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Gut ; 70(Suppl 4):A43, 2021.
Article in English | ProQuest Central | ID: covidwho-1504048


IntroductionAlthough dysphagia should be considered a high-risk symptom for cancer referral pathways, the yield of endoscopy for cancer is currently <5%. Even prior to the COVID-19 pandemic, this was a significant burden for endoscopy units and subjected patients to inappropriate concern at being referred and investigated for suspected cancer. The BSG endorsed use of the Edinburgh Dysphagia Score (cut-off 3.5) to target endoscopy for those at highest risk,1 based on previously published results2.MethodsUse of the EDS was agreed as a service addition during the COVID-19 recovery period in SE London. All patients referred for dysphagia on the suspected cancer pathway in four acute Trusts were contacted either prior or on arrival in the endoscopy unit to complete the EDS, but the result did not alter the intended pathway (ie. all patients still completed endoscopy). Patients were then followed to final or working diagnosis as determined by the direct care team. As the EDS was primarily designed to prioritise for cancer diagnosis, this was the primary outcome measure. All other diagnoses were recorded and considered ‘significant’ if felt to be the cause of the patient’s presentation. Data on ethnicity was collected to ensure the reliability of the EDS in diverse patient groups found across SE London.Results240 patients (117F;mean age 55.7±14.7y;n=112 (46.7%) non-White British) completed their investigation pathway with 20 (8%) cancers diagnosed. 125 reported EDS <3.5 and none had upper GI cancer, while all 20 cancers occurred in the ESD>3.5 group (n=115;17.3%;median score 8(7-9)). Significant diagnoses were found in 35 patients (28%) with EDS<3.5 and 48 (41.7%) in the >3.5 group.ConclusionThe EDS cut-off of 3.5 had a 100% negative predictive value in this new prospective cohort and would have resulted in a more-than-doubling of ‘hit-rate’ for diagnosis of cancer. The rate of significant diagnoses in the <3.5 cohort emphasises that investigations are still required, but adoption of the EDS could be used to safely defer or divert patients, avoiding inappropriate use of suspected cancer pathways.ReferenceBr J Surg 2010;97(12):1831-7.

Cancer Cell ; 39(2): 257-275.e6, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1009339


Given the immune system's importance for cancer surveillance and treatment, we have investigated how it may be affected by SARS-CoV-2 infection of cancer patients. Across some heterogeneity in tumor type, stage, and treatment, virus-exposed solid cancer patients display a dominant impact of SARS-CoV-2, apparent from the resemblance of their immune signatures to those for COVID-19+ non-cancer patients. This is not the case for hematological malignancies, with virus-exposed patients collectively displaying heterogeneous humoral responses, an exhausted T cell phenotype and a high prevalence of prolonged virus shedding. Furthermore, while recovered solid cancer patients' immunophenotypes resemble those of non-virus-exposed cancer patients, recovered hematological cancer patients display distinct, lingering immunological legacies. Thus, while solid cancer patients, including those with advanced disease, seem no more at risk of SARS-CoV-2-associated immune dysregulation than the general population, hematological cancer patients show complex immunological consequences of SARS-CoV-2 exposure that might usefully inform their care.

COVID-19/immunology , Neoplasms/immunology , Neoplasms/virology , Severe Acute Respiratory Syndrome/immunology , Adult , Aged , Aged, 80 and over , COVID-19/etiology , COVID-19/mortality , Female , Hematologic Neoplasms/immunology , Hematologic Neoplasms/mortality , Hematologic Neoplasms/therapy , Hematologic Neoplasms/virology , Humans , Immunophenotyping , Male , Middle Aged , Nasopharynx/virology , Neoplasms/mortality , Neoplasms/therapy , Severe Acute Respiratory Syndrome/etiology , Severe Acute Respiratory Syndrome/mortality , Severe Acute Respiratory Syndrome/virology , T-Lymphocytes/virology , Virus Shedding , Young Adult