Inmate cancer patient - Highlighting the importance of a holistic approach to oncological care

Purpose: Inmate oncologic patients' rates increased drastically worldwide. Elderly, limited exercise, unhealthy diet, hepatitis, HIV + status, tobacco and alcohol use, constitute the main cancer risk factors. We present an outline of practical oncological management and ethical thinking, in the specific environment of a detention facility. Methods: PubMed, Cochrane Database of Controlled Trials, SCOPUS and grey literature were extensively searched up to October 2021. Incarcerated oncologic patients experience various everyday challenges:their confinement in high security facilities, the lack of access to critical care and related ethical dilemmas inherent to the context of a correctional facility. Results: The detention facilities may be inadequate in providing early cancer diagnosis and appropriate care mainly due to a lack of specialized personnel, b) in-house or in external specialized cancer hospitals, care variability (e.g. admissions in small local or regional hospitals), c) delays in providing access and d) gatekeeper systems. There is a paucity of administration of a)systemic therapy (chemotherapy, targeted drug therapy etc),b)radiotherapy, c) palliative care, and d)enrollment in clinical trials. Conclusions: Correctional facilities must encourage teamwork between healthcare and correctional professionals in order to improve the provided anticancer care.

Vaccine third dose and cancer patients: necessity or luxury?

The current state of the SARS-CoV-2 pandemic is an equilibrium between expanding vaccine coverage on the one hand, and emergence of variants of concern which compromise vaccine effectiveness and enhance viral transmission on the other. Inequity in vaccine distribution, primarily an ethical issue, challenges this equilibrium, as industrialized countries prepare to administer a third booster dose to their population. Solid tumor cancer patients typically respond well to initial full vaccination and someone could argue that they should not be prioritized for an adjuvant third dose, since protection from severe disease has largely been achieved with the two-dose regimen. Nevertheless, their immune status is dynamic and not all of them exhibit an adequate immune response. A booster third dose is necessary for the inadequate responders, while it will result in better protection of all patients from mild disease as well, which if presented could have ominous consequences due to their overall frailty, and their need to adhere to strict therapeutic schemes. International scientific and public health communities should develop approaches that allow for wide immediate vaccination coverage of the developing world, in parallel with administration of adjuvant doses to solid tumor cancer patients (and other at-risk categories) of the developed nations, in order to avoid prolonging the pandemic, which will be prospectively against cancer patients' best interest.

CureCancer digital tool in the routine clinical oncology practice facilitates PROs, communicating with HCPs, treatment adherence and “distancing interventions” during COVID-19 and reduces costs: A feasibility and satisfaction study

Background: CureCancer is a patient-centered/patient-driven digital tool integrated in the routine oncology practice. Patients self-create their medical profile, record their symptoms and communicate them to health care professionals (HCPs). We aimed to assess the tool’s feasibility and patients’ satisfaction. Methods: 14 Centers participated, starting from 02.2020. COVID-19 epidemic period was included. Patients signed consent to upload their data, report their symptoms and complete 2 questionnaires. Results following the completion of the 1st questionnaire are reported. Results: 78 patients were enrolled and 68 (87%) uploaded their data to date;60 of 68 (88%), 30 males and 30 females, median age 53 years, completed the 1st questionnaire. Thirty-seven (61.6%) were University graduates. Cancer types included breast cancer (21.6%), Head/Neck cancer, pancreatic cancer and other cancers. Ten patients reported “other”, 4 reported multiple cancers, 28 had metastatic disease and 45 active treatment. Registration and use of the platform was reported as “very to very much” easy by 52 (86.6%) and 50 (83.3%) patients, respectively. File uploading was “very to very much” easy for 33 (55%) patients;49 (81.6%) preferred the digital way and 50 (83.3%) will introduce it to others. Patients highlighted that CureCancer improved communication with HCPs, increased their sense of safety, facilitated treatment adherence and interventions at distance, particularly when outside the Cancer Center and during the COVID-19 pandemic, reduced the number of visits, time and out-of-pocket expenses. Benefits liked best were easy data access, improved communication and sense of safety. Conclusions: CureCancer use was feasible, increased communication with HCPs, patients’ sense of safety, treatment adherence and medical interventions at distancing, reduced visits and saved time and money. Continuing integration of CureCancer to embed PROs in routine cancer care is expected to improve treatment outcomes within or outside the Cancer Center and in pandemics and to reduce costs. Legal entity responsible for the study: Hellenic Society of Medical Oncology. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.