5-12, but were uncommon in older adolescents and adults. The most common systemic adverse effect was rigors in children 5-12, while adolescents and adults reported fatigue most frequently. Quality of life analysis is ongoing and will be presented at the meeting. Conclusions: It is feasible to collect detailed toxicity and quality of life data in a large cohort of cancer patients receiving COVID-19 vaccinations. Data to date are reassuring that severe adverse events and interruptions to cancer therapy are uncommon.
ABSTRACT
Background: COVID-19 infection has poor outcomes for patients (pts) with cancer. Understanding vaccine response as a correlate of protection from severe infection is essential to advise pts regarding protective behaviours and optimal vaccine schedule. This Australian cohort is unique due to low rates of COVID-19 exposure at study entry (July-November 2021). and use of a 3 dose schedule. Pts initially received 2 doses of either BNT162b2 (Pf) at a 3 week interval, or ChadOx1-S (AZ) at a 6 week interval, all then received a 3rd dose, either mRNA-1273 (Mod) or Pf after 2-4 months, and finally a 4th dose at an interval of a further 3 months, for a subset. Methods: SerOzNET (ACTRN12621001004853) has enrolled pts with solid and haematological (haem) cancers prior to initial vaccination. Serial blood samples were processed for serum, PBMC and PMN at timepoints: 0, then 3-4 weeks post dose 1 then 2 then 3 then 4 (where administered). We report here neutralizing antibodies (nAb) against wild type (wt) and delta and omicron variants of concern (VOC);quantitative S-protein IgG antibody (Abbott);Tcell correlates measured by levels of interferon-g (IFN g), tumour necrosis factor-a, interleukins (IL-) 2/ 4/5/13;and epigenetic profiling of T cells. Results: The cohort consists of 401 pts with median age 58 (range 18-85);59% female;128 (32%) haem cancers. 377 (94%) are on current or recent (< 12 months) systemic therapy: 162 (43%) chemotherapy, 62 (16%) immunotherapy, 40 (10%) combined chemo/immunotherapy, 113 (29%) hormonal or targeted therapy. 42 (10%) received anti-CD20 therapy < 12 months, 6 (1.4%) had allogeneic stem cell transplant. NAb levels against wt are available for 256 pts post dose 1, 245 pts post dose 2 and 159 pts post dose 3 (will be updated). Response rates post dose were respectively 27%, 77% and 88%. Pts with haem cancer were less likely to respond to vaccination at any time compared to pts with solid cancer (p < 0.001, chi-squared test). After 3 doses, 3.8% of pts with solid cancer and 27.8% with haem cancer lacked NAb. NAb results to VOC delta are available for 92 pts post dose 2: 25/92 (27%) were negative, compared with a non-response rate to wt of 15% at same time in same pts. IFN-γ-Spike response was detectable in 18/31 (58%) and 24/30 (80%) pts post dose 1 and 2 respectively. 101 pts to date have received a 4th dose;data will be available at the meeting, as will epigenetic profiles and detailed clinicopathological correlations. Conclusions: This interim analysis shows that a significant proportion of pts with haem cancers (27.8%) lack protective Sars-CoV-2 antibodies following 3 vaccinations, whereas only 3.8% of solid cancer pts lack detectable response. Results from other B and T cell parameters may also be important in identifying pts less well protected by vaccination. Follow up is ongoing, response rate post 4th dose will be presented at the meeting.
