ABSTRACT
Introduction: Colorectal Cancer (CRC) is on the rise, prompting the need for earlier screening in the United States (U.S.) population. The American Cancer Society now recommends screening for CRC in patients with average risk at the age of 45. Further complicating this picture, the COVID-19 pandemic has disrupted the routine screening process for CRC, which we hypothesize has impacted the stage at which CRC is detected. We sought to determine the extent to which the COVID-19 pandemic has affected colorectal cancer diagnosis trends at a large urban community hospital. Method(s): We performed a retrospective analysis of patients, comparing two time periods: pre-pandemic (1/1/2019-1/31/2020) and during COVID pandemic (2/1/2020-9/29/21). Data was extracted from the electronic medical record (EMR) to compile a database of patients diagnosed with CRC during these time periods. Patients included in this study had a new diagnosis of colorectal cancer and either followed with colorectal specialists at the hospital or had undergone tissue biopsy analysis by the Department of Pathology. The primary outcome was determining the stage at which CRC was detected and the modality utilized for CRC screening in that patient. Additional variables collected were as follows: age, pathological findings (grade, presence of tumor mutations, or microsatellite instability), gender, race, and insurance. Result(s): Data was collected from a total of 380 patients, which included 190 patients diagnosed with CRC within the timeframe defined as pre-pandemic and 190 diagnosed with CRC within the timeframe defined as during the pandemic. CRC diagnosis was analyzed in terms of TNM stage at time of diagnosis (Stages 0 through IV). Stage III and IV were grouped together and categorized as a late-stage diagnosis, whereas Stages 0, I, and II were grouped together and categorized as an early-stage diagnosis. Late-stage diagnosis was found in 34.7% (66/190) of patients in the pre-pandemic group. In comparison, late-stage diagnosis was found in 46.3% (88/190) of patients in the during pandemic group. Conclusion(s): Our results suggest that the COVID-19 pandemic did produce delays in care and work-up for CRC. We believe this is why CRC stage at the time of initial diagnosis was later for patients diagnosed during the pandemic than for patients diagnosed prior to the pandemic. In the future, we hope to evaluate if the impact of COVID-19 is reflected in tumor grade and genetic mutations at the time of diagnosis, and determine race and gender disparities.
ABSTRACT
Background: The COVID-19 pandemic had a significant impact on the healthcare system globally, including oncology. Which, in turn, led to significant delays in diagnostic and therapeutic procedures. This work aims to evaluate COVID-19 impact on the treatment of bone sarcoma in adult patients based on experience in a single, high-volume institution. Method(s): We have analyzed the early local outcomes (i.e., the possibility of limb-sparing surgery) in all patients with primary bone tumours treated between 2016-01-28 and 2022-11-07 in Polish main sarcoma reference center. Patients treated in the 2016-2019 period were labelled as a "pre-pandemic" group, and patients treated in the 2020-2022 - "pandemic". Mann-Whitney U and Chi-square tests were used in the statistical analysis. Result(s): There were 302 eligible patients identified. The group characteristics are presented in the table. There were no differences in patient-related variables and histological subtypes of tumours between the two groups. The tumour size did not differ (p = 0.053), when all tumour grades were considered, but high-grade tumours were larger in the "pandemic" group (p = 0.034). This was reflected in the percentage of limb-sparing surgeries which dropped from 83.3% to 68.2% ("pre-pandemic" vs "pandemic", p = 0.004). This difference was even more evident in the case of high-grade tumors - 78% vs. 54%, respectively (p = 0.001). [Formula presented] Conclusion(s): To our knowledge, this is the first report of the long-lasting detrimental impact of the COVID-19 pandemic on oncologic treatment outcomes in adult patients with primary malignant bone tumors. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology
ABSTRACT
