Suggested Modifications to the Management of Patients With Breast Cancer During the COVID-19 Pandemic: Web-Based Survey Study.

BACKGROUND: Management of patients with cancer in the current era of the COVID-19 pandemic poses a significant challenge to health care systems. Breast cancer is the most common cancer internationally. Breast cancer is a disease that involves surgery, chemotherapy, hormonal therapy, targeted therapy, radiotherapy, and, more recently, immunotherapy in its management plan. The immune system requires months to recover from these medications, and this condition is even worse in patients with metastatic breast cancer who need ongoing treatment with these drugs. Some of these drugs, such as inhibitors of cyclin-dependent kinases 4 and 6, can cause rare but life-threating lung inflammation. Patients with breast cancer who have metastatic disease to the lungs can experience deterioration of disease symptoms with COVID-19 infection. Oncologists treating patients with breast cancer are facing a difficult situation regarding treatment choice. The impact that COVID-19 has had on breast cancer care is unknown, including how to provide the best care possible without compromising patient and community safety. OBJECTIVE: The aim of this study was to explore the views of oncologists regarding the management of patients with breast cancer during the COVID-19 pandemic. METHODS: A web-based SurveyMonkey questionnaire was submitted to licensed oncologists involved in breast cancer management in Saudi Arabia, Egypt, and United Arab Emirates. The survey focused on characteristics of the participants, infection risk among patients with cancer, and possible treatment modifications related to different types of breast cancer. RESULTS: The survey was completed by 82 participants. For early hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, 61 of the 82 participants (74%) supported using neoadjuvant hormonal therapy in selected patients, and 58% (48/82) preferred giving 6 over 8 cycles of adjuvant chemotherapy when indicated. Only 43% (35/82) preferred inhibitors of cyclin-dependent kinases 4 and 6 with hormonal therapy as the first-line treatment in all patients with metastatic HR-positive disease. A total of 55 of the 82 participants (67%) supported using adjuvant trastuzumab for 6 instead of 12 months in selected patients with HER2-positive breast cancer. For metastatic HER2-positive, HR-positive breast cancer, 80% of participants (66/82) supported the use of hormonal therapy with dual anti-HER2 blockade in selected patients. The preferred choice of first-line treatment in metastatic triple negative patients with BRCA mutation and programmed cell death 1 ligand 1 (PD-L1) <1% was poly(adenosine diphosphate-ribose) polymerase inhibitor according to 41% (34/82) of the participants, and atezolizumab with nab-paclitaxel was preferred for PD-L1 >1% according to 71% (58/82) of the participants. CONCLUSIONS: Several modifications in breast cancer management were supported by the survey participants. These modifications need to be discussed on a local basis, taking into account the local infrastructure and available resources.

Level of Anxiety Among Healthcare Workers at a Comprehensive Cancer Center During the Coronavirus Disease 2019 Pandemic.

Objective The recent coronavirus pandemic (SARS-CoV-2) has severely increased the burden on the field of oncology, leading to the implementation of new rules to overcome its negative impact. An important issue is the psychological impact of the pandemic on already vulnerable populations, such as oncology staff, as reported by oncology associations. This study assessed the anxiety level among oncology staff during the coronavirus disease 2019 pandemic and related it to its risk factors and the effectiveness of departmental interventions that seek to provide coping methods. Methods A cross-sectional survey was administered to the oncology staff at our oncology center. Generalized anxiety disorder scale "yes-or-no" questions were used to determine secondary objectives regarding the concern of infection and the impact of a departmental intervention on overcoming distress. Results Overall, 199 participants were included in the analysis; more than 60% were women, with a median age of 34 years. More than 50% had anxiety and the most significant risk factors were parenthood and contraction of infection (P-value 0.03 and 0.02, respectively). Most responders reported an increase in the workload during the pandemic, but coping methods applied by the administration had improved anxiety levels as reported by a majority of the responders. Conclusion Oncology staff members have been negatively affected by the pandemic, although coping methods helped to improve anxiety. In the future, attention must be focused on the most vulnerable groups.

Predictors of poor precautionary practices towards COVID-19 among cancer patients.

Objective: Our study goal was to evaluate the behavioral response and practices of cancer patients to the coronavirus disease 2019 (COVID-19) pandemic in the Middle East and north Africa. Methods: A cross-sectional study was conducted using a validated anonymous 45-question survey administered via SurveyMonkey® to cancer patients in 13 centers in Algeria, Egypt, Jordan, Kuwait, Morocco and Saudi Arabia. Results: During the study period (from 21 April to 30 May 2020), 3642 patients participated in the study. The majority of patients (84.81%) were worried about contracting the infection. The reported strict adherence to precautions included avoiding the following actions: hand-shaking (77.40%), hugging and kissing (82.89%), social gathering (90.09%), meeting friends (84.68%) and visiting markets (75.65%). In a multivariate analysis, patients with poor precautionary practices were about twice as likely to cancel their medical appointment or a treatment session. Conclusion: Improving cancer patients' knowledge of and adherence to precautionary measures is needed not just to reduce the risk of acquiring infection but also to minimize the interruption of their medical care.

