Housing and respiratory health: Exposures, health effects and interventions

Housing quality and affordability are well established as social determinants of health through direct and indirect mechanisms. Respiratory illnesses related to housing are nearly all the result of housing disrepair that allows intrusion into the home of environmental agents that are directly or indirectly associated with disease. Structural deficiencies such as leaks, cracks in the foundation or holes in the home's exterior can facilitate the presence of mould, which is causally linked to the development of asthma and is associated with exacerbation of asthma symptoms in children and adults. Indoor cleanliness can also contribute to the presence of mice and cockroaches. Proper ventilation can improve air quality, reducing exposure to PM, VOCs and infectious respiratory agents. Disparities in exposure to the housing conditions associated with respiratory disease are readily apparent across socioeconomic lines. Low-income families are less likely to be able to afford the costs of maintaining a home, which prevents them from making repairs that could improve respiratory health.Copyright © ERS 2023.

Lung cancer screening use before & during the COVID-19 pandemic in the US: Population-based evidence from 2019-2021

Introduction: Lung cancer is the leading cause of cancer-related death in the US with an estimated 236,740 new cases and 130,180 deaths expected in 2022. While early detection with low-dose computed tomography reduces lung cancer mortality by at least 20%, there has been a low uptake of lung cancer screening (LCS) use in the US. The COVID-19 pandemic caused significant disruption in cancer screening. Yet, little is known about how COVID-19 impacted already low use of LCS. This study aims to estimate LCS use before (2019) and during (2020 and 2021) the COVID-19 pandemic among LCS-eligible population in the US. Method(s): We used population-based, nationally representative, cross-section data from the 2019 (n=4,484), 2020 (n=1,239) and 2021 (n=1,673) Behavioral Risk Factor Surveillance System, Lung Cancer Screening module. The outcome was self-reported LCS use among eligible adults in the past 12 months. For 2019 and 2020, the eligibility was defined based on US Preventive Services Task Force (USPSTF) initial criteria-adults aged 55 to 80 years old, who were current and former smokers (had quit within the past 15 years) with at least 30 pack years of smoking history. For 2021, we used the USPSTF updated criteria- adults aged 50 to 80 years, current and former smokers (who had quit within the past 15 years) with at least 20 pack years of smoking history. We applied sampling weights to account for the complex survey design to generate population estimates and conducted weighted descriptive statistics and logistic regression models. Result(s): Overall, there were an estimated 1,559,137 LCS-eligible respondents from 16 US states in 2019 (AZ, ID, KY, ME, MN, MS, MT, NC, ND, PA, RI, SC, UT, VT, WV, WI), 200,301 LCS-eligible respondents from five states in 2020 (DE, ME, NJ, ND, SD), and 668,359 LCS-eligible respondents from four states in 2021 (ME, MI, NJ, RI). Among 2,427,797 LCS-eligible adults, 254,890;38,875;and 122,240 individuals reported receiving LCS in 2019, 2020 and 2021, respectively. Overall, 16.4% (95% CI 14.4-18.5), 19.4% (95% CI 15.3-24.3), and 18.3% (95% CI 15.6-21.3) received LCS during 2019, 2020, and 2021, respectively. In all years, the proportion of LCS use was higher among adults aged 65-74, insured, those with fair and poor health, lung disease and history of cancer (other than lung cancer). In 2020, a higher proportion of adults living in urban areas reported receiving LCS compared to those living in rural areas (20.36% vs. 12.7%, p=0.01). Compared to non-Hispanic White adults, the odds of receiving LCS was lower among Hispanic adults and higher among Non-Hispanic American Indian/Alaskan Native adults in 2020 and 2021, respectively. Conclusion(s): LCS uptake remains low in the US. An estimated 2,011,792 adults at high-risk for developing lung cancer did not receive LCS during 2019, 2020 and 2021. Efforts should be focused to increase LCS awareness and uptake across the US to reduce lung cancer burden.