Background: The effect of time to surgery after completion of neoadjuvant chemotherapy and outcomes in breast cancer patients remains poorly defined and unclear. Acceptable time to surgery has frequently been arbitrarily defined as between four to eight weeks. Various factors including resource limitation, scheduling conflicts, complications after chemotherapy, patient hesitation or interruptions from major events such as the recent Covid-19 pandemic can delay time to surgery, raising concern of an adverse impact on recurrence and survival outcomes. This study aims to ascertain if time to surgery after completion of neoadjuvant chemotherapy impacts disease free survival (DFS) and overall survival (OS). Material(s) and Method(s): This single-institution retrospective study included patients who underwent neoadjuvant therapy and subsequent surgery from 2006 to 2017. Demographic, clinicopathological factors and surgical data from 250 patients were analysed. 105 patients received surgery within 28 days (group 1). 119 patients received surgery within 29 to 56 days (group 2), and 26 patients received surgery after 57 days or more (group 3). DFS and OS among the three groups were compared. Result(s): Age, race, pre-chemotherapy stage, tumour type, grade, hormone receptor status, Her2 status, focality, lymphovascular invasion (LVI), radiological response to chemotherapy, type of surgery, pathological response to chemotherapy, and receipt of adjuvant radiotherapy were not significantly different between the three groups. Receipt of adjuvant chemotherapy was statistically significant (p = 0.0248) with 39 patients (37.1%) in group 1, 32 patients (26.9%) in group 2 and 3 patients (11.5%) in group 3 receiving further chemotherapy after surgery. Mean follow-up duration was 44.5 months. DFS and OS between the three groups were not found to be significantly different (p = 0.5920 and p = 0.6133 respectively). Conclusion(s): Time to surgery after completion of neoadjuvant chemotherapy did not appear to affect recurrence or survival outcomes. This result was demonstrated despite fewer patients in the group with the longest duration to surgery receiving adjuvant chemotherapy. This may be due to the efficacy of neoadjuvant chemotherapy in decreasing or eliminating micro-metastatic disease, an important factor in cancer recurrence and survival. Limitations of this study includes its retrospective nature and small sample size. Findings from this study may allow more flexibility and reduce the burden of scheduling patients for surgery within the usual four to eight week window in centres with resource and scheduling constraints. Further studies examining a larger population over a wide range of time durations could help clinicians better tailor time to surgery after neoadjuvant therapy. No conflict of interest. Copyright © 2022 Elsevier Ltd. All rights reserved
ABSTRACT
Background: Maintenance in FL patients (pts) improves progression free survival (PFS). SARS-Cov2 pandemic posed unique challenges for immunocompromised pts. Aims: The aim is to evaluate the outcome of FL pts in maintenance with antiCD20-MoAb during SARS-Cov2 pandemic and how suspension of therapy affected lymphoma outcome and the risk of SARS-Cov2 infection and its morbidity and mortality. Methods: This is an observational, multicenter, retrospective and prospective study. Results: A total of 420 from 18 Italian Hematological Centers were included in the analysis. Median age was 62 years old (range 27-91 years), 216 pts (51%) were male. Main clinical characteristics of the population were: histological grade 1-2 vs 3A in 288 (69%) vs 109 (26%), while not valuable in 23 (5%) pts;limited I-II vs advanced III-IV stage in 57 (14%) vs 361 (86%) pts, not reported in 2 cases. FLIPI score was low vs intermediate vs high in 71 (17%) vs 151 (36%) vs 192 (46%) patients, respectively, not valuable in 6 cases. All 420 patients included were in maintenance treatment with antiCD20 MoAb at the time of the onset of SARS-Cov2 pandemic (March 2020): 333 (79%) pts were receiving maintenance after a first line, while 87 (21%) after a second line. 342 (81%) pts were receiving Rituximab, while 75 (18%) Obinutuzumab, 3 patients did not start the planned maintenance because of pandemic spread. Status of disease after induction was complete remission (CR) in 374 (89%), partial response (PR) in 41 (10%), progressive disease (PD) in 1, not evaluated in 4 pts, respectively. At the end of maintenance was CR in 265 (63%), PR in 19 (4%), stable disease (SD) in one and PD in 14 (3%) patients, respectively, maintenance is stiil ongoing in 121 (29%) pts. Because of SARS-Cov2 pandemic from March 2020 consequences on maintenance treatment were: temporary suspension in 122 (29%), definitively interruption in123 (29%), no modification in 175 (42%) of