ABSTRACT
Background: Defining cancer and treatment-related factors which influence protection against COVID-19 following vaccination are important given the worse outcomes following infection in this group. Sophisticated and detailed studies which go beyond a single measure are required particularly with correlation to multiple disease and treatment factors. This study cohort is unique due to (a) very low prior COVID-19 infection at time of sampling (July-Nov 2021), (b) vaccines studied were BNT162b2 (Pf) given 3 weeks apart or ChAdOx1 (AZ) spaced 12 weeks (dose 1, 2) (c) most participants then received a third dose 2 months later (heterologous for AZ). Methods: SerOzNET (ACTRN12621001004853) enrols Australian blood and solid cancer patients prior to vaccination, with serial blood analyses and qualitative measures. We measured neutralizing antibodies (nAb) against SARS-CoV-2 wild type (wt) and variants of concern delta and omicron, quantitative S-protein IgG antibody level (Abbott), and T-cell correlates (interferon-g, tumour necrosis factor-a, interleukins 2/4/5/13) and epigenetic profiling at baseline and 3-4 weeks post dose 1, 2 +/- 3.Results: 379 participants were included, median age 58 years (IQR 47-66) and 60% female. 30% participants had hematological malignancies with the remainder solid organ cancers. 90% patients were on current systemic cancer treatment (most commonly chemotherapy in 41%, chemoimmunotherapy or immunotherapy in 20%). In 331 patients where treatment intent was recorded, 47% was palliative. Only one patient had known prior COVID-19 infection. Of the initial 94 participants who received Pf vaccination, median (IQR) neutralizing antibody titre 4 weeks following dose 2 was 80 (40-160) for SARS-CoV-2 wt and 40 (0-80) for delta variant. Conclusion: Neutralizing antibody titres in this Australian cancer population following Pf vaccination appear lower than those reported elsewhere such as CAPTURE study (Fendler et al, 2021), possibly related to shorter interdose interval. Preliminary data highlights low nAb titres as expected in haematology patients but also in some cases with treatment not traditionally associated with immunosuppression such as hormonal therapy. These results will be updated in February 2022 with third dose, AZ and omicron variant data.
ABSTRACT
Introduction People with cancer are particularly vulnerable to COVID-19 and have been prioritised in vaccination programs. This group has reported concerns regarding the interactions between vaccines, cancer and anti-cancer treatments. We explored vaccine hesitancy in the disease-specific context of cancer Methods An online survey was conducted in Australia from June to October 2021. We developed a six-item scale assessing vaccine concerns in the context of chronic disease (Disease Influenced Vaccine Acceptance Scale DIVAS-6). Results There were 2691 evaluable responses;59% female, 71% from metropolitan areas, 36% with metastatic disease and 56% on current anti-cancer treatment. Commonest cancer types included breast 36.6%, genitourinary 18.6% and gastrointestinal 18%. Self-reported vaccine uptake was 80%. Overall, 57% agreed with the statement 'cancer makes me more worried about being infected with COVID-19.' Their doctor's recommendation regarding the vaccine was considered important by 79% of participants. 67% agreed with the statement that 'cancer means having the vaccine is more important.' This was different between vaccinated and unvaccinated participants (72% vs 46%). Unvaccinated participants had more concerns regarding vaccine efficacy (60% vs 34%), side effects (72% vs 29%) and interactions with anticancer treatment (53% vs 18%). Conclusions People with cancer have disease-specific concerns regarding COVID-19 vaccines. Use of DIVAS-6 can guide communication in this medically vulnerable population.
ABSTRACT
Introduction Despite people with underlying comorbidities being particularly vulnerable to poor outcomes from SARS-CoV-2 infection, vaccine hesitancy remains problematic. There are no scales that measure disease or treatment-related vaccine concerns. Methods We developed a six-item scale assessing disease-related COVID-19 vaccine attitudes and concerns (The Disease Influenced COVID-19 Vaccine Acceptance Scale: DIVAS-6). A survey incorporating the DIVAS-6 was completed by 4683 participants with severe and/or chronic illness (3560 cancer;842 diabetes;281 multiple sclerosis). The survey included the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale, demographic, diseaserelated and vaccination status questions. Results Six items were loaded onto two factors, disease complacency and disease-related vaccine vulnerability. Cronbach's alpha was 0.73 and 0.85 respectively. Measurement invariance analysis showed the two factors displayed psychometric equivalence across the patient groups. Each factor significantly correlated with the two Oxford COVID-19 Vaccine scales, showing convergent validity. The summary score showed good-to-excellent vaccination status discriminative ability (95% CI .77-.80). Conclusions This is the first validated scale measuring disease-related COVID-19 vaccine attitudes and concerns and should assist with guiding information delivery about COVID-19 vaccination in medically vulnerable populations.
