ABSTRACT
Objectives: Investigate the utilization of cycled antineoplastic therapies (where dosages vary per monthly supply) for various cancers among Medicare-eligible patients, and medical costs and outcomes associated with discontinuation gaps in monthly adherence. Method(s): This retrospective study used the MarketScan Supplemental and Coordination of Benefits Design databases from 2019-2020. Discontinuations were calculated for 2020 utilizing cycled medications (8 generic products) from 6 therapeutic categories, where discontinuation was defined as the first gap in medication supply during the last 6 months of the year at intervals of >=1.5*prior supply. Continuous enrollment was required, as were ICD oncology diagnosis codes for those at least 65 years of age. New to therapy/diagnosis was inferred from 2019 metric files. Patients were excluded if hospice care and inpatient transplant services were indicated. Models examined adherence level (discontinued or not) and 10 covariates (including COVID-19 indications), with interaction terms, for significant associations with medical costs (inpatient and outpatient), hospitalizations, and length of hospital stay (LOS). Result(s): Patients who met metric criteria (n=1,357;Mean age 73.9) had a discontinuation rate of 16.7%. A total of 64.0% were new to therapy/diagnosis and 5.2% were identified having COVID-19 in 2020. However, COVID-19 was not significantly correlated with a discontinuation. Hospitalization rate was at 30.3% with mean LOS=9.8. Models found significant discontinuation effects with increased total medical costs ($11,977, p<.03), odds of hospitalization (2.7, p<.0001), and LOS (5.4, p<.03). COVID-19 patients had significantly higher total medical costs ($18,145, p<.007), odds of hospitalization (6.3, p<.0001), and non-oncology LOS (4.6, p<.009). Significant covariate interactions are discussed in the poster. Conclusion(s): Medication adherence (fewer gaps in medication coverage) on cycled oral antineoplastics can lead to lower medical costs and fewer hospitalization events or LOS as compared to lower adherence levels. This was independent of COVID-19 indications that were associated with increased costs, hospitalization, and non-cancer LOS.Copyright © 2023
ABSTRACT
Introduction: Despite several studies, the impact of coronavirus disease 2019 on patients with multiple myeloma remains uncertain. Material(s) and Method(s): We performed a survey that covered the period of the first and second waves of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in 23 centers inseven countries. Out of 352 patients with myeloma and SARS-CoV-2, 23% died. Results/Conclusions: Logistic regression showed a lower risk of death among patients treated with proteasome inhibitor and a higher risk of death for those who had a severe or a very severe course of disease.Copyright © 2023 Sciendo. All rights reserved.
ABSTRACT
The process of eliminating viral infection and massive control from spreading furthermore by any variants may lead to a pandemic in the near future. On the other aspect, the impact of eradicating by the initial stage to prevent, treat carcinoma to decline the affected and death rate to maximum amount by Molecular Docking. The quickest and easiest method to search out the potential drugs is by analyzing the ligand-protein interactions compared to the traditional ways. Drugs of antivirals and anti-cancer drugs are given for treating viral infections and cancers. Massive kinds of viruses affect humans with several diseases, from self-curable diseases to acute mortal diseases. In cancer, the diseases are known by the cells within humans;multiplication occurs and forming the tumors of malignant cells with the flexibility to be a pathological process. Herbal medicines are known to play enormous role by giving initial priority. Various plant species are being employed to cure or prevent viral infections and cancers. Molecular docking provides a fast understanding of the ligand's exploration of conformations, poses among drug targets' binding sites, and predicts the binding affinity of protein-ligand. Its main approach is to spot top-ranked conformations on compounds and means of docking to the active site of target of interest. Intake of naturally suggested fruits and vegetables leads to the goal of decreasing the death rate, and the count of females who are liable to breast cancers.Copyright All © 2023 are reserved by International Journal of Pharmaceutical Sciences and Research.
