Oncology workload in a tertiary hospital during the COVID-19 pandemic

Introduction: Workload in oncology during a pandemic is expected to increase as manpower is shunted to other areas of need in combating the pandemic. This increased workload, coupled with the high care needs of cancer patients, can have negative effects on both healthcare providers and their patients. Method(s): This study aims to quantify the workload of medical oncologists compared to internal medicine physicians and general surgeons during the current COVID-19 pandemic, as well as the previous H1N1 pandemic in 2009. Result(s): Our data showed decrease in inpatient and outpatient workload across all three specialties, but the decrease was least in medical oncology (medical oncology -18.5% inpatient and -3.8% outpatient, internal medicine -5.7% inpatient and -24.4% outpatient, general surgery -17.6% inpatient, and -39.1% outpatient). The decrease in general surgery workload was statistically significant. The proportion of emergency department admissions to medical oncology increased during the COVID-19 pandemic. Furthermore, the study compared the workload during COVID-19 with the prior H1N1 pandemic in 2009 and showed a more drastic decrease in patient numbers across all three specialties during COVID-19. Discussion(s): We conclude that inpatient and outpatient workload in medical oncology remains high despite an ongoing COVID-19 pandemic. The inpatient medical oncology workload is largely contributed by the stable number of emergency department admissions, as patients who require urgent care will present to a healthcare facility, pandemic or not. Healthcare systems should maintain manpower in medical oncology to manage this vulnerable group of patients in light of the prolonged COVID-19 pandemic. Copyright © The Author(s) 2022.

The Cancer Patient between Complication and Complexity: The External Individual World in Cancer Treatment

Background: Complication and complexity are two aspects that the cancer patient carries with him during the time he spends in cancer treatment. The tumor is to be considered a disease that is part of the biological complications that affect one or more organs of our body, which refer to a very specific treatment, to surgical interventions of a certain type, to any pain therapy, etc. Complexity, on the other hand, represents a term that refers to the description of the ensemble that make up the individuality of the cancer patient. Therefore, within the treatment, various elements that are part of the patient's world and that can represent a strength in the oncological path must be taken into consideration. Material(s) and Method(s): 80 patients from the oncology ward participated in the research, recruited in 2019 (n = 40) and in 2020-2021 (N = 40). The semi-structured clinical psychological interview, lasting one hour, was used as a data collection tool, which examined the evaluation of the patient's depression, anxiety and altered emotional states regarding the presence or fewer family affections during hospitalization, visits from friends, knowledge of one's status as a cancer patient. Result(s): From the analysis of the data it emerges that the oncological patients who suffered from depression, anxiety or elements attributable to altered emotional states in 2019 are 32.50% of the sample examined while in 2020 and 2021 the recorded incidence includes about 90.00% of the sample. This higher incidence derives mainly from the consequence of the closure to visits by family members in the medical oncology ward for the sars-cov-2 pandemic, rather than from the other factors taken into consideration, leading, in the most serious cases, to requests for early discharge by of the patient himself. Conclusion(s): Understanding the worlds within the cancer patient should not be seen as an obstacle to treatment but as a resource to be used to improve patient compliance. Placing the complexity of the individual at the center of the analysis determines a decrease in anxiety, depression and altered emotional states with an increase in the doctorpatient relationship, effectiveness of treatments, circulation of information and trust in care.

The Global Status of Universal Health Coverage and Oncology Care

The reduction of preventable deaths from non-communicable diseases, including cancers, is one of the main targets of universal health coverage. Not only there is a shortage of financial resources for universal health coverage for cancer patients in many coun-tries, but also there are many challenges in the continuity and the quality of care. There are disparities rooted in both providers’ and patients’ behavior at the time of care. Unmet needs for information on treatment and prognosis, inadequate cost coverage of care, and inadequate support for other living costs are contributing factors to poor prognosis in cancer patients, especially in cases with advanced stages and those living in low-income countries. There is a need for a comprehensive, holistic approach to the care of cancer patients considering the patients’ socioeconomic and cultural status and the institutional status of the providers.

SCREENING AND PREVENTION OF JOB BURNOUT IN THE COVID ERA: AN ITALIAN EXPERIENCE

Introduction the risk of healthcare workers (HCWs) burnout is affected by individual and organizational factors and has been dramatically increased by the COVID-19 pandemic. Since 2007 the Oncology Department of the Udine University-Hospital has cooperated with a network of psychologists to explore the organizational climate and prevent work-related stress. The last survey was conducted from april to june 2021. Methods the items included were: job burnout, emotional intelligence, quality of communication among HCWs, ethical dimension, leadership, relationship with cancer and death. Anonymous questionnaires were administered to 94 HCWs: medical oncology consultants and trainees, nurses, HC assistants, psychologists and administrative staff. Professional category, age and length of service were the variables considered. Results despite the work overload observed in 2021, our group remained solid as critical situations were contained. Emotional health in the end-of-life setting was nurtured to prevent HCWs distress. Job burnout remains a critical issue, also due to a growing administrative burden, tensions experienced by HCWs and the absence of caregivers in the oncologic ward. To limit job burnout, it may be crucial to train HCWs in communication, doctor-patient relationship skills and team-building activities. Conclusions preventing job burnout with targeted interventions to promote teamhealth is crucial, especially during the pandemic.

