Advance directives among patients with advanced cancer in Mexico

Background: Completion of advance directives can help to ensure consistency with people's preferences at the end of life. However, disparities in access to advance care planning is common among Hispanic population and little is known about their end-of life wishes. Although in Mexico, advance directives were legalized in 2008, only 21% of people know about it. Objective(s): To describe end-of-life wishes among patients with advanced cancer planning in a third level hospital in Mexico City. Method(s): We conducted a cross-sectional analysis of advance directives planning from patients with advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompanamos). Patients with a life expectancy of 6 months or less were invited to complete advance directives (AD). Life expectancy was calculated using the palliative performance scale (PPS). Descriptive statistics were used for this analysis. Result(s): From September 2017 to November 2021, a total of 238 patients were invited to complete AD and 55 (23.1%) completed it, 14.5% in 2017, 29% in 2018, 34.5% in 2019, 9% in 2020 and 12.7% in 2021. The mean age among those who completed AD was 65.8 years (range 38-91), 52.7% were women and 61.8% had gastrointestinal cancer. Fortythree (78.1%) patients stated their wish to die at home, 18.1% to have cardiopulmonary reanimation, 9% invasive mechanical ventilation, 24.4% tube feeding, 90.9% pain medications, 10.9% organ donation, 40% cremation, 38.1% a funeral and 50.9% a death ritual. At median follow up of 5 months (0-39), 43 (78.1%) patients have died, and their endo-of-life wishes were respected in 77.5 % of them concerning the place of death and in 96.7% regarding cardiopulmonary reanimation and invasive mechanical ventilation. Conclusion(s): In our patient navigator-led supportive program approximately a quarter of patients with advanced cancer and a life expectancy of 6 month or less completed AD and end-of-life wishes were respected in a significant proportion of them. Telemedicine methods used to invite patients during COVID-19 pandemic decreased the proportion of AD completion. Although, advanced care planning is associated with improved in quality of care at the end of life, several barriers and disparities exist among Hispanics and strategies to improve their completion are needed.

CLINICAL PSYCHOLOGY DURING THE COVID-19 PANDEMIC: EXPERIENCES FROM SIX FRONTLINE HOSPITALS IN MEXICO

Around the world, the COVID-19 pandemic has generated clinical challenges for health personnel in general, and particularly hospital personnel. In Mexico, the clinical psychologists who are part of the local hospital systems have adapted professional practices to provide mental health care in COVID-19 frontline hospitals. This text describes the actions, lessons, and challenges arising from treating patients, families, and health workers in six COVID-19 hospitals in Mexico. It highlights the main problems identified, strategies to address them, and the barriers encountered during this pandemic. Finally, this paper may be useful for planning clinical psychological activities within COVID-19 hospitals in locations where new waves of contagion appear.

Concerns and difficulties associated with the COVID-19 pandemic among older adults with cancer in Mexico

