Real-life daily activity: the impact of misbeliefs on quality of life among cancer patients.

BACKGROUND: While side-effects and health-related quality of life (QoL) are routinely assessed in clinical trials, commonly used tools do not measure patients' ability to maintain normal daily activities. QoL can be severely affected directly by the disease, the treatment side-effects and by personal and societal misconceptions promoting avoidance from activities perceived as dangerous for cancer patients. We examined practices of actively treated patients with cancer. METHODS: A questionnaire was designed, assessing daily activities (11 items) and dietary limitations (7 items) distributed between October and December 2019 (before the coronavirus pandemic) among patients treated at the Oncology Division of Tel Aviv Sourasky Medical Center. RESULTS: The study population comprised 208 patients who participated in the survey. The majority reported at least one social-environmental avoidance or dietary limitation (136, 65% and 120, 57.7%, respectively), including abstaining from social contact, avoiding pets, public domains, traveling and maintaining dietary constraints. Adoption of these measures was not associated with clinical, demographic factors and treatment type. The major sources guiding restrictions came from advice of non-medical personnel (55.7%), the Internet (7.2%) and personal choice by the patients themselves (24%). CONCLUSIONS: Most cancer patients reported compromised daily activities, which are likely attributed to misbeliefs about disease and treatment, and have a deleterious impact on QoL, in its wider sense, namely, the ability to conduct a full and meaningful life. These findings call for the development and implementation of tools examining patients' real-life activity, beyond side-effects or health-related QoL (HRQoL). We propose this assessment as an integral part in the evaluation of new drugs and technologies and as an additional endpoint in pivotal clinical trials.

THE BINARY PATH OF RISKS IN PENSION SYSTEMS AND POLITICAL PRESSURE

In this paper, we offer an explanation for cyclical reforms to pension systems, based on the experience of countries in Central and Eastern Europe (CEE) over the last three decades. We conclude that in making the transition to funded pension design, governments not only transfer longevity and fiscal risks to the individual but also absorb risks transferred from the public, with each market actor transferring undiversifiable risks to the other. This pathway of hidden risks, which has not previously been discussed in the literature, stems from a public expectation that citizens will enjoy risk premiums and adequate old-age benefits, an expectation that evolves into political pressure. The outcomes of this risk path are realized in financial transfers, such as means-tested social security and minimum pension guarantees. Consequently, funded pension designs converge naturally into a new landscape paradigm of risk-sharing, with intergenerational and intragenerational components. Financial crises such as the one accompanying the recent COVID-19 pandemic foster the convergence process. © 2022 Pluto Journals. All rights reserved.

The changing face of wildlife tourism during the COVID-19 pandemic: an opportunity to strive towards sustainability? (Special Issue: COVID-19 and tourism.)

The COVID-19 pandemic constitutes one of the greatest challenges in the history of the tourism industry. Travel restrictions imposed in many countries to manage the global spread and community transmission allow to study the environmental effects on tourism destinations. Here we investigate the case of wildlife tourism in Sri Lanka, a country that has experienced unsustainable wildlife tourism practices before COVID-19. Semi-structured interviews of wildlife tourism stakeholders of Sri Lanka's national parks demonstrated how the travel restrictions during COVID-19 provided a temporary relief from environmental impacts. We discuss various measures on how to maintain more sustainable practices of wildlife tourism in Sri Lanka and other countries in the long term seizing this unusual opportunity.

Oncology Treatments during the COVID-19 Pandemic in Israel: the ONCOR Study

Background: The increased susceptibility of cancer patients to coronavirus disease-2019 (COVID-19) infections and complicaions calls for special precautions while treating cancer patientS during COVID-19 pandemic. Thus, oncology departments have had to implement a wide array of prevention measures. Objectives: To address issues associated with cancer care during the COVID-19 pandemic and to assess the implementation of measures aimed at containment of COVID-19 diffusion while allowing continuation of quality cancer care. Methods: A national survey among oncology departments in Israel was conducted between 12 April 2020 and 14 April 2020. Eighteen heads of hospital-based oncology departments completed a self-report questionnaire regarding their institute's preparedness for treatment of cancer patients during the COVI 0-19 pandemic. Results: In this national survey, prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying in the departments. Most participants (78-89%) reported using a quick triage of patients and caregivers prior to their entrance to the oncology units, limiting the entrance of caregivers, and reducing unnecessary visits to the clinic. Switching to oral therapies rather than intravenous ones when possible was considered by 82% and shortage in personal protective equipment was reported by five (28%) heads of oncology departments. Some differences between large and small/medium sized medical centers were observed regarding issues related to COVI D-19 containment measures and changes in treatment. Conclusions: Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity.