How to read a paper about inequality in respiratory disease: Basic epidemiological principles and how inequalities are measured

Health inequalities in respiratory disease are widespread, and monitoring them is important for advocacy, the design and delivery of health services, and informing wider health policy. In this chapter, we introduce the different ways in which health inequalities can be quantified, including measures that quantify absolute and relative inequalities, and those that measure gaps between groups or differences across the entire social gradient. We consider the strengths and limitations of these different approaches and highlight things to look out for when reading a paper on health inequalities in respiratory health. These include how common the outcome is and whether other factors have been adjusted for, as both can have a crucial impact on interpretation and can lead to misleading conclusions.Copyright © ERS 2023.

The relationship between inflammatory diet score and cancer-specific outcomes: Systematic review and meta-analysis

Cancer remains one of the most prevalent diseases in the United States and a leading cause of death. Large prospective studies have found significant correlations between dietary intake and cancer. Chronic inflammation promotes pro-cancer inflammatory environments and nutrition can influence inflammation, with the intake of certain food items increasing inflammatory biomarkers. The objective of this research was to explore the relationship between inflammatory diet score measured by the Dietary Inflammatory index and all-cause mortality, cancer-specific mortality, and cancer recurrence among cancer survivors. Web of Science, Medline, CINHAL, and PsycINFO databases were searched to collect potentially eligible sources that focus on dietary inflammation and cancer outcomes. All sources were uploaded to Covidence software and screened by two independent blinded reviewers. The quality of the sources was assessed using the Newcastle Ottawa scale and relevant data was extracted and transferred to the Comprehensive Meta Analysis software and a random effects model was used to perform meta-analysis. Of the 1444 studies imported into the Covidence software, 13 passed all the screening stages and were included in the final analysis. Eight studies reported on pre-diagnosis diet while five others reported on postdiagnosis diet. Five studies reported on colorectal cancer, four on breast cancer, two on ovarian cancer, one on endometrial cancer and one on prostate cancer. Meta-analysis of the studies found that being in the highest postdiagnosis DII score indicating pro-inflammatory diet significantly increased the risk of all-cause death among cancer survivors by 33.5% (HR = 1.335, 95% CI = 1.049, 1.698, n = 6). Analysis did not show a statistically significant association between DII score and cancer mortality or recurrence (HR = 1.097, 95% CI = 0.939, 1.281, n = 6). Analysis by cancer subtype found a significant correlation between postdiagnosis DII score and all-cause mortality among the breast cancer survivors (HR = 1.335, 95% CI = 1.041, 1.711, n = 3) though there were no significant associations between DII and the outcomes of interest from the other cancer types. The meta-analysis concludes that being in the highest postdiagnosis DII score group significantly increased the risk of all-cause death among cancer survivors. This suggests that risk of all-cause mortality could be reduced for cancer survivors by consuming more anti-inflammatory food components and reducing consumption of pro-inflammatory foods. These findings also warrant more research in this field to clarify the relationship between dietary inflammation as measured by the DII and cancer outcomes, particularly cancer-specific mortality.

Viruses and the risk of lung cancer: prevention and treatment

Lung cancer is the most common cancer in males and the second most common among females both in Europe and worldwide. Moreover, lung cancer is the leading cause of death due to cancer in males. The European region accounts for 23% of total cancer cases and 20% of cancer-related deaths. Relationships have been described between a number of infectious agents and cancers, but our knowledge of the role of viruses, both respiratory and systemic, in the pathogenesis of lung cancer is still rudimentary and has been poorly disseminated. In this chapter, we review the available evidence on the involvement of HPV, Epstein-Barr virus, HIV, cytomegalovirus and measles virus in the epidemiology and pathogenesis of lung cancer.Copyright © ERS 2021.