Lay abstract COVID-19 poses a higher risk for patients with cancer than other patients; therefore, it is prudent that they adhere to precautionary measures to protect themselves from the infection. We conducted a study to evaluate the behaviors and practices of these patients in response to the COVID-19 pandemic in the Middle, East and North Africa. We developed a survey of 45 questions that was distributed in 13 centers in Algeria, Egypt, Jordan, Kuwait, Morocco and Saudi Arabia between 21 April and 30 May 2020. About 85% of the 3642 patients who participated in the study were worried about contracting the infection. A substantial percentage of them (10­30%) were not adhering to various precautions and social distancing rules. On the other hand, 16% of them canceled medical appointments and 12% canceled treatment sessions. Our study showed the need for better adherence of patients with cancer to the infection precautions and most importantly, the need to have a better compliance with their treatment plans, such as keeping their scheduled appointments, to avoid harms from treatment delays.

E-Learning for Undergraduate Medical Students.

PURPOSE: Disruption of education can lead to drastic changes and therefore, we need to maximize the benefits of e-technology. We aimed to explore changes in knowledge, attitudes, and challenges regarding e-learning during the COVID-19 pandemic and determine how e-learning has influenced academic performance. METHODS: We conducted a self-administrated electronic survey to collect information on undergraduate medical students' e-learning. We evaluated its validity, reliability and pilot tested the instrument. RESULTS: Between August 7 and 19, 2020, we received 995 responses. The majority of respondents answered that they knew about the tools used for e-learning, such as mobile learning, links, online classes, e-assessment; 84% (n=836), 82% (n=815), 82% (n=811) and 80% (n=796), respectively. Two-third of the respondents gained fair/very good knowledge from online classes and discussion boards; 65% (n=635), and 63% (n=620), respectively. Regarding attitudes, less than half had "somewhat" adequate knowledge and proper training; 45% (n=449) and 36% (n=361), respectively, and less than a third had "somewhat" positive feelings; 29% (n=289). The reported challenges were poor Internet speed (55%, n=545) and the lack of clinical experience and physical examination skills (51%, n=512). There is a statistical difference between the test score for the first and second semesters for year 6, year 5, year 4, and year 2 (P value < 0.05). CONCLUSION: Most respondents reported that they knew about e-learning tools and answered that they gained fair/very good amounts of knowledge accompanied by acceptable attitudes. The challenges need to be addressed to improve e-learning infrastructure. The transition to e-learning accompanied by increased academic performance.

The willingness of the Saudi Arabian population to participate in the COVID-19 vaccine trial: A case-control study.

OBJECTIVES: This study examines the Saudi Arabian population's willingness to participate in clinical trials for the coronavirus disease 2019 (COVID-19) vaccine, comparing recovered cases' willingness with that of healthy volunteers. METHODS: A case-control study was conducted on the Saudi Arabian population during September 2020. The data were collected from recovered COVID-19 participants as the case group, and healthy volunteers as the control group. RESULTS: The data showed that 42.2% (n = 315) of recovered COVID-19 cases were more willing to participate in the COVID-19 vaccine trial than healthy volunteers (299; 38.1%) with a p < 0.001. The proportion of the participants who were willing to donate plasma was significantly higher among recovered participants, 84.2% (n = 112), than healthy volunteers, 76.3% (n = 87), with a p < 0.0001. The most significant factor responsible for a willingness to participate was the belief that vaccine discovery would help scientific developments (r = 0.525 and 0.465 for case and control, respectively). In comparison, significant reasons behind the unwillingness to participate were the risk of exposure to an unproven vaccine, r = 0.377 and 0.497 for case and control, respectively (p < 0.001), and a discomfort with being treated as an experimental subject (r = 0.275 and 0.374 for case and control, respectively). CONCLUSIONS: The differences in readiness toward the COVID-19 vaccine trial in our study does not indicate any passive exposure of participants to an unproven clinical trial vaccine, nor does it shed light on well-informed risk-related decisions. However, certain factors can significantly influence decision-making while contributing toward clinical research. This study's results must not be used for the individuals' recruitment bias in a COVID-19 vaccine trial.

Mortality and morbidity of curative and palliative anticancer treatments during the COVID-19 pandemic: A multicenter population-based retrospective study.