ABSTRACT
Introduction Limited data exist regarding safety of COVID19 vaccinations for patients with cancer. Methods SerOzNET (ACTRN12621001004853) is a large prospective study of adults and children with cancer undergoing Sars-CoV-2 vaccination. Participants undertake a validated hesitancy survey at enrolment (Oxford COVID-19 Vaccine Confidence and Complacency Scale) and prior to the 3rd vaccine dose. Quality of life is assessed with serial EORTC QLQ-C30 (adults) or PedsQL (children). Patient- reported vaccine toxicity is assessed by patient-reported CTCAE items for common vaccine related AEs and patient-reported impact of vaccination on cancer treatment . Medically ascertained vaccine toxicity is assessed by study investigators one month after the 3rd vaccination dose. Results Five hundred and four participants have been enrolled (403 adults (80%) and 101 children (20%)). Baseline hesitancy surveys have been completed by 349 adults (87%), 58 parents (57%) and 51/86 eligible children (59%). Patient toxicity surveys have been returned post dose 1 for 445 (88%), post dose 2 for 417 (83%) and post dose 3 for 280 (56%). Incidence of any AEs was high (77-100% depending on age and dose), however the incidence of severe AEs (patient reported) was low (0-10% depending on age and dose). Interruptions to cancer treatment after vaccination were uncommon (2-12%). Conclusions Data to date are reassuring that severe adverse events and interruptions to cancer therapy post COVID19 vaccination are uncommon.
ABSTRACT
Introduction People with blood cancers are prioritised to receive COVID-19 vaccination. However, it is unclear how prevalent vaccine hesitancy is in this group. This analysis investigated vaccine uptake and vaccine hesitancy in people with blood cancers in Australia. Methods An online survey was conducted at nine health services in Australia from June to October 2021. Participant demographics and vaccination status were recorded. Vaccine hesitancy was assessed using the Oxford COVID-19 Vaccine Hesitancy Scale (OHS). Regression was used to examine whether clinico-demographic factors predicted the OHS score and vaccination status. Results Of the 869 participants, the mean age was 64.2 years, and 43.6% (n = 379) were female. A high proportion of participants had received at least one COVID-19 vaccine dose (85.3%, n = 741). Increasing age, speaking English as a first language, attending a regional health service, longer time since diagnosis and not currently receiving treatment were associated with being vaccinated. Participants who reported higher vaccine hesitancy were younger in age, more likely to have vocational qualifications and speak English as a second language. Conclusions There is a high rate of vaccination uptake in patients with blood cancers. However, younger patients and patients from culturally and linguistically diverse backgrounds appear to have lower vaccination uptake rates and higher levels of vaccine hesitancy. Tailored counselling may reduce the risk of adverse events due to COVID-19 infection.
ABSTRACT
Background The COVID-19 pandemic has necessitated a restructuring of cancer care due to resourcing demands and revised risk-benefit considerations which relate the risks of cancer progression with the risks of COVID-19 related morbidity and mortality. Specific treatment adjustments for individual patients have not been widely reported. The impact of treatment changes on the outcome of cancer patients have also not been well documented. We report the experience of a large Australian metropolitan multisite cancer service that undertook proactive review of systemic anti-cancer therapy (SACT) of all patients in response to the pandemic. The aim was to re-balance the risks and benefits of current treatment strategies in light of the pandemic. Method From March-April 2020, all current SACT orders (excluding those related to clinical trials) were reviewed by an independent team of clinicians. Patients on curative therapy, or with large perceived benefit were reviewed but not included in further processing. For all other SACT orders, a documented recommendation regarding planned treatment was sent to the patient's individual clinician for consideration. A categorical assessment of the recommendations is presented. Results 570 SACT orders were reviewed, pertaining to 317 patients. 731 individual recommendations were made. The cohort consisted of 130 males and 187 females, with a median age of 62 years. Treatment was undertaken with curative intent in 38% of patients, while 62% of patients were treated with palliative intent. Distribution by tumour types was typical of epidemiology and casemix of a metropolitan oncology service. The most frequent recommendations made by the independent review team were: no change (23%), change in formulation of same drug (9%), shorten duration of treatment (9%), treatment break (8%), re-evaluate benefit of current treatment (8%), treatment cessation (7%), and referral for home-based treatment (6%). Overall, 71% of recommendations of the review team were accepted by the patient's individual clinician. A variation to recommendations suggested by the review team was implemented for 8% of SACT orders. Recommendations which were not implemented were mostly initiated by the patient's individual clinician (70%), while 14% were due to patient choice. Conclusion This is the only dataset known to date of the impact of COVID-19 on adjustments of SACT for cancer patients at the start of the pandemic in Australia, and provides key insights into discrete adjustments made for cancer patients. The majority of patients underwent modifications in their cancer therapy made in the context of competing risks to their health posed by COVID-19.