pts, respectively. Median number of maintenance treatment administered at the time of SARS-Cov2 pandemic onset was 2 (range 1-12), median number of courses administered at the time of analysis was 8 (range 0-12), in patients who modified treatment because of pandemic median number of performed courses was 7 (range 0-11) and median number of lost cycles were 2 (range 1-12). Pts were divided into two groups according to type of approach to maintenance during pandemic: pts who interrupted maintenance (temporary or definitively): groups A (245 (58%) pts) vs pts who did not modified maintenance: group B (175 (42%) pts). No differences in clinical characteristics, type of therapy and response were observed between the two groups. 29(7%) relapses were observed: 16 (7%) vs 13 (7%) in group A vs B, respectively. 70 (17%) pts experienced SARS-Cov2 positivity: 47 (19%) vs 23 (13%) in group A vs B, respectively. 53 (76%) pts had symptomatic COVID syndrome and 43 (61%) were hospitalized, with no differences between the two groups. Anti-SARS-Cov2 vaccine was administered in 349 patients, serology assessment was done in 46% of cases, showing 21 (13%) reactive vs 138 (87%) not reactive pts, with no differences between the two groups. 21 (30%) pts died because of COVID: 9 (19%) vs 12 (52%) in groups A vs B, respectively. Summary/Conclusion: Suspension of maintenance treatment during SARS-Cov2 pandemic did not show a protection in terms of SARS-Cov2 positivity and morbidity. A trend in lower mortality is suggested. No differences in terms of relapse rate were observed, but longer follow up is needed.
ABSTRACT
Background: Maintenance in FL patients (pts) improves progression free survival (PFS). SARS-Cov2 pandemic posed unique challenges for immunocompromised pts. Methods: This is an observational, multicenter, retrospective and prospective study. The aim is to evaluate the outcome of FL pts in maintenance with antiCD20-MoAb during SARS-Cov2 pandemic and how suspension of therapy affected lymphoma outcome and the risk of SARS-Cov2 infection and its morbidity and mortality. Results: 420 pts from 18 Italian Centers were included. Median age was 62 years old (range 27-91), 216 pts (51%) were male. Main clinical characteristics were: histological grade 1-2 vs 3A vs not valuable in 288 (69%) vs 109 (26%) vs 23 (5%), respectively;advanced stage in 361 (86%), high FLIPI score in 192 (46%) pts. All 420 pts were in antiCD20-MoAb maintenance at the time of SARS-Cov2 pandemic onset (March 2020): 333 (79%) were receiving maintenance after a first line, while 87 (21%) after a second line. 342 (81%) pts were receiving Rituximab, while 75 (18%) Obinutuzumab, 3 pts did not start the planned maintenance. Status of disease after induction was complete remission (CR) in 374 (89%), partial response (PR) in 41 (10%), progressive disease (PD) in 1, not evaluated in 4 patients, respectively. At the end of maintenance was CR in 265 (63%), PR in 19 (4%), stable disease (SD) in one and PD in 14 (3%) pts, maintenance is ongoing in 121 (29%) pts. Because of SARS-Cov2 pandemic maintenance treatment was temporary suspended in 122 (29%), definitively interrupted in123 (29%), not changed in 175 (42%). Median number of maintenance treatment administered at March 2020 was 2 (range 1-12), in pts who modified treatment median number of performed vs lost courses was 7 (range 0-11) vs 2 (range 1-12). Patients were divided into two groups according to the approach to maintenance during pandemic: pts who interrupted maintenance (temporary or definitively): groups A (245 (58%) cases) vs pts who did not modified maintenance: group B (175 (42%)). No differences in clinical characteristics, type of therapy and response were observed between the two groups. 29(7%) relapses were observed: 16 (7%) vs 13 (7%) in group A vs B. 70 (17%) pts experienced SARS-Cov2 positivity: 47 (19%) vs 23 (13%) in group A vs B. 53 (76%) pts had symptomatic COVID and 43 (61%) were hospitalized, with no differences between the two groups. Anti-SARS-Cov2 vaccine was administered in 349 patients, serology assessment was done in 46% of cases, showing 21 (13%) reactive vs 138 (87%) not reactive patients, with no differences between the two groups. 21 (30%) pts died because of COVID: 9 (19%) vs 12 (52%) in groups A vs B. Conclusions: Suspension of maintenance during SARS-Cov2 pandemic did not show a protection in terms of SARS-Cov2 positivity and morbidity. A trend in lower mortality is suggested. No differences in terms of relapse rate were observed, but longer follow up is needed.