Administration of effective anticancer treatments should continue during pandemics. However, the outcomes of curative and palliative anticancer treatments during the coronavirus disease (COVID-19) pandemic remain unclear. The present retrospective observational study aimed to determine the 30-day mortality and morbidity of curative and palliative anticancer treatments during the COVID-19 pandemic. Between March 1 and June 30, 2020, all adults (n=2,504) with solid and hematological malignancies irrespective of cancer stage and type of anticancer treatments at five large comprehensive cancer centers in Saudi Arabia were included. The 30-day mortality was 5.1% (n=127) for all patients receiving anticancer treatment, 1.8% (n=24) for curative intent, 8.6% (n=103) for palliative intent and 13.4% (n=12) for COVID-19 cases. The 30-day morbidity was 28.2% (n=705) for all patients, 17.9% (n=234) for curative intent, 39.3% (n=470) for palliative intent and 75% (n=77) for COVID-19 cases. The 30-day mortality was significantly increased with male sex [odds ratio (OR), 2.011; 95% confidence interval (CI), 1.141-3.546; P=0.016], body mass index (BMI) <25 (OR, 1.997; 95% CI, 1.292-3.087; P=0.002), hormone therapy (OR, 6.315; 95% CI, 0.074-2.068; P=0.001) and number of cycles (OR, 2.110; 95% CI, 0.830-0.948; P=0.001), but decreased with Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0-1 (OR, 0.157; 95% CI, 0.098-0.256; P=0.001), stage I-II cancer (OR, 0.254; 95% CI, 0.069-0.934; P=0.039) and curative intent (OR, 0.217; 95% CI, 0.106-0.443; P=0.001). Furthermore, the 30-day morbidity significantly increased with age >65 years (OR, 1.420; 95% CI, 1.075-1.877; P=0.014), BMI <25 (OR, 1.484; 95% CI, 1.194-1.845; P=0.001), chemotherapy (OR, 1.397; 95% CI, 1.089-5.438; P=0.032), hormone therapy (OR, 1.527; 95% CI, 0.211-1.322; P=0.038) and immunotherapy (OR, 1.859; 95% CI, 0.648-4.287; P=0.038), but decreased with ECOG-PS of 0-1 (OR, 0.502; 95% CI, 0.399-0.632; P=0.001), breast cancer (OR, 0.569; 95% CI, 0.387-0.836; P=0.004) and curative intent (OR, 0.410; 95% CI, 0.296-0.586; P=0.001). The mortality risk was lowest with curative treatments. Therefore, such treatments should not be delayed. The morbidity risk doubled with palliative treatments and was highest among COVID-19 cases. Mortality appeared to be driven by male sex, BMI <25, hormonal therapy and number of cycles, while morbidity increased with age >65 years, BMI <25, chemotherapy, hormonal therapy and immunotherapy. Therefore, oncologists should select the most effective anticancer treatments based on the aforementioned factors.

Suggested modifications in oncology/hematology inpatient service in Saudi Arabia during coronavirus disease-2019 (COVID-19) pandemic.

BACKGROUND: Management of cancer patients in the current era of coronavirus disease-2019 (COVID-19) pandemic poses significant challenges on health-care systems. However, it is mandatory to keep the required level of care of cancer patients while taking the necessary precautions to maintain the safety of both patients and health-care professionals (HCPs). The present survey explores suggested modifications of inpatient oncology/hematology care during the COVID-19 pandemic. MATERIALS AND METHODS: A web-based questionnaire using SurveyMonkey was distributed to HCPs taking care of inpatient hematology/oncology service including oncologists, hematologists, and inpatient nurses in Saudi Arabia. The 25 items selected for the survey focused on five domains including characteristics of HCPs, COVID-19 infection risk among admitted patients, possible modifications related to physicians/nursing practice, and suggested infection control measures. Clinical sensibility assessment was conducted to evaluate the comprehensiveness, clarity, and face validity of our instrument on a scale of 1-5. The percentages of HCP responses to the suggested modifications in the survey were assessed in descriptive statistics to summarize data and report views of participants. RESULTS: Of 215 HCPs, 195 responded and completed the survey. Of the respondents, 30.4% were medical oncologists, whereas hematologists and nurses constituted 6.7% and 62.9% of the participants, respectively. The majority of respondents (87.6%) work in governmental hospitals. The majority of participants (82%) have diagnosed patients with COVID-19 in their hospitals and modifications in inpatient practice during the COVID-19 pandemic were supported by 95% of respondents. The supported modifications by participants include enhanced use of oral medications (83.5%), phone calls to admitted stable patients by physicians, instead of physical interview (77%), decreasing frequency of vital signs assessment in stable patients (91%), decreasing the duration of stay in patients rooms (89%), using peripheral instead of central lines (76%), using video-based educational materials to patients through hospital TV network (91%), testing for COVID -19 before scheduled radiology imaging and procedures (74%), and performing routine nasopharyngeal swabs for HCPs (67%). CONCLUSION: Several modifications in inpatient oncology/hematology practice were supported by the survey participants. These suggestions need to be discussed on local basis considering local infrastructure, available resources, and level of required care.