ABSTRACT
Background: People with cancer are at higher risk of serious illness and death from COVID-19 infection. We investigated the differences in COVID-19 vaccine uptake and attitudes in people with various solid organ and hematological malignancies. Methods: An online survey of adult patients with cancer attending eight health services across four states in Australia, was conducted from June to September 2021. Demographics, cancer history and vaccination status were recorded. Only completed surveys were analysed. Variables were compared with chi-squared and multivariable analysis using logistic regression. Vaccine hesitancy was assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford Vaccine Confidence and Complacency Scale, and the Monash Disease Vaccine Acceptance Scale. T-test analysis was used to examine relationships between the scales and groups. Results: There were 2997 evaluable responses;53.2% female, 61.8% from metropolitan areas, 27.5% with metastatic solid organ disease and 50.6% on current anti-cancer treatment. Patients with GI cancers comprised 13.5% (n = 405), compared with hematological 28.4%, breast 24.6%, genitourinary 14.1% and other cancer types 19.4%. Vaccination rates were significantly lower for respondents with GI cancers compared to other cancer types (71.6% v 79.3%;p< 0.001). Significant differences in the GI cancer population compared to all others were: more males (p < 0.001), lower level of education (p= 0.001), fewer reporting English as first language (p = 0.02) and shorter time since cancer diagnosis (p < 0.001). These remainedsignificant after logistic regression. Among GI cancer respondents, factors associated with being vaccinated compared to unvaccinated included: older age (p < 0.001), higher education level (p = 0.03) and English as first language (p = 0.01). There was no significant difference in the scales measuring vaccine hesitancy, confidence and complacency, for the GI cancer population compared to other cancers. As expected, there were significant differences in all scales comparing vaccinated to unvaccinated respondents with GI cancers. Conclusions: In our large, contemporary survey, Australians with GI cancers report lower COVID19 vaccine uptake compared with patients with other cancer types. We identified demographic and disease related characteristics that contribute to these differences. Interventions and targeted communication are required for people with GI cancers to maximise vaccination uptake in this medically vulnerable group.
ABSTRACT
Background: The COSA Teletrial framework was piloted in 2017 and recently adopted as the national principles for teletrials (1). The Monash-Gippsland (MG) Teletrial project was initiated in 2019, funded by the Victorian Cancer Agency, aiming to increase clinical trials access for regional patients. The project was impacted by the COVID-19 pandemic lockdowns and recommenced in April 2021. Key learnings from the project are presented here. Aims: To report on the barriers and enablers found within the MG Teletrial project. Methods : A review of project meeting minutes was undertaken alongside informal discussions with participants and key stakeholders. Challenges affecting Latrobe Regional Hospital (LRH) in adopting open trials at Monash Health (MH) were itemised below. Results : Governance processes are lengthy and complex despite the adoption of COSA model by both health services with existing central ethics approval. Infrastructure and partnerships: Outsourcing of LRH pathology and radiology to private providers requires additional contracting and costs. Lack of cancer prescribing software at MH and common Electronic Medical Record pose difficulties with source documents management. The funding from collaborative partnerships allows LRH to successfully join the Regional Trials with critical research resources. Regular communications via teleconferencing has greatly facilitated progress. Staffing: The nature of appointments with fractional oncologist at LRH present challenges in clinical trials development. Access to the project funded full-timeMH Teletrial fellow working alongside the Trials Hub funded consultant and LRH study coordinator was essential. Logistics: Staff exchanges for training have been repeatedly thwarted by sudden lockdowns. Technical issues including a major malware attack on LRH email significantly impacted communications for months in 2019. Conclusions : The establishment of Teletrial at a greenfield site is complex and requires significant, longer term infrastructure support, including human and non-human resources.