ABSTRACT
Background: Lymphoma is one of the most common primary malignancies of the hematopoietic system. Lymphoid neoplasms are classified into Hodgkin’s and Non-Hodgkin’s lymphoma. Non-Hodgkin lymphoma accounts for about 5% of all cases of malignancies, It is less predictable than Hodgkin lymphoma and more liable for extra-nodal spread. Males are slightly more affected than females with higher incidence in white population. B-cell lymphomas have higher incidence in adults while T-cell lymphomas have higher incidence in children. With many imaging modalities that can describe the morphological changes in lymph nodes, it’s almost exclusive for the PET/CT to describe the biological changes in those lymph nodes through their uptake of FDG which has a great value in determining whether those lymph nodes are affected or not, which in turn will play an important role in treatment & management plan. What gives PET/CT scan the upper hand is that it acts on the biological level of the cells which permit early discovering of the affected lymph nodes, much earlier than standard C.T or MRI scan.
ABSTRACT
Background: Primary causes of tricuspid regurgitation (TR) account for 8-10% of cases, whereas secondary causes account for >90%. Given this disparity, there is paucity of data to help guide treatment. Case: A 55-year-old man presented with DOE, fatigue, and diarrhea. He initially presented to urgent care to be tested for COVID-19, however, was found to have a pulsatile neck and was sent to the emergency department. Further history significant for lethargy, bilateral lower extremity swelling, and PND. On presentation, he was normotensive and tachycardic to 110 bpm. Pertinent physical exam findings included facial erythema, severe jugular venous distention with prominent C-V waves, a holosystolic murmur without radiation, and 2+ lower extremity pitting edema. Pertinent laboratory studies include NT-Pro-BNP of 802 pg/mL (reference range, 15 - 125 pg/mL). Infectious workup was positive for SARS-CoV-2. Transthoracic echocardiogram (TTE) demonstrated preserved ejection fraction of 55-60%, dilation of the right atrium and ventricle with normal function, and a small pericardial effusion. Evaluation of the tricuspid valve showed wide-open regurgitation with thickened and restricted leaflets. Decision-making: Given concern for carcinoid valvular disease, oncologic workup was performed that revealed a serum serotonin of 1493 ng/mL (reference range, 21-321 ng/mL), 24-hour urine serotonin of >300 mg/24 hr (reference range, 0.0-14.9 mg/24 hr), and chromogranin A of 806.7 ng/mL (reference range, 0.0-101.8 ng/mL). PET/CT demonstrated Dotatate uptake within the liver and mesenteric lymph nodes. Percutaneous liver biopsy confirmed metastatic well-differentiated neuroendocrine tumor, grade 1. He was started on octreotide and furosemide for symptomatic management. Currently, he is pending endoscopic tricuspid valve replacement which will be guided by decreased tumor progression. Conclusion: Carcinoid heart disease, while rare, represents an important etiology of valvular dysfunction. Despite a well-recognized clinical entity, establishing a diagnosis and making an individualized treatment plan remains a significant challenge utilizing several subspecialties.