[Effect of Covid-19 on Oncology Patients in Israel: From the Experience of a Tertiary Center]

INTRODUCTION: The Covid-19 pandemic affects cancer patients in a variety of ways, ranging from delay in diagnosis and treatment to directly causing serious illness. To date, data on the characteristics of Covid-19 disease among cancer patients in Israel have not been published. The aim of this study was to characterize Covid-19 disease patterns among cancer patients treated at a tertiary center. METHODS: Cancer patients positive for Covid-19 between March and October 2020 (including the 1st and 2nd outbreaks) were identified by crossing the databases of the oncology clinic with those of the test data performed at the hospital and in the community. Clinical and demographic data were collected from the medical records. RESULTS: During the study period, 60 cancer patients, out of ~12,000 were identified as positive for Covid-19. Three additional asymptomatic patients were identified by a mandatory screening program established for patients being hospitalized at the oncology department. Of all patients who were diagnosed as positive for Covid-19, 29 (48%) were defined as having a severe disease and 10 (34%) of them died during the data collection period. Those with severe illness were significantly older (71 vs 59 years old p-0.001) and more of them had metastatic disease (47% vs. 53% p-0.01). No significant associations were found between the type of cancer, type of oncology treatment and the severity of Covid-19. Among patients who received active treatment, a delay in treatment was observed for a median time of 17 days. DISCUSSION: Our data indicate relatively low incidence of Covid-19 infection among actively treated cancer patients, possibly due to strict adherence of these patients to social distancing rules. As no association was noted between Covid-19 severity and the oncology treatment, it is probably appropriate to continue optimal cancer care and avoid treatment interruptions even in times of Covid-19 outbreaks.

The expectation for risk-sharing cycle: Theoretical model and global implementation

In this paper, we offer an explanation to pension systems cyclical reforms, based on Central East Europe (CEE) countries experience over the last three decades. We claim that in the transition to funded pension design, the government not only transfers longevity and fiscal risks to the individualbut also absorbs risks transferred from the public, where each market actor transfers undiversifiable risks to the other. This hidden risk path that has not been discussed yet in the literature, stemmed from the public expectation to risk premium or adequate old age benefits that evolves to political pressure. The outcomes of this risk path realized in financial transfers, such as social security, means-tested and minimum pension guarantee. Consequently, funded pension designs naturally converge to a new landscape paradigm of risk sharing, including intergenerational and intra-generational play. Financial crises such as the recent COVID-19 pandemic foster the convergence process. © 2021 Karadeniz Technical University. All rights reserved.

Oncology treatments during COVID-19 pandemic in Israel: ONCOR study

Background: The SARS-CoV-2 pandemic outbreak declared by the World Health Organization in March 2020 challenged health systems in affected countries and raised concerns for its potential direct and indirect impact on cancer patients. Cancer patients are at high risk for COVID-19 infections and complications due to factors related to their underlying condition and treatments. We aimed to evaluate the impact of COVID-19 on clinical activity of the oncology departments in Israel, and to assess the implementation of measures aimed at containment of COVID-19 diffusion, while allowing continuation of quality cancer care. Methods: A national survey among 18 of 19 oncology departments in Israel was conducted on April 2020 focusing on the institute's preparedness for treatment of their cancer patients during the COVID-19pandemic. Results: Prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying at the departments. most participants reported employing a quick triage of patients and caregivers, prior to their entrance to the oncology units. Most departments limited the entrance of caregivers;one third not allowing entrance of any caregivers and more than half allowing entrance of only one caregiver. Some differences between large and small/medium sized medical centers were observed, with less strict measures taken by the smaller hospitals. Most departments implemented steps aimed at reducing unnecessary visits to the clinic. These included a shift to telephone interactions or telemedicine (78%) and switching to oral therapies, rather than intravenous ones, when possible. This approach was taken mostly by the medium/small hospitals compared to large hospitals (60% vs. 92%, p = 0.1). Conclusions: Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity. However, some differences between large and small hospitals were noted. These findings call for either better allocation of resources in case of an epidemic.

[a Delicate Balance of Oncology Practice during the Covid-19 Pandemic]

BACKGROUND: The SARS-COV-2 virus emerged in Israel in March 2020 and compelled restructuring of the Israeli health care system. Despite the paucity of data, it appears that oncology patients suffer from a higher risk of complications due to COVID-19 infection, including hospitalization in the intensive care unit (ICU) and death. A delicate balance exists between the oncologists' obligation to provide optimal and effective cancer treatment and the risks enveloping treatment that may place patients vulnerable to contraction of the virus. In an effort to reorganized oncological units, guidelines were published by the American and European oncology unions (ASCO, ESMO), including cancellation of frontal meetings, converting to telemedicine and changes in treatment protocols mitigating the exposure of patients to hospital visitations. Khoury et al. reported their experiences and challenges at Bnai Zion Hospital in Haifa during the first days of the pandemic, recounting the protection of staff, patients and reorganization of the oncological unit.