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Considering the paucity of data on long-term Health-Related Quality of Life (HRQoL) in coronavirus disease 2019 (COVID-19) intensive care unit (ICU) survivors, we present one-year follow-up results on patients' HRQoL and compare them with those of the already reported 6-month follow-up. We conducted a prospective cohort study of patients in COVID-19 ICU between March and June 2020. A HRQoL analysis was performed six months and 1 year after discharge by means of a short-form-36 (SF-36) questionnaire. Hospital mortality in 403 ICU COVID-19 patients was 44.9%;further 4.0% died between hospital discharge and 6-month follow-up and only 0.5% died in the next six months. The median physical component of HRQoL increased from 43.7 (interquartile range (IQR): 31.7-52.7) at 6 months to 46.0 (IQR: 38.0-53.0) 1 year after hospital discharge (p = 0.007). In multivariable regression analysis, age >50 (odds ratio (OR) 0.270) and female sex (OR 0.144) were independently associated with reduced physical HRQoL 1 year after discharge. The median mental component of HRQoL increased from 50.6 (IQR: 42.0-55.8) at 6 months to 53.0 (IQR: 47.0-56.0) 1 year after discharge (p = 0.035), with no significant predictors. Increased HRQoL was associated with an improvement in patients' physical status, role functioning, emotional well-being (all p < 0.001) and social functioning (p = 0.007). ICU COVID-19 patients' HRQoL slightly improved 1 year after discharge, when compared to results of the 6-month follow-up. Medications received during ICU stay had no effect on physical or mental HRQoL.Copyright © 2023 The Author(s). Published by MRE Press.
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Background: The Omicron (B.1.1.529) SARS-CoV-2 variant is highly transmissible and escapes vaccinal immunity. Evidence is lacking as to the impact of Omicron in oncological patients. Method(s): Capitalizing on OnCovid study data (NCT04393974), we analysed COVID-19 morbidity and case fatality rate at 28 days (CFR28) of unvaccinated patients across 3 phases defined following the evolution of the pandemic in Europe, according to date of COVID-19 diagnosis: "Pre-vaccination" phase (27/02/2020-30/11/2020), "Alpha- Delta variant" phase (01/12/2020-14/12/2021), "Omicron variant" phase (15/12/2021-31/01/2022). Finding(s): By the data lock of 04/02/2022, 3820 patients from 37 institutions across 6 countries were entered. Out of 3473 eligible patients, 2033 (58.6%), 1075 (30.9%) and 365 (10.5%) were diagnosed during the Pre-vaccination, Alpha-Delta and Omicron phases. In total 659 (61.3%) and 42 (11.5%) were unvaccinated in the Alpha-Delta and Omicron. Unvaccinated patients across the Omicron, Alpha-Delta and Pre-vaccination phases experienced similar CFR28 (27.5%, 28%, 29%, respectively). Following propensity score matching, 42 unvaccinated Omicron patients were matched with 122 and 121 patients from the Pre-vaccination and Alpha-Delta phases respectively, based on country of origin, sex, age, comorbidity burden, primary tumour, cancer stage and status, and the receipt of systemic anticancer therapy at COVID-19. Unvaccinated Omicron patients experienced improved COVID-19 outcomes in comparison to patients diagnosed during the Prevaccination phase. Morbidity and mortality were comparable to those of unvaccinated patients diagnosed during the Alpha-Delta phase. Interpretation(s): Despite time-dependent improvements in outcomes reported in the Omicron phase, patients with cancer remain highly vulnerable to SARS-CoV-2 in absence of vaccinal protection. This study provides unequivocal evidence in support of universal vaccination of patients with cancer as a protective measure against morbidity and mortality from COVID-19.