ABSTRACT
Herbal plant extracts or purified phytocomponents have been extensively used to treat several diseases since ancient times. The Indian Ayurvedic system and Chinese traditional medicines have documented the medicinal properties of important herbs. In Ayurveda, the polyherbal formulation is known to exhibit better therapeutic efficacy compared to a single herb. This review focuses on six key ayurvedic herbal plants namely, Tinospora cordifolia, Withania somnifera, Glycyrrhiza glabra/Licorice, Zingiber officinale, Emblica officinalis and Ocimum sanctum. These plants possess specific phytocomponents that aid them in fighting infections and keeping body healthy and stress-free. Plants were selected due to their reported antimicrobial and anti-inflammatory effects in several diseases and effectiveness in controlling viral pathogenesis. An ad-vanced literature search was carried out using Pubmed and google scholar. Result(s): These medicinal plants are known to exhibit several protective features against various diseases or infections. Here we have particularly emphasized on antioxidant, anti-inflammatory, anti-microbial and immunomodulatory properties which are common in these six plants. Recent literature analysis has revealed Ashwagandha to be protective for Covid-19 too. The formulation from such herbs can exhibit synergism and hence better effectiveness against infection and related dis-eases. The importance of these medicinal herbs becomes highly prominent as it maintains the har-monious balance by way of boosting the immunity in a human body. Further, greater mechanistic analyses are required to prove their efficacy in fighting infectious diseases like Covid-19. It opens the arena for in-depth research of identifying and isolating the active components from these herbs and evaluating their potency to inhibit viral infections as polyherbal formulations.Copyright © 2023 Bentham Science Publishers.
ABSTRACT
Hyssopus officinalis is a traditional medicinal plant that belongs to the family Lamiaceae, which has been used for centuries for various purposes like carminative, expectorant, and cough reliever. It has been used for the treatment of numerous diseases in patients such as ulcers, asthma, jaundice, leprosy, dropsy, bronchitis, COPD, diabetes, AIDS, bacterial and fungal infections as an herbal remedy due to its fewer side effects and is more efficacies than other traditional medicine. Major classes of chemical compounds found in H. officinalis essential oil are bicyclic monoter-penes, monoterpenoids, acyclic monoterpenes, phenolic monoterpenoids, monocyclic monoterpenes, monocyclic sesquiterpenes, tricyclic sesquiterpenes, bicyclic sesquiterpenes, tricyclic sesquiterpe-noids, straight chain saturated hydrocarbons. Some of the major chemical constituents present in the H. officinalis are beta-pinene, alpha-pinene, 1, 8-cineole, apigenin, diosmin, caffeic acid, rosmarinic acid, cis-pinocamphone, trans-pinocamphone, iso-pinocamphone, pinocarvone, which are responsible for its various pharmacological activity. Various studies have been performed on the pharmacological activity of its extract, such as antioxidant, antimicrobial, anti-diabetic, anticancer, antiviral, anti-inflammatory, analgesic, anti-leishmanial, anthelmintic, anti-protozoal, and anti-anxiety. Recently, it is used as an anticancer agent and has been demonstrated by studying its cytotoxic and apoptotic effects on breast cancer and colon cancer cells. It is used as a potent antibacterial and antifungal agent being studied on the antibiotic-resistant bacterial and fungal strains recently, which can be further useful in developing herbal medicine against AMR. It is an excellent natural antioxidant due to the presence of polyphenolic compounds, and H. officinalis is used in various food industries as a source of natural antioxidants, which has minimum side effects as compared to artificial antioxi-dants. Furthermore, the pharmacological activity of these individual chemical constituents in H. officinalis extract still needs to be investigated for identifying the effectiveness of this plant in the natural treatment of various diseases. This review aims to collect various data regarding the traditional herbal plant hyssop (Hyssopus officinalis), including its photochemistry, chemical structures of the phyto-constituents and pharmacological profile, along with all the pharmacological models. This plant has significant importance in the health industry, so further studies are required on its effective usage against various emerging health problems, including COVID-19, cancer, diabetes, AMR.Copyright © 2023 Bentham Science Publishers.
