Stressors and the adaptation of telemedicine for women on poly(ADP-ribose) polymerase (PARP) inhibitor maintenance during the COVID-19 pandemic

Poly(ADP-ribose) polymerase inhibitor maintenance (PARPm) therapy is now available to all women with advanced ovarian cancer following response to initial chemotherapy. As the COVID-19 pandemic has resulted in unprecedented challenges for cancer patients, we aimed to evaluate the unique experience for women on maintenance PARP inhibitors. Women with a current or prior diagnosis of ovarian cancer completed an online survey focusing on treatment interruptions and quality of life (QOL). QOL was measured with the Cancer Worry Scale and Hospital Anxiety and Depression Scale. The survey was distributed through survivor networks and social media. The chi-square and ANOVA test were used with a Bonferroni correction to account for multiple comparison testing. Six hundred and three women, from 41 states, visited the survey website between March 30 and April 13, 2020 and 525 (87%) completed the survey and provided information on current treatment status. Sixty-four women (12%) were on PARPm, 153 (29%) on other anti-cancer therapy and 308 (59%) on no treatment. Other anticancer therapies included intravenous chemotherapy (61, 40%), anti-angiogenic (29, 19%), hormonal (25, 16%), oral chemotherapy (12, 8%), immunotherapy (10, 6.5%) and other (16, 10%). There were no differences among women on PARPm, no treatment or other treatment for disease stage, medical comorbidities, COVID-19 symptoms or treatment delays. Women on PARPm were more likely to be self-described as immunocompromised versus women not on treatment (79% vs. 34%, P<0.001) and women on hormonal therapy (79% vs. 40%, P=0.002) and similar to women on oral -anti-cancer therapy (78% vs. 58%, P=0.336). Women on PARPm were more likely to use telemedicine versus women not on treatment (44% vs. 16%, P<0.001) and had similar use of telemedicine compared to all other treatment groups. For women on PARPm, higher cancer worry scores were associated with increased use of telemedicine (used telemedicine - 14.4 vs. did not use telemedicine - 13.3, P=0.007). There were no significant differences in reported cancer worry, anxiety or depression between women on PARPm, other anti-cancer therapy and no treatment. [Display omitted] The COVID-19 crisis is impacting cancer care and it is critical that providers consider and address the unique stressors facing women with ovarian cancer during this challenging time. Women on PARPm, in particular, perceive themselves as immunocompromised, perhaps making them more open to alternative means of care delivery, as demonstrated by their willingness to adopt telemedicine. Women with ovarian cancer on PARPm report similar cancer worry, anxiety and depression to women not on treatment and those on other anti-cancer treatment. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Leveraging health information technology to collect family cancer history: a systematic review and meta-analysis

Collection of an accurate and comprehensive family cancer history (FCH) can help to identify millions of individuals at risk-for familial cancer syndromes. However, there are no formal guidelines for FCH collection and, as a result, there is wide variability in in strategies employed and accuracy of family health history across medical systems. Information technology (IT) provides a promising solution, a tool that has been shown to improve clinical documentation, workflows, quality of care, patient safety, communication and clinical decision support, and that can be completed remotely and safely during a pandemic. The aim of this study is to evaluate the literature on existing strategies whereby medical providers utilize information technology (IT) to assemble FCH. A systematic search of online databases (PubMed, EMBASE, MEDLINE, and the Cochrane Library) between 1980 and 2020 was performed. Meta-analysis was used to estimate pooled results across studies. Statistical heterogeneity was assessed through the chi-square test (i.e., Cochrane Q test) and the inconsistency statistic (I2). A random effects analysis was used to calculate the pooled proportions and means. The comprehensive search produced 4005 publications. Thirty-two peer-reviewed studies met inclusion criteria. Twenty-seven distinct IT tools were evaluated which included the following categories: electronic survey administered prior to visit (21, 65.6%), electronic survey administered via tablet in the medical office (6, 18.8%), electronic survey via kiosk (4, 12.5%) and animated virtual counselor (1, 3.1%). Among the 196,566 included patients, 87.0% completed the FCH tool (electronic survey prior to the visit - 85.0 %;electronic survey in the medical office - 89.0 %). The time required for survey completion was 35.2 minutes (CI 14.3 -56.2). Twelve percent of patients (n=11,093) were referred for genetic assessment based on the output of the FCH tool. Among the studied methods of FCH collection, 7 (21.9%) had the capacity to interface directly with the patient's electronic medical record. [Display omitted] The rapidly advancing field of germline cancer genetics coupled with a growing emphasis on disease prevention and incorporation of technology into medical care algorithms prior to and accelerated by the COVID-19 pandemic make utilization of IT strategies for collection of FCH a promising option. Our systematic review and meta-analysis found that electronic FCH collection can be completed successfully by patients in a time efficient manner. This information may be useful as many healthcare systems continue to restructure the way in which patients interact with their healthcare teams. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Factors contributing to treatment delays among Medicaid-insured patients with gynecologic malignancies during COVID-19 in New York City