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Background: Immunogenicity and safety of SARS-CoV-2 vaccines have been widely investigated in patients (pts) with cancer. However, their effectiveness against Coronavirus disease 2019 (COVID-19) and the additional protective effect of a booster dose in this population are yet to be defined. Methods: Using OnCovid study data (NCT04393974), a European registry enrolling consecutive pts with cancer and COVID-19, we evaluated morbidity and 14 days case fatality rates (CFR14) from COVID-19 in pts who were unvaccinated, vaccinated (either partially/full vaccinated but not boosted) and those who had received a third dose. Analyses were restricted to pts diagnosed between 17/11/2021 (first breakthrough infection in a boosted pt) and the 31/01/2022. Pts with unknown vaccination status were excluded. Results: By the data lock of 22/02/2022, out of 3820 consecutive pts from 36 institutions, 415 pts from 3 countries (UK, Spain, Italy) were eligible for analysis. Among them, 51 (12.3%) were unvaccinated, 178 (42.9%) were vaccinated and 186 (44.8%) were boosted. Among vaccinated pts, 26 (14.6%) were partially vaccinated (1 dose). Pts with haematological malignancies had more likely received a booster dose prior to infection (25.4% vs 13.6% and 11.8%, p = 0.02). We found no other associations between vaccination status and pts' characteristics including sex, age, comorbidities, smoking history, tumour stage, tumour status and receipt of systemic anticancer therapy. Compared to unvaccinated pts, boosted and vaccinated pts achieved improved CFR14 (6.8% and 7.0% vs 22.4%, p = 0.01), COVID-19-related hospitalization rates (26.1% and 20.6% vs 41.2%, p = 0.01) and COVID-19-related complications rates (14.5% and 15.7% vs 31.4%). Using multivariable Inverse Probability of Treatment Weighting (IPTW) models adjusted for sex, comorbidities, tumour status and country of origin we confirmed that boosted (OR 0.21, 95%CI: 0.05-0.89) and vaccinated pts (OR 0.19, 95%CI: 0.04-0.81) achieved improved CFR14 compared to unvaccinated pts, whilst a significantly reduced risk of COVID-19 complications (OR 0.26, 95%CI: 0.07-0.93) was reported for vaccinated pts only. Conclusions: SARS-CoV-2 vaccines protect from COVID-19 morbidity and mortality in pts with cancer. Accounting for the enrichment of haematologic pts in the boosted group, the observation of comparable mortality outcomes between boosted and vaccinated pts is reassuring and suggests boosting to be associated with reduced mortality in more vulnerable subjects, despite evidence of adverse features in this group.
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Background: SARS-CoV-2 pandemic changed oncology clinical practice. Health care workers (HCW) in oncology experienced double concerns as they had to guarantee patients global care while protecting them from the infection. We performed a longitudinal survey during this year to evaluate how daily practice and life of cancer HCW has changed. Methods: Three online surveys were sent to Italian Association of Medical Oncology (AIOM) members of Piedmont and Valle d'Aosta during the first wave, just before the second wave and at the end of the second wave. The 5 main topics were: population characteristics, changes in working practice, SARS-CoV-2 swab management, the influence of the pandemic on diagnostic, and on therapeutic paths. Results: 201, 186 and 136 HCW responded to the 3 surveys, respectively. 45% were oncologists, 28% nurses, 5% palliative doctors, and 9% interns. 75% did not received adequate training and 50% adequate personal protective equipment during the 1st wave. Screening by molecular swabs increased during time (from 6% in the 1st wave to 93.7% at the end of the 2nd wave). HCW main concerns were on beloved ones, lack of COVID-19 guidelines and practical skills (1st survey), the fear of a 2nd wave and its consequences (2nd survey), the persistence of emergency despite vaccines (3rd survey). Most HCW intended to be vaccinated (94%). Pandemic changed HCW-patient relationship due to the lack of physical contact and hampered non-verbal communication. A moderate to significant reduction of first oncological consultations occurred. Most follow-up visits were remotely conducted and palliative care activation was delayed in 40% of cases. Conclusions: This survey explored how cancer HCW suffered and reacted in different phases of SARS-CoV-2 pandemic. To know the discomforts, fears and perplexities of HCW must indicate where to act to restart and continue to guarantee patients and their families the best therapies and paths.
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Background: The long-term impact of COVID-19 in cancer patients (pts) is undefined. Methods: Among 2795 consecutive pts with COVID-19 and cancer registered to OnCovid between 01/2020 and 02/2021, we examined clinical outcomes of pts reassessed post COVID-19 recovery. Results: Among 1557 COVID-19 survivors, 234 (15%) reported sequelae including respiratory symptoms (49.6%), fatigue (41%) and cognitive/psychological dysfunction (4.3%). Persisting COVID-19 sequelae were more likely found in males (p=0.0407) aged ≥65 years (p=0.0489) with ≥2 comorbidities (p=0.0006) and positive smoking history (p=0.0004). Sequelae were associated with history of prior hospitalisation (p<0.0001), complicated disease (p<0.0001) and COVID-19 therapy (p=0.0002). With a median post-COVID-19 follow up of 128 days (95%CI 113-148), multivariable analysis of survival revealed COVID-19 sequelae to be associated with an increased risk of death (HR 1.76, 95%CI 1.16-2.66) after adjusting for sex, age, comorbidities, tumour characteristics, anticancer therapy and COVID-19 severity. Out of 473 patients who were on systemic anticancer therapy (SACT) at COVID-19 diagnosis;62 (13.1%) permanently discontinued therapy and 75 (15.8%) received SACT adjustments, respectively. Discontinuations were due to worsening performance status (45.1%), disease progression (16.1%) and residual organ disfunction (6.3%). SACT adjustments were pursued to avoid hospital attendance (40%), prevent immunosuppression (57.3%) or adverse events (20.3%). Multivariable analyses showed permanent discontinuation to be associated with an increased risk of death (HR 4.2, 95%CI: 1.62-10.7), whereas SACT adjustments did not adversely affect survival. Conclusions: Sequelae post-COVID-19 affect up to 15% of patients with cancer and adversely influence survival and oncological outcomes after recovery. SACT adjustments can be safely pursued to preserve oncological outcomes in patients who remain eligible to treatment.