ABSTRACT
Background Since March 2020, Chile has been affected by the coronavirus disease 2019 (COVID-19) pandemic, which has caused disruptions throughout the world, greatly impacting health services and healthcare workers. Objective To describe the demographic characteristics related to the COVID-19 pandemic in orthopedic surgeons and orthopedic surgery residents in Chile. Methods We conducted an on-line survey requesting data on demographics, work, exposure to and infection by COVID-19, symptoms, and protection practices. Results A total of 567 surgeons answered the survey;37 (6.4%) had had COVID-19, without gender differences. Therewas a higher rate of infectionamong residents, 9 from73 (12.3%), than among surgeons, 28 from 494 (5.7%), as well as higher rates of infection among those working more than 60 hours (p<0.05). Among those infected, 31 (83.8%) were from the Metropolitan Region (MR), where the rate of infection was significantly higher compared with other regions (p< 0.05). Only 8 (21.6%) of those infected had medical history. Hospitalization was required by 3 (5.4%), 1 of them in the Intensive care Unit (ICU), and the remaining were handled at home. The most frequent location of infection was the workplace, with the common areas being the main suspected sites, followed by outpatient clinics and orthopedic surgery wards. In total, 40.5% (15) of the sample reported having infected other individuals. There was also an impact in the surgeon s income: 14.8% (84) reported a decrease lower than 20%, and 45% (256), a decrease higher than 50%. This decrease was higher among surgeons than among residents, and higher among those from the MR compared to other regions (p< 0.05). Conclusion Even though orthopedic surgery practice has been reduced by the pandemic, orthopedic surgeons have been exposed to the risk of infection by COVID-19. The workplace seems to be the site that poses the greatest risk, especially the common areas.Copyright © 2022 Georg Thieme Verlag. All rights reserved.
ABSTRACT
COVID-19 is a disease caused by SARS-CoV-2 that can trigger respiratory tract infection. Due to its tendency to affect the upper respiratory tract (sinuses, nose and throat) or lower respiratory tract (windpipe and lungs), this disease is life-threatening and affects a large number of populations. This virus's unique and complex nature enhances the scope to look into the direction of herbal plants and their constituents for its prevention and treatment. The herbal remedies can have preventive as well as therapeutic actions. This review focuses on various aspects of using herbal medicines for COVID-19, as herbal constituents may also have adverse effects. Various studies revealed that some medicinal plants show life-threatening adverse effects, so selecting plants, and their related studies should be appropriate and strategic. This article includes various factors that should be considered before herbal drug use in COVID-19 patients. These are clinical trials, safety, molecular mechanism, and self-medication, which have been elaborated. This article also discusses the targets of covid-19 and different coronavirus strains. As before, treatment diagnosis of the disease is very important. Various patents have been filed and granted for its proper diagnosis so that its treatment can be easy.Copyright © 2022 Society of Pharmaceutical Sciences and Research. All rights reserved.
ABSTRACT
Background: There has been lot of speculation around the possible side effects associated with COVID vaccination and incidence of facial palsy is one of them. Bilateral facial palsy is less likely to be idiopathic as compared to unilateral facial nerve palsy and warrants further investigations to find any secondary cause. COVID 19 infection and the vaccinations for the same are also included in the unique list of differentials. Case report: We report an interesting case of bilateral rapidly sequential facial nerve palsy following the administration of COVID vaccination that showed subsequent improvement. We provide literature review to report the current incidence of same, secondary to the vaccination as well the infection itself Case presentation: Following the introduction of COVID 19 vaccine, there have been reports of various cranial nerve involvement including lower motor neuron type facial paresis. Bilateral facial palsy is less likely to be idiopathic as compared to unilateral palsy(23% vs 70%) and requires further work up to determine the etiology before determining to be idiopathic. Unilateral facial palsy(FP) has been reported in the Phase I and II trials for Pfizer and Moderna vaccine, with a total of 7 cases reported in these initial trials. To date, there is no direct evidence that these vaccines have increased the incidence of facial palsy as compared to adverse events reported with other vaccines or compared to COVID 19 infection itself. We report a unique case of bilateral lower motor neuron type facial palsy noted in a young male within hours of receiving the vaccine that later improved with treatment. Reports of simultaneous bilateral facial palsy after vaccine are rare with only few cases reported to date in literature. Conclusion(s): In conclusion from current available literature, we would like to postulate that though there is a risk of facial nerve palsy following the vaccination, it is comparable to the risks associated with any other vaccinations and not been higher than the non-vaccinated population. The overall risk is higher with the actual COVID 19 infection itself as compared to the vaccine.Copyright © 2022
ABSTRACT