When New York City (NYC) emerged as a COVID-19 epicenter, hospitals and clinicians were forced to quickly change practice models of health care delivery. We sought to determine the impact of COVID-19 on treatment delays that occurred during the peak of the pandemic among low-income gynecologic oncology patients in NYC. Medicaid-insured patients receiving gynecologic oncology care at two affiliated centers between March 15 and April 15, 2020 were identified for telephone interview. Eligible patients included those with precancerous or cancerous gynecologic diseases or hereditary breast and ovarian cancer (HBOC) syndromes. Demographics, clinical characteristics, and reasons for treatment delays were identified through self-report and confirmed with chart review at the time of interview and at 6-month follow up. Outcomes were classified as delays in the following: surgery, adjuvant treatment (chemotherapy/radiation), and surveillance visits. Of the 158 eligible patients identified, 100 completed the interview. A total of 47 patients experienced an average treatment delay of 85.3 days (range: 7-210): surveillance visit (n=33), surgery (n=10), chemotherapy (n=3), radiation (n=1). Within this group, the median age was 58 years (range: 19-86). Self-identified race included: African-American (23.5%), Hispanic (31.9%), non-Hispanic White (17%), Asian (9.1%), Other (8.5%). The majority of patients (80.9%) had an annual income < $40,000. Clinically relevant surveillance delays occurred in 3 patients. A delayed diagnosis of vulvar cancer due to missed biopsy (follow up at 49 days) and 2 patients with delayed diagnosis of recurrent ovarian/primary peritoneal cancer;one died from disease and the other is undergoing chemotherapy. Surgical delays were identified in 10 patients: high grade cervical/vulvar dysplasia (n=3);endometrial intraepithelial neoplasia (EIN) (n=2);endometrial cancer (n=2);risk reducing surgery for HBOC syndromes (n=2);metastatic gastrointestinal adenocarcinoma to the ovary (n=1). Among the patients with endometrial cancer, one procedure delayed by 1 week was able to proceed and one transferred care. No upstaging of cancer diagnosis resulted from delays. Chemotherapy delays occurred in 3 patients with an average delay of 47.7 days. Of these patients, 2 were found to have progression of disease resulting in death (n=1) and decision to pursue hospice (n=1);one had a personal COVID-19 diagnosis. A delay in radiation treatment of 70 days was reported in 2.1% (n=1). A total of 9 patients were lost to follow up. Characteristics of patients lost to follow up include Hispanic/Latino race/ethnicity, essential worker, living with children in a high COVID-positive area (37.5%, n=3) or individuals who experienced a change in employment status (25%;n=2). [Display omitted] COVID-19 resulted in significant treatment delays among Medicaid-insured gynecologic oncology patients. As we continue to minimize clinical encounters, interventions aimed at providing timely oncology care during the COVID-19 pandemic is essential to prevent widening disparities in low-income populations. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Financial toxicity, mental health, and gynecologic cancer treatment: The effect of the COVID-19 pandemic among low-income women in New York City.