Optimizing the Communication with Cancer Patients During the COVID-19 Pandemic: Patient Perspectives.

BACKGROUND: During curfew, patients are self-isolated at home and worried. Patient-doctor interactions may be disrupted and therefore need to be replaced by alternative effective communication methods. PURPOSE: To describe the preferences of cancer patients with respect to communication methods and the use of patient-accessible electronic health records (PAEHRs). To record the impact on cancer patients during the COVID-19 pandemic and the knowledge and attitude of the patients towards it. PATIENTS AND METHODS: We created a self-administered electronic survey that was piloted and evaluated for its clinical relevance. Using convenient sampling methods, we surveyed the cancer patients in our Oncology Center. RESULTS: We received 385 responses between April 15 and April 30, 2020. The preferred method for communication was a phone call with a 92% response rate followed by the electronic patient portal, mobile application, telemedicine and text message in 75%, 76%, 73%, and 72%, respectively. The majority (97%) preferred the use of PAEHRs for appointments, 95% for drug delivery and to view laboratory tests, and 92% in requesting medical reports. In our survey, 22% of patients with cancer reported that their medical cancer care had not been affected by COVID-19. They reported that trusted sources of information during COVID-19 included the Ministry of Health with 98% and doctors with 94%. Sixty-one percent know that they are more susceptible to COVID-19 infection and 91% of respondents supported the notion of digital transformation in the caring of cancer patients. CONCLUSION: Our study revealed a general acceptance of patients to telecommunication as substitute to in-person interaction with their physicians. Interaction between cancer patients and health care providers should not be disrupted but should be augmented with more effective platforms to improve health care outcomes.

Virtual Management of Patients With Cancer During the COVID-19 Pandemic: Web-Based Questionnaire Study.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, patients with cancer in rural settings and distant geographical areas will be affected the most by curfews. Virtual management (telemedicine) has been shown to reduce health costs and improve access to care. OBJECTIVE: The aim of this survey is to understand oncologists' awareness of and views on virtual management, challenges, and preferences, as well as their priorities regarding the prescribing of anticancer treatments during the COVID-19 pandemic. METHODS: We created a self-administrated electronic survey about the virtual management of patients with cancer during the COVID-19 pandemic. We evaluated its clinical sensibility and pilot tested the instrument. We surveyed practicing oncologists in Gulf and Arab countries using snowball sampling via emails and social media networks. Reminders were sent 1 and 2 weeks later using SurveyMonkey. RESULTS: We received 222 responses from validated oncologists from April 2-22, 2020. An awareness of virtual clinics, virtual multidisciplinary teams, and virtual prescriptions was reported by 182 (82%), 175 (79%), and 166 (75%) respondents, respectively. Reported challenges associated with virtual management were the lack of physical exam (n=134, 60%), patients' awareness and access (n=131, 59%), the lack of physical attendance of patients (n=93, 42%), information technology (IT) support (n=82, 37%), and the safety of virtual management (n=78, 35%). Overall, 111 (50%) and 107 (48%) oncologists did not prefer the virtual prescription of chemotherapy and novel immunotherapy, respectively. However, 188 (85%), 165 (74%), and 127 (57%) oncologists preferred the virtual prescription of hormonal therapy, bone modifying agents, and targeted therapy, respectively. In total, 184 (83%), 183 (83%), and 176 (80%) oncologists preferred to continue neoadjuvant, adjuvant, and perioperative treatments, respectively. Overall, 118 (53%) respondents preferred to continue first-line palliative treatment, in contrast to 68 (30%) and 47 (21%) respondents indicating a preference to interrupt second- and third-line palliative treatment, respectively. For administration of virtual prescriptions, all respondents preferred the oral route and 118 (53%) preferred the subcutaneous route. In contrast, 193 (87%) did not prefer the intravenous route for virtual prescriptions. Overall, 102 (46%) oncologists responded that they would "definitely" prefer to manage patients with cancer virtually. CONCLUSIONS: Oncologists have a high level of awareness of virtual management. Although their survey responses indicated that second- and third-line palliative treatments should be interrupted, they stated that neoadjuvant, adjuvant, perioperative, and first-line palliative treatments should continue. Our results confirm that oncologists' views on the priority of anticancer treatments are consistent with the evolving literature during the COVID-19 pandemic. Challenges to virtual management should be addressed to improve the care of patients with cancer.