Introduction: Efficient and comprehensive trial oversight and data management ensures valid, robust outcomes necessary to inform health policy and improve patient outcomes. This is particularly challenging in the context of multicenter trials. The format of this session will include four introductory presentations (15 min each), followed by 30-min panel discussion/Q&A focusing on recent experiences and innovative approaches utilized within the Wake Forest NCI Community Oncology Research Program Research Base (WF NCORP RB). Since 2017, WF has managed 15 studies with approximately 3000 patient and 1000 provider/stakeholder accruals across 1000 potential participating community oncology practices within the United States and Puerto Rico. These practices often operate differently from academic medical centers, with varying patient capacity, provider number and level of engagement, use of advanced practice providers, and services offered. In addition, practices within this network have heterogeneous utility of electronic health records (EHRs) and display a wide range of clinical research staffing models. The COVID-19 pandemic has highlighted the need for streamlining research visits and maximizing telehealth technologies when applicable, particularly for intervention non-therapeutic clinical trials. As such, research expectations must be standardized to ensure quality trial conduct and data collection across diverse practices. Recently, the WF NCORP RB has taken many steps to improve efficiency and data quality across our studies. This session will discuss a comprehensive approach to data quality and management across the lifespan of a trial. This starts with consent/ recruitment strategies and general oversight/ monitoring of our portfolio of trials. WF RB now utilizes REDCap for all data capture, as this allows direct data entry for site personnel and participant entered patient-reported outcomes using surveys. In addition, REDCap facilitates data monitoring, query, and auditing strategies. We will also introduce a team-based approach to adjudicate complex outcomes. Talk 1 (15 min): Specifically, Karen Craver, our RB administrator, will discuss approaches to obtain robust data as a result of strong screening and recruitment. She will provide an overview on how we survey practice research staff within the Landscape assessment and brief, pre-trial interest surveys to identify optimal target populations during the planning stage. We utilize our internal EHR to create custom screening reports to identify potential participants and generalize these for other practices to customize and use as a screening tool within their clinic. The RB has integrated remote consenting in part due to the pandemic, but we realize the need to continue offering flexibility in consent modality moving forward. Talk 2 (15 min): Emily Dressler, lead Biostatistician, will discuss oversight of the RB portfolio using dynamic reports within Tableau. These reports update daily and provide a comprehensive assessment of all ongoing and completed studies. RB personnel can filter reports to create custom results subset by timeframe, practice or set of practices, trial type, and/or other demographic characteristics. This has greatly reduced the request for study-specific accrual reports and has standardized our reporting across studies. She will also discuss the rationale for transitioning to REDCap, including strengths and weaknesses for integrating in multicenter studies. Talk 3 (15 min): Bill Stanfield, lead data manager, will demonstrate our utilization of the REDCap Data Resolution Workflow and Data Quality modules to efficiently manage data collection, data quality, and audits. He will show how REDCap can be used to seamlessly communicate with research staff to obtain missing or late data, verify out of range values, and then validate and lock responses for analysis. Talk 4 (15 min): Glenn Lesser, WF NCORP multiple principal investigator (mPI), will discuss a team approach to adjudicating cancer treatment information that often consists of combination of surgery, radiation, chemotherapy, or immunotherapy/targeted agents. This remains a particularly challenging problem in large trials enrolling patients with multiple types of cancer who may be treated with a wide spectrum of standard therapeutic regimens. This diversity limits both the effectiveness of automated reviews of remote data entries and the study-specific training of data management staff at sites. Data are pulled in real time from multiple forms within REDCap and collated into participant-level summaries of treatment, starting with the time of baseline assessment and sorted sequentially for each drug administration or event. A multidisciplinary team of data managers, biostatisticians, and clinicians meet to adjudicate each participant as data collection completes. Particularly for trials with multiple cancer types or treatment regimens, our experience with this approach has shown it identifies significant data gaps in treatment, with at least 75% of entries requiring clarification from research staff prior to finalizing and locking data. This process highlighted the challenge of real-time adjudication of treatment data in patients receiving multiple anti-cancer agents, given at varying doses and schedules, and in multiple combinations and/or phases over an individual patient's course of therapy. Panel (30 min): We will conclude with a panel discussion and Q&A. The panel will contribute additional perspective on implications of these strategies in the conduct of multilevel cancer care delivery research studies. We will also incorporate perspectives from NCORP community sites implementing these strategies. Panelists will discuss the broad applicability of these strategies for diverse trials, with attention to size/ complexity, database vendor, and patient population.