A narrative review on radiation risk from imaging for COVID-19: Breaking the myths and the mithya

Radiotherapy-induced secondary malignancy is a well-known occurrence. During the COVID-19 pandemic, many people have undergone serial computed tomography (CT) imaging, and concerns have been raised regarding radiation-induced malignancies due to frequent scanning. Accordingly, various low and ultra-low-dose CT (LDCT) thorax protocols have been developed to reduce the dose of radiation. Major governing bodies worldwide have established guidelines regarding the indications for CT scans and chest X-rays during the pandemic. We, therefore, aimed to provide facts about the effects of radiation (both diagnostic and therapeutic). Through this article, we intend to break the myths and 'mithya' (misbeliefs) regarding diagnostic radiation and its association with cancer in this COVID-19 era. For this review, we performed a search in Google using specific keywords pertaining to imaging during COVID-19 and radiation risk. We also included the names of various global governing bodies in the Google search. We included only full text articles and guidelines from authentic websites. From this review, we conclude that if we follow the recommendations of various global governing bodies and use CT scan only in cases of moderate to severe COVID-related symptoms, adhere to the principle of 'as low as reasonably achievable' for radiation protection, and use LDCT scan protocols, we can significantly reduce the mean effective radiation dose delivered and the estimated cancer risk.Copyright © 2023 Cancer Research, Statistics, and Treatment. All rights reserved.

Implications of COVID-19 Pandemic on Ovarian Cancer Mortality

Ovarian cancers are the most prevalent cancers with the highest mortality among women. Most women with advanced stages require multimodal therapy, including surgery, radiotherapy, and chemotherapy. The advent of the coronavirus disease in the 2019 has affected the entire system of healthcare delivery in majority of patients suffering from cancer. During these tough times, patients suffering from ovarian cancer face mental trauma, which involves delays in diagnosis and prognosis, surgeries, chemotherapy, and radiotherapy. Instead of in-person visits, tele consultations were performed with a fear of being infected with the pandemic. This review, have prioritized the repercussions of COVID-19 on patients with ovarian cancer, Monitoring of CA125 trend in patients of ovarian cancer with COVID-19 and how COVID-19 affects the rate of mortality in cancer patients. © 2023 Bharati Vidyapeeth, New Delhi.

Hepatocellular Carcinoma Presenting as a Clival Mass

Introduction: Hepatocellular carcinoma (HCC) comprises the majority of primary liver cancer and has a poor prognosis. Clivus metastasis is rare with only a few reported cases in the medical literature. We report a case of a patient who presented with clival mass found to have metastatic HCC. Case Description/Methods: A 63-year-old woman presented for neurosurgical evaluation after she was found to have a skull base mass on computerized tomography (CT) of the head at an outside hospital. She endorsed dysphagia for three months, however denied headaches or visual disturbances. A magnetic resonance imaging (MRI) revealed a 5.4 cm by 2.9 cm by 3.6 cm mass in the clivus, which was deemed as the cause of dysphagia (Figure 1a). The patient subsequently underwent an endoscopic transsphenoidal resection of the clival mass. Histopathology from the tissue revealed a hepatoid carcinoma, concerning for metastatic HCC (Figure 1b and 2c). Immunohistochemical strains were positive for hepatocytic marker arginase-1 (Figure 1d). Laboratory studies revealed alpha fetoprotein (AFP) of 56,344 ng/mL, CA-125 of 376 ng/mL, normal B-HCG and carcinoembryonic antigen (CEA). Thereafter, a triple phase CT of the liver revealed two LI-RADS 5 lesions suggestive of HCC as the primary malignancy. Patient's case was discussed at multidisciplinary tumor board with recommendations for systemic immunotherapy with atezolimumab plus bevacizumab and radiation therapy to the clivus. Discussion(s): The incidence of HCC has almost tripled since the 1980s making it the fastest rising cause of cancer related deaths. Metastasis to the brain comprises 0.26% to 2.2% of cases and the skull base is the most rarely affected anatomical site. Although CNS presentation is rare, we may see more neurological manifestations of metastatic HCC with the persistence of chronic hepatitis infections, the rise of metabolic diseases such as NASH, and an increase in alcohol-related liver disease during the COVID-19 pandemic. Although exceedingly rare, metastasis to the clivus should be considered in the differential diagnosis of skull base masses. Despite detection and treatment, prognosis remains poor and emphasis should be placed on consistent HCC surveillance. This case emphasizes that skull masses must be evaluated diligently as they can be the first sign of underlying liver malignancy. Given the morbidity and mortality associated with HCC, recognition of atypical manifestations of HCC can lead to a prompt diagnosis and initiation of life-saving treatment. (Figure Presented).

