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Journal of Thoracic Oncology ; 17(9):S24, 2022.
Article in English | EMBASE | ID: covidwho-2031502

ABSTRACT

Introduction: Unintentional weight loss is common in lung cancer, with 40-60% of patients presenting with this at diagnosis. Weight loss and depleted nutritional status have been identified as negative prognostic variables for survival and directly impact the effectiveness of cancer treatments. The Lung Oncology team at the University Hospital Southampton (UHS) received external funding from Bionical Solutions and AstraZeneca for a part time oncology Dietitian to join the team in treating this patient group. The aim was to determine if specialist Dietitian input improves patients’ nutritional outcomes in those diagnosed with Stage III Non-Small Cell Lung Carcinomas (NSCLC) undergoing radical treatment. Methods: Over 12 months (February 2021-February 2022) all patients with stage III NSCLC received specialist Dietitian input during their radiotherapy treatment. Non-patient identifiable data was collected, which included;whether patients were enterally fed, admission rates and reason, and their weights at the start, middle, end and 2 weeks post radiotherapy. This data was compared to previously collected data in 2018 with the same patient group. No ethical approval was required. Results: A total of 50 patient data sets and 11 feedback questionnaires were collected over 11 months. Between the start and end of radiotherapy, patients experienced;2.1% overall average weight loss, 64% experienced <3.0% unintentional weight loss and 0% experienced >9.6% unintentional weight loss. In 2021 patients reached their lowest weight earlier at 70% of their way through radiotherapy compared with 86% in 2018. Patients maximum unintentional weight loss was 3.2% in 2021 compared with 4.4% in 2018. This is likely due to closer monitoring and dietitian input in 2021. Admission rates were higher in 2021 (n=13, 26%) compared to 2018 (n=5, 18.5%). However, this may be due to changes to patients’ radiotherapy treatment plans in 2021 due to the covid pandemic, resulting in more intense treatments. Patients requiring nasogastric (NGT) feeding increased from 0 in 2018 to 6 in 2021. This is likely due to increased awareness of the importance of nutritional support attributable to dietetic involvement in the multidisciplinary team. All patients who completed the feedback questionnaire found dietetic consultations useful and were able to follow most, or all dietary advice. 91% felt well supported during their treatment with dietetic input. Final Outcomes: Patients experienced reduced weight loss during treatment with Dietitian input compared to 2018 data where there was minimal dietetic input. Increased number of patients required NGTs compared to 2018, therefore Dietitian input is required in this area of oncology. Most patients felt well supported receiving dietetic input during treatment. Increased admission rates compared to 2018, however more nutrition support related admissions in 2021. Conclusions: Overall, patients lost less weight during treatment with Dietitian involvement in their care which is a positive factor in the prognostic outcomes. In addition, most patients felt seeing a Dietitian during treatment improved their experience and felt well supported. The final outcomes support the British Dietetic Associations’ recommendation that there is a dedicated dietetic service for lung cancer patients’, and they are seen by a Dietitian during their treatment. Keywords: Dietitian involvement, Reduced weight loss, Improved patient outcomes

2.
Radiotherapy and Oncology ; 161:S241-S242, 2021.
Article in English | EMBASE | ID: covidwho-1492800

ABSTRACT

Purpose or Objective CD19 CAR-T therapy is the most effective salvage treatment for relapsed/refractory DLBCL. However the manufacture of CAR-T cells takes several weeks and patients (pts) are at risk of progression during this time and usually require some form of bridging therapy to contain their disease. Radiotherapy (RT) is an attractive bridging option, as the chance of response to further conventional cytotoxic therapy is low. RT is generally delivered in the window between apheresis and infusion and requires careful scheduling. The aim of this study is to evaluate the feasibility, toxicity and early outcome of bridging RT in a cohort of pts undergoing CAR-T therapy for DLBCL. Materials and Methods This was a prospective analysis of pts receiving bridging RT since the start of CAR-T programme at our institution. We collected data on pt demographics, disease and RT details, as well as outcomes including early response, relapse, survival and toxicity. Results (Table presented.) Between April 2019 & January 2021 a total of 27 pts have received bridging RT. Of these 23 have been infused (1 not infused due to COVID19, 1 due to cardiac function & 2 pending). The CAR-T therapy was delivered in 1 Haematology Institution, but bridging RT in 9 different referring centres. Pt and disease characteristics and RT details are shown in table 1. The median time from CT planning scan to start of RT was 10 days (4-42). The median time between apheresis and start of RT was 5 days (-37-21;3 patients received RT prior to apheresis at -37,-35 &-29 days) and median time between end of RT and CAR-T infusion was 19 days (10-116). No pts were delayed due to RT toxicity. Toxicity data was available for 22 pts. 10 (45.5%) reported no toxicity. Only 1 pt had grade 3 toxicity (vomiting & diarrhoea) and RT was stopped. The most common toxicities were skin reaction (n=5) & fatigue (n=4). 25/27 (92.6%) pts underwent a PET-CT between bridging RT & infusion. In 22 (88%) pts there was response in treatment field (CMR=2, PMR=20). In 13 (59.1%) of those pts there was evidence of progressive disease (PD) outside the field, but none were prevented from receiving CAR-T infusion due to PD. With median FU of 8.8 (0.6-20.6) months from date of CAR-T infusion, 12/ 23 (52.2%) infused pts have relapsed, (2 infield, 5 out of field, 5 in both) with a local control rate of 69.6%;CMR (12;52.2%) and PMR (4;17.4%). 7 pts have died since infusion, 6 due to PD and 1 due to sepsis. Median PFS was 5.1 months (95% CI 0.0-11.9 months) and median OS 17.8 months (95% CI 12.7-22.9 months). 1 pt had infusion delayed due to COVID19 infection and died of PD. Conclusion RT was a safe and effective bridging option in this cohort of DLBCL pts pre CAR-T therapy. With close collaboration between Haematologists and Radiation Oncologists, it is possible to deliver a course of radical dose RT in the narrow window between apheresis and infusion, even across a wide geographical network. Further work is required to determine which pts benefit most from bridging RT and the optimal dose and schedule.