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Background: The outbreak of the COVID-19 pandemic led to a rapid reorganization of health care system in Italy. Therefore, CS slowed down during the two lockdown periods including for BC primary prevention such as mammography and breast ultrasound. Hence, the aim of our retrospective analysis was to evaluate the impact of the discontinuation of CS and subsequent delay in surgical treatment during COVID-19 on BC diagnosis. Patients and methods: All patients who underwent breast surgery after BC diagnosis from March 8, 2019 to March 8, 2021 were included in the study. Our population was then divided into two groups: group A, pre-Pandemic group, considered women who underwent surgical procedures from March 2019 to March 2020. Group B, Pandemic group, included patients who underwent breast surgery from March 9, 2020 to March 8, 2021. Results: A total of 524 newly diagnosed patients were evaluated;n=239 and n=285 in the pre-Pandemic and Pandemic, respectively. We observe an increase of patients with lymph-node involvement (35% vs 29% p= 0.14) and with a higher cancer stage (Stage III-IV 20% vs 15% p=0.13), but not statistically significative in the Pandemic Group compared to the pre-Pandemic group. Conclusions: In our analysis, the slowdown of CS for BC did not have a significant impact on BC diagnosis even though our data reveal a slight increase of advanced BC stage in pandemic group. Hence, a potential explanation could be identified in our efforts to keep diagnosis and treating oncological patients. Nevertheless, new data about post covid BC diagnosis are not still available. Reasonable, our findings are most likely going to be re-debeated in few years to clarify if this trend could be confirmed.
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High mortality rates in elderly patients or in those with underlying chronic illnesses and/or a compromised immune system is a peculiar feature of COVID-19 infection. The possible coexistence of a cancer and COVID-19 infection in the same individual prompted concerns regarding their synergistic effect on prognosis. In order to balance patients' needs with the risks related to the infection, the question oncologists have asked from the beginning of the first wave of the pandemic has been: 'how can we deal with COVID-19 infection in cancer patients?' In pursuing its mission, the Associazione Italiana Oncologia Medica (AIOM) has made every possible effort to support cancer patients, health care professionals and institutions in the decision-making processes the pandemic has engendered within this scenario. The relevant documents as well as the educational and institutional initiatives the AIOM has taken are reported in this article.
Subject(s)
COVID-19 Vaccines , COVID-19 , Neoplasms , Societies, Medical , COVID-19/prevention & control , Central Venous Catheters , Clinical Trials as Topic , Humans , Influenza Vaccines , Neoplasms/therapy , Oncologists , Practice Guidelines as TopicABSTRACT
Background: Dimension and speed of the COVID19 health emergency forced pressing reorganization of the hospital machine with foreseeable repercussions on both cancer patients and healthcare professionals. A survey to the latter had the aim to describe oncology reaction at the time of Coronavirus spread in Piedmont and Valle d'Aosta. Material and methods: An electronic survey containing questions regarding the organizational, relational and management aspects of the emergency COVID19 as sent to Piedmont and Valle d'Aosta health workers in oncology on April 7th 2020. Results: 201 questionnaires were completed: 60% oncologists, 33% nurses, 7% palliativists;41% <45y;33% university hospital, 32% non-university hospital 32% ASL. 91% considered the pre-triage model and COVID questionnaire as essential for identifying suspected patients. Structures were converted for assistance of COVID patients in 76% of cases and 26% of the health workers accepted a role change:18% on voluntary basis, while only 24% believe to have received adequate training. On clinical activity, significant reduction (48%) was registered only for first visits (CAS) while interdisciplinary discussions (GIC) have been maintained although with alternative modalities (remotely,77%). 88% of follow-up visits were remotely conducted. Considering relational aspects, discomfort mainly concerned absence of physical contact and forms of non-verbal communication hampered by the PPE, increased communication time. However, healthcare provider-patient relationship has not changed (20%), even allowing a more transparent and empathic interaction despite the use of alternative means of communication. Health professionals suffered the lack of a reference in the management of the pandemic and/or guidelines of behavior and specific skills. Major concern was the lack of PPE and the fear to be a source of infection for one's family (in 67% of cases a physical distancing from one's family nucleus was carried out or would have been desired). 52% operators report they have not yet received the swab test;in case of swab test, this was carried out due to presence of symptoms (8%) or intermediate-high risk due to prolonged contact with a COVID case, with 60% believing times and procedures were inadequate. Conclusions: This picture is a precious benchmark to face with in order to reorganize the oncological activity in the immediate future, taking great account of the perception and experience of oncology operators. Submitted on behalf of the AIOM Piemonte & Valle d'Aosta Regional Board.