Outcomes of COVID-19 in children with cancer - Report from the Indian Pediatric Oncology Group (InPOG) COVID-19 registry in India

Introduction: The clinical outcomes of COVID-19 infection in children with cancer have been variable worldwide. Therefore, we aimed to collect data from all regions in India through a national collaborative study and identify factors that cause mortality directly related to COVID-19 infection. Method(s): Data was collected prospectively on children across India on cancer therapy and diagnosed with COVID-19 infections from 47 centers from April 2020 to October 2021. Information was recorded on the demographics, the number of children that required intervention, and the outcome of the infection. In addition, we analyzed the impact of the delta variant in 2021. Result(s): A total of 659 children were studied, of whom 64% were male and 36% were female. The data from the eastern region was sparse, and this was a collection bias. COVID-19 infection was predominantly seen in children less than five years. The delta variant had a higher impact in the southern region, and this was statistically significant. Of the 659 children, 30 children died (4.5%), however only 7 of the deaths were directly attributed to COVID-19 infection (1%). Conclusion(s): The study reports the largest nationally representative cohort of children with cancer and COVID-19 to date in India. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Complete characterization of the cohort has provided further insights into the effects of COVID-19 on cancer outcomes. The low mortality allows us to recommend that specific cancer treatments be continued without delays in therapy.Copyright © 2022

Competitive cause of death in elderly breast cancer survivors

Background: Breats cancer is a major health problem in elderly ( >= 70 years) women. Increase incidence with age and the progressive increase in life expectancy mean that the numbers in elderly breast cancer diagnosis are increasing. These patients do not always receive the proper treatment and despite this the survival of this population is not always depends on cancer, there are other competing causes of death typical of the aging population. Method(s): A retrospective observational analysis of women >= age 70 diagnosed with breast carcinoma in HUPHM between 2014 and 2020 was made. Clinical, pathological data and stages at diagnosis were analyzed. We checked our patients with the national death center (official national registry) thus obtaining an exact date of death and the cause of death. Data updated in January 2023 , ensuring a minimum follow-up of 24 months. We excluded deaths from Covid or of unknown cause to avoid bias. Result(s): A total of 421 patients were analyzed, mean age of 78.6 years and median follow-up of 48 months. 28% of patients had died at the time of analysis, 11% due to cancer and 17% from other causes. If we analyze the population deceased by cancer, no deaths are detected in patients diagnosed with carcinoma in situ (4% of the population), in stage I (30% of the population) the cumulative incidence of cancer death at 5 years is 3%, 7% In stage II (30% of the population), 15% in stage III (16%) and 70% in stage IV (12%). Death by other causes are more frequent in early breast cancer, the cumulative incidence at 5 years are 10% in stage I, 22% in stage II, 44% in satge III and just 10% in stage IV. The most frequent causes of death in this population were caridovascular events and infections. There are no differences in 5-year mortality according to histological subtypes 20%, 12%, 25% and 12% for triple negative, Rh+/HER2-, RH+/her2+ and RH-/HER2+ respectively. Conclusion(s): Although elderly patients do not receive optical treatments, mortality from cancer in early stages is incidental at 5 years, a different scenario is seen in metastatic disease in which the patient's prognosis depends mainly on the oncological disease, Therefore, an effort should be made in the treatment of these patients with metastatic breast cancer since adequate treatments can have a clearly positive impact on the survival of patients. 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