Background: The COVID-19 pandemic has impacted the well-being of people not only due to the disease but also because of stay-at-home orders, social distancing, unemployment, and different kinds of loses. Older adults have particularly suffered during the pandemic, with increased health-related concerns and anxiety leading to increased vulnerability. However, little is known about the effects of the pandemic on older adults with cancer living in developing countries. They are facing issues related to their diagnosis and treatment, as well as the effects of the pandemic on their care and on the well-being of their families. To improve care for this vulnerable population, we studied the concerns and difficulties associated with COVID-19 among older Mexican adults with cancer. Methods: We included patients age ≥65 with the 10 most common tumors in Mexico according to GLOBOCAN and within 3-24 months of cancer diagnosis at two public hospitals in Mexico City. Patients were contacted telephonically and asked to complete a survey reporting the difficulties encountered during the COVID-19 pandemic and to rate their concerns associated with cancer care management using a 0-10 Likert-type scale, with higher ratings meaning increased concerns. Focused interviews were used to describe the individual experience of selected patients and their relatives related to COVID-19 and cancer care. Results: Between April 20, 2020 and December 1, 2021, 67 patients (mean age 71.9, min 65, max 90;35.8% female;62.7% living with a partner) were included. The most common tumors were prostate (43%), colon (16%), and lung (12%). 46% had Stage IV disease, and 61% had a life expectancy of more than a year. Twenty-five percent of patients reported encountering at least one difficulty in obtaining cancer care due to the COVID-19 pandemic. 43% of the patients reported difficulties with accessing follow-up cancer care;39% reported issues with obtaining medications, including chemotherapy;and 34% reported problems obtaining medical care in general, including oncology visits. Regarding concerns, 33% of the patients reported being 'very worried' or 'extremely worried' about the COVID-19 pandemic. The most relevant concerns were related to getting infected with COVID-19 (or having a family member who became infected) (mean rating 7.9, SD 2.9);not being able to pay for cancer treatments or medical care (mean rating 6.9, SD 3.5);and worsening of cancer due to delayed care during the pandemic (mean rating 6.6, SD 3.7). Conclusions: A significant proportion of older adults with cancer in Mexico faced difficulties obtaining cancer treatment and followup care during the COVID-19 pandemic. Their most relevant concerns included getting infected, financial losses, and progression of disease. Creating systems to provide continued cancer care for vulnerable populations in developing countries is essential to face the COVID-19 pandemic.

Eating behavior during COVID-19 pandemic: Comparison between people with obesity, overweight and normal weight

Introduction: In response to the COVID-19 pandemic, many governments have invoked national or regional lockdowns. These lockdowns have had a range of effects including changes to eating behavior and emotional wellbeing. The restrictions could have had positive and negative impact on eating habits such as increased home cooked meals and reducing fast food consumption. However, for some, eating frequency may have increased due to isolation and stress. To date, little is known about the difference between people living with obesity (PwO), with overweight (PwOW) and normal weight (PwNW). Methods: General population and patients from a tertiary care hospital aged ≥ 18 years completed an online survey from 29 April to 19 July 2020. Demographic data including self-reported weight and height, habits of eating and drinking alcohol (“In the last 24 hours, approximately how many hours have you spent“, with a 5 points Likert scale: 0, 1, 1-3, 3-7, > 8 hours), cognitive restraint, uncontrolled eating and emotional eating, through the Three Factor Eating Questionnaire (TFEQ-R18) were obtained. We compared PwO (BMI ≥30, n=313), PwOW (BMI 25-29.9, n=195) and PwNW (BMI 18.5-24.9, n=240). Results: Most respondents were women (PwO 65%, PwOW 60%, PwNW 77%). PwNW were younger than PwO and PwOW (40.9±14.4 vs 46.3±11.1 and 48.5±13.4 years respectively, p<.001). Whilst there was no difference in the time spent eating in the last 24 hours (2.6±0.7, 2.6±0.7 and 2.7±0.6 for PWO, PwOW and PwNW respectively, p=.087) and in cognitive restraint (15.5±3.8, 15.8±3.8 and 15.3±4.2 for PWO, PwOW and PwNW respectively, p=.490), there was significant differences in the time spent drinking alcohol in the last 24 hours (PwO 1.1±0.5 vs PwNW 1.2±0.6, p<.05), in uncontrolled eating (PwO 17.4±7 vs PwOW 14.4±5.4 and PwNW 15.5±6, p<.001), and in emotional eating (PwO 6.6±3 vs PwOW 5.4±2.6 and PwNW 5.6±2.5, p<.001). Conclusion: PwO report spent similar time eating in the past 24 hours and cognitive restraint in order not to gain weight than PwOW and PwNW. However, PwO have more uncontrolled eating and emotional eating compared to PwOW and PwNW. PwNW spent more time drinking alcohol in the last 24 hours than PwO. It is important to consider proactive development of strategies to support all to cope during the pandemic given the likely increased stress and anxiety. These results suggest that greater support for PwO is needed regarding uncontrolled eating and emotional eating. Future research should consider the long-term impact of the pandemic on weight and health status.