CANCER PATIENT MANAGEMENT DURING COVID-19 PANDEMIC: AN AUDIT OF A SINGLE-SURGEON UNIT IN A COVID-HOTSPOT

Introduction Pandemic has affected health care globally affecting the routine practices in hospitals. Treatment delivery for cancer patients posed specific challenges in lieu of reducing risk of exposure. The current report evaluates the effect of COVID-19 on breast cancer treatment and management at a single-surgeon cancer care unit in one of the hotspots in India. Prashanti Cancer Care Mission (PCCM), is a public charitable trust that supports an Oncosurgeon's practice with a mission to support cancer patients by providing subsidized treatment, counselling, and fostering support group activities. PCCM's Orchid's Breast Health clinic is a multidisciplinary health care unit working closely in association with PCCM's research arm Centre for translational cancer research (CTCR). Methods In response to the pandemic, adjustments were made in the clinical practice to accommodate social distancing. Patient consultations were done over phone call or in-clinic visit with prior appointment to reduce the risk of exposure. Total number of patients treated at the clinic, total footfall, chemotherapies administered, and essential surgeries performed were assessed Results The report summarizes the effect of pandemic on cancer care and management at a single unit of cancer clinic through various phases of lock-down that were implemented in India to curb the spread of COVID-19. Conclusions The methodology adopted here for care and management of the cancer patients can serve as a guiding principle for cancer care units in the country.

Improving compliance with blood and platelet transfusion thresholds on a tertiary haematology ward

Restrictive transfusion thresholds are accepted as optimal blood management for patients receiving transfusions. 1 Unnecessary blood transfusions result in increased blood product shortages (exacerbated by the COVID-19 pandemic), 2 adverse patient outcomes and significant costs to health systems. 3 To improve transfusion practice, we aimed to minimise inappropriate transfusions through exploring and targeting areas of noncompliance with locally agreed red blood cell (RBC) and platelet transfusion thresholds of 80 g/l and 10∗109/l respectively. We conducted a retrospective multicycle audit over 4 months (Aug 2020, Feb 2021, May 2021 and Jun 2021) for all patients on the Haematology-Oncology ward. Standards were set at 100% compliance with local hospital guidelines. We analysed the number of RBC and platelet transfusions, pre-and post-transfusion haemoglobin and platelet counts, and clinical indications for transfusion. Actions implemented following each cycle composed of departmental meetings, teaching for foundation doctors and trainees, trust guideline updates and creation of a RBC transfusion checklist on our electronic 'EPIC' prescribing system. 4 Percentage compliance for RBC transfusions improved from 89% to 95% following actions implemented per audit cycle. Inappropriate RBC transfusions associated with discharge decreased from 10% to 1% and transfusion of two RBC units without appropriate increment decreased from 10% to 3%. Although percentage compliance of platelet transfusions did not improve from Aug 2020 to Jun 2021, they were consistently higher (97%) compared to RBC transfusions. This may be secondary to differing causes for inappropriate platelet transfusions detected each cycle. Despite inappropriate HLA-platelet use detected in the latest cycle, there are improvements in documentation to justify platelet transfusions outside normal threshold (100% in latest cycle), total number of platelets transfused and transfusion associated with discharge. Our audit has been successful in improving overall transfusion practice on the Haematology-Oncology ward. Ongoing education and re-audit will ensure this is maintained. (Table Presented).

A proposal of a "ready to use" COVID-19 control strategy in an Oncology ward: Utopia or reality?

The Coronavirus Disease-2019 (COVID-19) pandemic is spreading in Italy and Lombardy is one of the most affected region. Cancer patients are higher risk of complication from COVID-19 complications; therefore they should be protected from contagion while still ensuring access to cancer care. The aim of this article is to suggest a strategy to reorganize hospital spaces and Healthcare Professionals (HCPs) staff in order to avoid COVID-19 nosocomial infection in an Oncology ward. SARS-CoV-2 is primarily transmitted through respiratory droplets and by contact. We speculated that precautions against droplet and contact transmission should be the proper way to preserve ward from COVID-19. The essence of our protocol involves: triage outside of the ward, identification of risk zones, traffic control, surveillance of all the involved subjects. Whoever attends the ward must follow the general risk prevention and mitigation measures. The application of this practical strategy can contribute to breaking the cycle of community-hospital-community transmission.