ABSTRACT
The role of real-world evidence (RWE) in regulatory, drug development, and healthcare decision-making is rapidly expanding. While RWE cannot substitute the evidence obtained from randomized controlled studies (RCTs), the two can be viewed as complementary sources with the same goal of understanding and improving patient's outcomes. However, the hopes of RWE have been tempered by several critical aspects/ challenges such as quality of data sources, potential for systematic bias, or formulating a research question using causal inference framework. In this session, we will discuss commonly encountered issues and recommend key methodological considerations and potential solutions for (1) assessing representativeness and generalizing results from experimental to non-experimental studies, (2) identifying under-represented groups in clinical trials for pharmacotherapy for opioid use disorder, (3) characterizing and increasing diversity in clinical trials, and (4) assessing biases and constructing valid ''synthetic control'' arms for (oncology) clinical trials. Each speaker will have 15-20 min each, followed by a 10-min discussion. Additional Q&A time will be allocated at the end of the session. The individual s are described in more detail below. (1) Ben Ackerman;Title: Using real-world data to assess representativeness and improve generalizations of study findings Randomized trials are considered the gold standard for estimating causal effects. Trial findings are often used to inform policy and programming efforts, yet their results may not generalize well to a relevant target population if the trial sample is not representative of the population of interest. More specifically, generalizations will be hindered if a trial is not similar to the population with respect to characteristics that moderate the treatment effect. Statistical methods have been developed to assess representativeness and improve generalizability by combining trials with data from non-experimental studies. Real-world datasets derived from electronic health records are promising resources that can supplement trial data when applying such methods. However, identifying the right real-world data source with the appropriate characteristics captured can be challenging in practice. In this talk, we will articulate a framework for combining trial and real-world data to assess representativeness and ultimately addressing concerns of generalizability. Through this framework, we will provide guidance on defining the target population of interest, identifying a suitable real-world data source describing that population, harmonizing across the data sources, and drawing meaningful comparisons between the trial and target population. This work will provide researchers with methods and tools to contextualize trial findings within the target population of interest through the use of real-world data. (2) Kara Rudolph;Title: Characterizing subgroups that are under-represented in clinical trials for pharmacotherapy for opioid use disorder The opioid epidemic in the United States is a public health emergency, exacerbated by the Covid-19 pandemic. Medications for opioid use disorder (MOUD)- injection naltrexone, buprenorphine, and methadone- are the most effective tools for improving outcomes and preventing overdose among persons with opioid use disorder (OUD), but engagement in MOUD, especially long-term engagement typically required for a successful outcome, is unacceptably low. Long-term engagement rates tend to be even lower in real-world settings-what National Institute on Drug Abuse (NIDA) has termed the research-to-practice gap. This discrepancy between trial and real-world MOUD effectiveness could be partially attributable to differences between clinical trial and real-world population characteristics (e.g. in terms of psychiatric and substance use comorbidities, previous treatment experience, and immigration status) if treatment effects are modified (increased/decreased) by some of these characteristics that also relate to trial participation. We identif and characterize clinically meaningful, interpretable subgroups of persons seeking OUD treatment in US usualcare settings who are not represented or underrepresented in MOUD trials based on multiple characteristics simultaneously. This moves us beyond existing approaches for assessing representation that have generally been limited to considering one individual-level characteristic at a time (e.g. race/ethnicity). (3) Madison Stoms;Title: Minority representation in clinical trials: generalizing trial results to diverse populations Since its origin, medical