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J Natl Cancer Inst ; 114(4): 571-578, 2022 Apr 11.
Article in English | MEDLINE | ID: covidwho-1566036


BACKGROUND: The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the COVID-19 pandemic's impact on time to treatment initiation (TTI) and treatment selection for patients newly diagnosed with metastatic solid cancer. METHODS: We used an electronic health record-derived longitudinal database curated via technology-enabled abstraction to identify 14 136 US patients newly diagnosed with de novo or recurrent metastatic solid cancer between January 1 and July 31 in 2019 or 2020. Patients received care at approximately 280 predominantly community-based oncology practices. Controlled interrupted time series analyses assessed the impact of the COVID-19 pandemic period (April-July 2020) on TTI, defined as the number of days from metastatic diagnosis to receipt of first-line systemic therapy, and use of myelosuppressive therapy. RESULTS: The adjusted probability of treatment within 30 days of diagnosis was similar across periods (January-March 2019 = 41.7%, 95% confidence interval [CI] = 32.2% to 51.1%; April-July 2019 = 42.6%, 95% CI = 32.4% to 52.7%; January-March 2020 = 44.5%, 95% CI = 30.4% to 58.6%; April-July 2020 = 46.8%, 95% CI= 34.6% to 59.0%; adjusted percentage-point difference-in-differences = 1.4%, 95% CI = -2.7% to 5.5%). Among 5962 patients who received first-line systemic therapy, there was no association between the pandemic period and use of myelosuppressive therapy (adjusted percentage-point difference-in-differences = 1.6%, 95% CI = -2.6% to 5.8%). There was no meaningful effect modification by cancer type, race, or age. CONCLUSIONS: Despite known pandemic-related delays in surveillance and diagnosis, the COVID-19 pandemic did not affect TTI or treatment selection for patients with metastatic solid cancers.

COVID-19 , Neoplasms, Second Primary , COVID-19/epidemiology , Humans , Neoplasm Recurrence, Local/epidemiology , Neoplasms, Second Primary/epidemiology , Pandemics , Time-to-Treatment , United States/epidemiology
Clin Lymphoma Myeloma Leuk ; 21(1): e66-e75, 2021 01.
Article in English | MEDLINE | ID: covidwho-718689


Histiocytic disorders are an exceptionally rare group of diseases with diverse manifestations and a paucity of approved treatments, thereby leading to various challenges in their diagnosis and management. With the discovery of novel molecular targets and the incorporation of targeted agents in the management of various adult histiocytic disorders, their management has become increasingly complex. In an attempt to improve the understanding of the clinical features and management of common adult histiocytic disorders (Langerhans cell histiocytosis, Erdheim-Chester disease, Rosai-Dorfman disease, and hemophagocytic lymphohistiocytosis), we created this document based on existing literature and expert opinion.

Erdheim-Chester Disease/drug therapy , Histiocytosis, Langerhans-Cell/drug therapy , Histiocytosis, Sinus/drug therapy , Lymphohistiocytosis, Hemophagocytic/drug therapy , Adult , Drug Therapy, Combination , Erdheim-Chester Disease/diagnosis , Histiocytosis, Langerhans-Cell/diagnosis , Histiocytosis, Sinus/diagnosis , Humans , Lymphohistiocytosis, Hemophagocytic/diagnosis , Treatment Outcome