3.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277791

ABSTRACT

Introduction SARS-CoV-2 has created a hazardous environment for healthcare workers, with some of the riskiest procedures being those that generate aerosolized particles, such as tracheostomy surgery. Tracheostomy is both particle aerosolizing and extremely common, particularly for patients in respiratory distress. We utilized computational fluid dynamics (CFD) to model aerosolized particle spread during tracheostomy to deduce the viral loading risks posed to surgeons and anesthesiologists by aerosolized viruses. Additionally, we studied how these risks change with varying tracheal incision sizes. MethodsAn intubated subject's CT scan was virtually modified to replicate the tracheostomy procedure. An anatomically accurate trachea, thorax, incision, and operating room were created. Airflow simulations were performed to reproduce the exhalation occurring with removal of the intubation tube and opening of the airway to room pressure. Particles were released into the trachea from the primary bronchi, which then escaped into open air via the tracheal incision. Three tracheal incision sizes were modeled. Four particle sizes were released (0.2μ m-20μ m). Airflow was modeled for 20 seconds. ResultsFor small, medium, and large incisions, 68.7%, 68.4%, and 68.5% of particles by mass remained in the trachea, respectively (68.5% average of the three) (Figure1). Average size of escaped particles was 5.31μ m, 5.27μ m, and 5.29μ m for the small, medium, and large incisions respectively, while average particle size remaining in the trachea was 14.0μ m, 14.66μ m, 14.29μ m.From 4 to 8 seconds after initial particle release, the average particle size falling to the level of the patient's forehead increased from 11.6μ m to 18.4μ m. Large particles (10μ -20μ m) fell quickly, while smaller particles (0.2μ m to 2μ m) were more likely to remain suspended in air after 20 seconds. ConclusionsCFD particle aerosolization modeling of tracheostomy procedures can predict the viral loads healthcare workers are exposed to for the purpose of implementing proper safety precautions. These results highlight the extended residence times of aerosols in the absence of room ventilation which should ordinarily clear suspended particles, as well as the importance of considering smaller particles when designing personal protective equipment (PPE) for hospital staff. Large particles fall due to gravity relatively quickly, meaning the largest viral loads are airborne immediately after exhalation. Tracheal incision size was insignificant to the amount of aerosol generated during tracheostomy. In the absence of proper room ventilation, particles remained suspended in highest concentration directly above the patient's forehead, not directly above the tracheal incision. This implies physicians in this relative danger zone, such as anesthesiologists, need additional safety precautions.

5.
2nd African International Conference on Industrial Engineering and Operations Management, IEOM 2020 ; 59:565-572, 2020.
Article in English | Scopus | ID: covidwho-1232886

ABSTRACT

The COVID-19 pandemic has disrupted the everyday lives of people and businesses around the world, and a field greatly affected has been the United States pharmaceutical supply chain. This global pandemic has made preexisting issues within the supply chain’s structure more glaring than before with people’s lives being at risk. Demand for drugs is at least equivalent and likely higher in this current health setting. If companies are not providing the appropriate medications to their customers, then it can be the difference between life and death for some. To investigate the challenges behind the supply chain, the analysis was focused on problems before COVID-19, such as the lack of transparency, burdensome regulations, and logistical issues due to improper distribution. An investigation on how COVID-19 has impacted each specific part of the pharmaceutical supply chain leads to a discussion on what recommendations could be implemented to fix the presented issues. The U.S. pharmaceutical supply chain is a complex, global system that has become increasingly more challenging to navigate because of COVID-19. Shortages need to be mitigated, and the inevitability of a future vaccine for the virus needs to follow a proper logistics and distribution model to ensure its success. © IEOM Society International.

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