research has persistently lacked minority representation. In 2020 alone, the US Food and Drug Administration (FDA) reported that a mere 6% and 11% of clinical trial participants report Black and Hispanic race, respectively. Along with efforts to directly increase representation, via revised recruitment strategies, methods are being developed to leverage external data containing information on under-represented populations. The field from which these methods arise, real-world evidence (RWE), is rapidly emerging and aims to address clinical questions outside the scope of clinical trials. In this talk, we focus on generalizability and transportability methods, which can be used to extrapolate results from mostly racially homogeneous samples to diverse populations. We will also discuss the current state of diversity in clinical trials, important assumptions of generalizability and transportability methods, and applications relevant to increasing racial/ethnic representation. (4) Elizabeth Garrett-Mayer;Title: Leveraging RWD for new indications for FDA-approved anticancer agents: are we there yet? Vast amounts of health outcome data are available in real-world datasets (RWDs), like electronic health record databases and medical claim databases. In rare disease settings, performing randomized trials may be resource-intensive and inefficient due to accrual challenges. Efforts have been made to derive ''control arms'' from RWDs, representing a standard of care treatment arm, so all (or most) patients prospectively enrolled in a trial can be assigned to an experimental arm. Major challenges exist in ensuring that comparisons between the arms are meaningful, valid, and unbiased. This talk will discuss challenges, including potential for biases, harmonizing outcome measures, and efforts moving forward that will facilitate supplementing clinical trial data with RWD.
ABSTRACT
Background: The pattern of new drug approval is changing across the world as shown by the study using Center for Drug Evaluation and Research and European Medicines Agency data in US and UK with more drug approval for anti-cancer and immunomodulator drugs. There is a need to generate similar database for developed South East Asian countries too. Aims and Objectives: This study was conducted for one such country-Singapore for the new drug approval pattern of last 5 years (2017-2021). Material(s) and Method(s): This was a pharmacoepidemiological study, in which government drug regulatory website data available in public domain was searched. The new drug approval data were classified according to active ingredient, drug approval date, new drug application category, indication of drugs, and World Health Organization Anatomic Thoracic Classification. Result(s): In this study, 418 new drug approvals were found in last 5 years in Singapore. From this maximum, drug approvals were given to anti-neoplastic and immunomodulator category drugs. In anti-neoplastic category new drugs approval few examples were Trastuzumab deruxtecan and Tucatinib for breast cancer therapy and Tepotinib and Capmatinib for non-small cell lung cancer therapy. Conclusion(s): This study shows that drug development in anti-cancer drug and immunomodulator is significant in Singapore. This trend is quite matching with other country such as US and UK.Copyright © 2023 Priti Solanky, et al.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has become a major global public health event as a new acute respiratory infectious disease. During the COVID-19 pandemic, compared with the healthy population, cancer patients had a higher risk of developing comorbidities of other systems, due to their bad poor immunity and older age. Research showed that breast cancer, as a malignant disease, had the highest disease incidence in female patients. Breast cancer patients with COVID-19 infection often have worse prognosis, and they have to postpone anti-tumor treatment due to COVID-19 infection. At present, the effect of delayed treatment on the survival rate of breast cancer patients is unclear, and whether the treatment plan of these patients should be adjusted is still being studied. Through the systematic review of existing clinical research studies, the guidelines of various societies and the expert consensus, this paper reviews the selection and rationalization of breast cancer treatment options under the COVID-19 epidemic, and discusses the opportunity and approaches of anti-tumor treatment for breast cancer patients infected with COVID-19.Copyright © 2022 Editorial Department of Journal of Shanghai Second Medical University. All rights reserved.