BACKGROUND: New York City (NYC) emerged as an epicenter of the COVID-19 pandemic, and marginalized populations were affected at disproportionate rates. The authors sought to determine the impact of COVID-19 on cancer treatment, anxiety, and financial distress among low-income patients with gynecologic cancer during the peak of the NYC pandemic. METHODS: Medicaid-insured women who were receiving gynecologic oncology care at 2 affiliated centers were contacted by telephone interviews between March 15 and April 15, 2020. Demographics and clinical characteristics were obtained through self-report and retrospective chart review. Financial toxicity, anxiety, and cancer worry were assessed using modified, validated surveys. RESULTS: In total, 100 patients completed the telephone interview. The median age was 60 years (range, 19-86 years), and 71% had an annual income <$40,000. A change in employment status and early stage cancer (stage I and II) were associated with an increase in financial distress (P < .001 and P = .008, respectively). Early stage cancer and telehealth participation were significantly associated with increased worry about future finances (P = .017 and P = .04, respectively). Lower annual income (<$40,000) was associated with increased cancer worry and anxiety compared with higher annual income (>$40,000; P = .036 and P = .017, respectively). When controlling for telehealth participation, income, primary language, and residence in a high COVID-19 prevalence area, a delay in medical care resulted in a 4-fold increased rate of anxiety (P = .023, 95% CI, 1.278-14.50). Race was not significantly associated with increased financial distress, cancer worry, or anxiety. CONCLUSIONS: Low socioeconomic status was the most common risk factor for increased financial distress, cancer worry, and anxiety. Interventions aimed at improving access to timely oncology care should be implemented during this ongoing pandemic.

Perioperative Morbidity and Mortality of Patients With COVID-19 Who Undergo Urgent and Emergent Surgical Procedures.

OBJECTIVE: To evaluate the perioperative morbidity and mortality of patients with COVID-19 who undergo urgent and emergent surgery. SUMMARY BACKGROUND DATA: Although COVID-19 infection is usually associated with mild disease, it can lead to severe respiratory complications. Little is known about the perioperative outcomes of patients with COVID-19. METHODS: We examined patients who underwent urgent and emergent surgery at 2 hospitals in New York City from March 17 to April 15, 2020. Elective surgical procedures were cancelled throughout and routine, laboratory based COVID-19 screening was instituted on April 1. Mortality, complications, and admission to the intensive care unit were compared between patients with COVID-19 detected perioperatively and controls. RESULTS: Among 468 subjects, 36 (7.7%) had confirmed COVID-19. Among those with COVID-19, 55.6% were detected preoperatively and 44.4% postoperatively. Before the routine preoperative COVID-19 laboratory screening, 7.7% of cases were diagnosed preoperatively compared to 65.2% after institution of screening (P = 0.0008). The perioperative mortality rate was 16.7% in those with COVID-19 compared to 1.4% in COVID-19 negative subjects [aRR = 9.29; 95% confidence interval (CI), 5.68-15.21]. Serious complications were identified in 58.3% of COVID-19 subjects versus 6.0% of controls (aRR = 7.02; 95%CI, 4.96-9.92). Cardiac arrest, sepsis/shock, respiratory failure, pneumonia, acute respiratory distress syndrome, and acute kidney injury were more common in those with COVID-19. The intensive care unit admission rate was 36.1% in those with COVID-19 compared to 16.4% of controls (aRR = 1.34; 95%CI, 0.86-2.09). CONCLUSIONS: COVID-19 is associated with an increased risk for serious perioperative morbidity and mortality. A substantial number of patients with COVID-19 are not identified until after surgery.

Coronavirus Spectrum Infections (COVID-19, MERS, SARS) in Cancer Patients: A Systematic Review of the Literature.

BACKGROUND: Coronavirus 2019 (COVID-19) has spread rapidly around the world to become a global pandemic. There is limited data on the impact of COVID-19 among patients with cancer. METHODS: A systematic review was performed to determine outcomes of adult patients with cancer affected by coronavirus infections, specifically SARS, MERS, and COVID-19. Studies were independently screened by two reviewers and assessed for quality and bias. Outcomes measured included study characteristics, cancer type, phase of care at the time of diagnosis, and clinical presentation. Morbidity and mortality outcomes were analyzed to assess the severity of infection as compared to the general population. RESULTS: A total of 19 studies with 110 patients were included. Of these, 66.4% had COVID-19 infections, 32.7% MERS and only one patient with SARS. The majority of COVID-19 studies were based on studies in China. There was a 56.6% rate of a severe event, including ICU admission or requiring mechanical ventilation, with an overall 44.5% fatality rate. CONCLUSIONS: Patients with cancer with coronavirus infections may be more susceptible to higher morbidity and mortality.