ABSTRACT
INTRODUCTION AND OBJECTIVE: Patients with non-muscleinvasive bladder cancer (NMIBC) that recurs after treatment with intravesical Bacillus Calmette-Guerin (BCG) must weigh the risk of progression of bladder cancer and loss of a window of potential cure with medical therapy against the risk of morbidity and loss of quality of life (QOL) with radical cystectomy. The CISTO Study (NCT03933826) is a pragmatic, prospective observational cohort study comparing medical therapy (i.e., intravesical therapy or systemic immunotherapy) with radical cystectomy for recurrent highrisk NMIBC. Here we report on the design and progress of the CISTO Study. METHODS: 900 patients with recurrent high-risk NMIBC that has failed first-line BCG and who have chosen to undergo standard of care treatment will be enrolled. Patient stakeholders helped determine the primary outcome: 12-month patient-reported QOL using the EORTC QLQ-C30. Secondary outcomes include urinary and sexual function, decisional regret, financial distress, healthcare utilization, return to work/normal activities, progression, and recurrence-free, metastasis-free, and overall survival. Participants will be followed for up to 3 years. RESULTS: Enrollment is active at 32 sites across the US, including 23 university-based centers and 9 community sites. As of November 1, 2021, 173 participants have been enrolled, 104 of whom chose medical therapy and 69 of whom chose radical cystectomy. The completion rate for the primary outcome of QOL at 12 months is 94% (15 out of 16 participants to date). The inclusion of electronic consent and collection of PROs allowed recruitment and follow-up to continue remotely during the COVID-19 pandemic. Significant pandemic-related challenges have included slow study start-up at sites, staffing, periods of suspension, and delays in patients obtaining care. Strategies to address these challenges include improved methods for onboarding and training sites, all-site communication, confirming study eligibility, ing EHR data, and remote monitoring while adhering to the highest study standards. CONCLUSIONS: The CISTO Study will compare patient reported outcomes for those undergoing medical therapy with radical cystectomy for recurrent high-risk NMIBC. The CISTO Study has the potential to fill critical evidence gaps and provide for personalized, patient-centered care.
ABSTRACT
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted various clinical and research processes in urologic care. As part of a pragmatic clinical trial in bladder cancer, we collected information regarding the impact of COVID-19 at participating sites, which provides insight into how the pandemic has imposed constraints on clinical bladder cancer care and research. METHODS: Starting in May 2020, we distributed a monthly survey to sites participating in CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer, NCT0393382). The survey included questions about interruptions in routine clinical bladder cancer care, specifically assessing elective surgery restrictions, impact on radical cystectomy, TURBT, office cystoscopies, intravesical therapy, and intravesical bacillus Calmette- Guerin (BCG) supply. We report survey responses for sites that responded to > 50% of the monthly surveys from May 2020 to October 2021. RESULTS: From May 2020 through October 2021, 21 sites (66%) had > 50% monthly response rate. The time periods of greatest limitations on bladder cancer procedures (Figure 1) were May-July 2020, Dec-Jan 2020/2021, and Sept-Oct 2021, corresponding to the peak waves of COVID-19 infections. Elective surgery was most affected, with limitations or holds in those time periods at up to 76%, 38%, and 28% of CISTO sites, respectively. Most of the restrictions involved surgeries that required inpatient stays, potential intensive care unit admission, and staffing shortages. 9 sites (28%) experienced transient BCG shortages during the survey period. CONCLUSIONS: Clinical activity was most limited during the initial COVID-19 surge in Spring/Summer 2020. Despite higher COVID- 19 infection rates in subsequent waves, bladder cancer clinical activity has been maintained at CISTO sites throughout the COVID pandemic. Periodic BCG shortages continue to affect bladder cancer care across the US. (Figure Presented).
ABSTRACT
The goal of the present research, bibliographical and documentary, is to analyse how the COVID-19 pandemic affects the live of the churches, focus-sing on the celebration of the sacrament of Holy Communion/Eucharist, and how Catholic and Lutheran churches have sought to react to the given situation. In the Catholic case, masses are celebrated in the presence of a reduced number of per-sons and transmitted online. The Evangelical Church of the Lutheran Confession in Brazil - IECLB, for its part, has preferred to discourage the celebration of Holy Communion for the time being, which has resulted in a kind of already extended "Eucharistic fasting". Either solution has its advantages and disadvantages and its practical and doctrinal reasons to be in place. Analysing the different attitudes of the two aforementioned churches in relation to Eucharistic celebrations during the pandemic, the article explores new modalities that could be discovered for the celebration of Holy Communion/Eucharist in this context, as well as their respec-tive theological implications. © 2020 Faculdade Jesuita de Filosofia e Teologia. All rights reserved.
ABSTRACT
A new coronavirus/Covid-19 pandemic leads the humanity to rethink the meaning and the way of living and coexisting. The requirements used for the organization of personal and collective life are questioned and they suggest a reinvention of humanity. It is common to say that 'after the pandemic, nothing will be the same as before!' Really? This study aims to verify to what extent this context of changes also concerns the church, considered here in the Roman Catholic tradition in Brazil. Analyze how, during the pandemic, the church faces the challenge for changes in the way of carrying out a mission and celebrating the faith;it identifies the main areas of these changes and analyzes their effectiveness in accompanying the faithful during a pandemic. Finally, it raises a question if these changes point to a reinvention of the church for post-pandemic times, in line with the quest for the reinvention of humanity.