ABSTRACT
The remarkable success of messenger RNA vaccines against the ongoing coronavirus-2019 (COVID-19) pandemic renews attention toward nucleic acid therapeutics. While nucleic acid therapy using unmodified DNA or RNA is the primary focus in disease treatment, there is growing need to develop nucleic acid-based small molecules owing to their potential clinical benefits as drugs in terms of cost and scalability. While small molecules targeting protein-protein interactions are known to alter the transcriptional status of a cell, they can result in a transient effect and variation of bio-efficacy among patients. Small molecules targeting DNA and/or RNA are in demand in the precision medicine approach as they have consistent bioactivity among patients. This review details the progress of sequence-specific DNA-binding pyrrole-imidazole polyamides (PIPs) in modulating the transcriptional status of target gene(s) without altering the underlying DNA sequence. Here, the different versions of PIPs are listed, and also, how conjugating them with DNA alkylating agents, epigenetic modulators, and other drugs can improve their clinical utility as targeted transcription therapeutics. Owing to their specificity, functional diversity, and limited toxicity, PIP technology holds enormous promise as frontrunner in small-molecule-based nucleic acid drugs to precisely regulate therapeutically important genes on demand and treat intractable diseases.Copyright © 2023 Wiley-VCH GmbH.
ABSTRACT
The incidence of cancer continues to rise, with an estimated 1 in 2 of the UK population born after 1960 diagnosed with malignancy at some point during their lifetime. This is in the context of an ageing population with increasing multimorbidity and polypharmacy. Cancer patients are frequent users of emergency care services and have a high rate of ambulance conveyance and hospital admission after review in emergency departments. Presentations can be a consequence of the cancer, its treatment or coexistent morbidity. Given the expanding armamentarium of cancer therapies, acute and general physicians are faced with a myriad of complex issues and require a knowledge of the broad principles of initial assessment, initial management and timely access to the wider multi-professional cancer team. © 2022
ABSTRACT
Introduction: Identifying the patients at higher risk for poor outcomes after radiotherapy (RT) during coronavirus disease 19 (COVID-19) era is an unmet clinical need. Methods: The Ovid MEDLINE, Ovid Embase, Clarivate Analytics Web of Science, PubMed and Wiley-Blackwell Cochrane Library databases were searched. Eligible studies were required to address the outcomes of cancer patients who underwent RT during the COVID-19 era. The primary outcome was early mortality, while secondary outcomes included length of hospital stay, hospital admission, intensive care unit (ICU) admission and use of mechanical ventilation. Pooled event rates were calculated, and meta-regression and 'leave-one-out' sensitivity analyses were performed. Results: Twelve eligible studies were included out of 928. The prevalence of early mortality after COVID-19 infection was 21.0%. The prevalence of hospital admission, ICU admission and mechanical ventilation was 78.1, 15.4 and 20.0%, respectively. Meta-regression showed that older age was significantly and positively associated with early mortality (β = 0.0765± 0.0349, p = 0.0284), while breast cancer was negatively associated with early mortality (β=-1.2754±0.6373, p = 0.0454). Conclusions: Older age adversely impacts the early mortality rate in cancer patients during COVID-19 era. The risks of interruption/delay of cancer treatment should be weighed against the risk of increased morbidity and mortality from the infection. A global registry is needed to establish international oncologic guidelines during the COVID-19 era. © 2021 The Author(s).
ABSTRACT
Background: Colorectal cancer remains the fourth most common malignancy in Korea, and has been ranked as the third leading cause of cancer deaths in 2020. This study aims to describe the epidemiologic status of colorectal cancer in Korea, and provide basic data for effective primary and secondary prevention methods by summarizing risk factors and screening tools. Current Concepts: Although colorectal cancer incidence and mortality have decreased in recent years in Korea, it still poses a significant public health burden. From the early 1990s until the mid-2000s, the 5-year relative survival of patients with colorectal cancer in Korea continuously increased. This can be attributed to the successful introduction of the government-led screening program;development of improved surgical techniques, anticancer drugs, and adjuvant treatment;and advances medical resources and infrastructure along with economic growth. However, since the late 2000s, the improvement in survival has stagnated. The coronavirus disease 2019 outbreak has reduced hospital visits and screenings, which is assumed to cause delays in diagnosis, leading to a worse prognosis in the patients. To overcome these obstacles, it is essential to explore modifiable environmental risk factors and appropriate screening test methods in Korea. Discussion and Conclusion: Primary prevention through risk factor modification and secondary prevention using suitable screening programs can reduce the incidence and mortality rates of colorectal cancer.