Hepatitis C Burden in Greece, Italy, Portugal, and Spain: 2000-2019

Background: Viral Hepatitis remains a health priority. We performed a comprehensive evaluation of epidemiological HCV estimates in Southern countries of Western Europe and assessed the impact of the 2008 economic crisis on HCV burden. Method(s): We analyzed data of the Global Burden of Diseases to describe the patterns of six measures of HCV burden [prevalence, incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), disability adjusted life years (DALYs)] in Greece, Italy, Portugal, Spain. We assessed age-standardized rates (per 100,000 population) between 2000-2019, disaggregated by sex and age, and compared the annualized age-standardized rate of change (ARC%) in 2000-2010 (pre-austerity) and 2010-2019 (post-austerity). Result(s): Prevalence, incidence and YLDs rates of acute HCV showed a general stable trend in Western Europe (WE), globally and in the four studied countries except Italy, where, despite a marked decline (ARC: 1.4% in 2010-2019), the 2019 estimates [7.8 (95% UI 6.6-9.2)] were still 1.7-fold higher than in WE. Mortality, YLLs and DALYs associated with acute HCV decreased in the analyzed countries and peaked in Greece post-austerity. Globally and in Greece, mortality rate was higher in females than in males (1.3-times and 1.5-times in 2019, respectively). Mortality caused by chronic liver diseases including cirrhosis decreased globally, in WE and in all countries albeit at a lower rate in the post-austerity period (decrease in ARC for WE: 2.5% in 2000-2010;1.6 in 2010-2019). Liver cancer prevalence due to HCV increased in WE (ARC: 2.1%) and in the analyzed countries mainly in the pre-austerity period except for Italy. However, despite having the highest prevalence rate in both sexes, Italy showed major decreases in all six-disease metrics. HCV liver cancer mortality declined significantly only in Italy (ARC: 2.6%) and globally (ARC: 2.1%) especially in the pre-austerity period, while Portugal experienced a major increase postausterity. Overall, males and people over 70 years old are at greater risk of developing chronic liver diseases due to HCV infection. Conclusion(s): The economic crisis of 2008 negatively impacted hepatitis C related liver cancer mortality rates in Greece, Italy, Portugal and Spain. Despite the observed recovery in recent years, elimination of HCV infection by 2030 will be a major challenge in these countries and the COVID-19 pandemic and the current grim economic context are expected to compromise even further hepatitis C elimination.

Women Facing Head and Neck Cancer: Psychosocial Implications and Protective Factors

Background/Purpose: In the United States, 26% of newly diagnosed head and neck cancer (HNC) patients are women (Siegel et al., 2022). New cases have remained steady for 20 years, but the mortality rate has increased 1.9% per year. Currently, oral cavity and pharyngeal cancers have the second highest mortality rate of all cancers in women (www.seer.cancer.gov/report-to-nation/). This is alarming considering overall cancer mortality in women has dropped 1.4% (www.seer.cancer.gov/report-to-nation/). HNC disrupts the social, emotional, and physical lives of patients. The literature highlights such concerns as depression, problems with speech, eating, and body image, and social support needs (Bond et al., 2014;Hodges & Humphris, 2009;Locher et al., 2010;Maguire et al., 2017;Nund et al., 2015). The purpose of this study was to investigate the unique experience of being a woman with HNC. Problem: The psychosocial impact of HNC is documented in the literature;however, studies include few women and do not report results by sex. Method(s): Women were recruited from two academic medical centers in the Midwest. Participants were interviewed twice for 30-60 min each session. Most were interviewed using a virtual platform, with some in person or by phone. Each semi-structured interview was recorded and transcribed. Transcripts were analyzed using grounded theory techniques to identify themes. Result(s): This study included 10 women, with a mean age of 62.9 years. Several themes emerged, including physical and emotional impact of HNC, adjustment to life with cancer, coping and control, and support needs. Most surprisingly, this study found having HNC helped women feel prepared to navigate the Covid-19 pandemic. Topics included mask wearing, social interactions, family implications, societal views about illness, and feeling prepared. Conclusions and Implications: This study offers insights about the non-medical needs of women with head and neck cancer and provides some guidance on care provision.

Ethnic Differences in Cancer Deaths at Home before and during Pandemic

Introduction Place of death is a metric used for planning and monitoring palliative care (PC). The COVID-19 pandemic has seen a significant increase in cancer deaths at home. Aims To determine whether pandemic increases in the percentage of cancer deaths at home differ by ethnic group Methods Data source: death registrations in England, 2018 to 2021 with underlying cause of death cancer (ICD-10 C00-C97). Ethnic group derived from linked hospital episode data. The age and deprivation distribution across ethnic groups varies and each has a strong independent effect on place of death. so, calculated percentage deaths at home were standardised by these factors to make them comparable. Analysis concentrated on the largest ethnic groups: White, Asian/Asian British (Asian), and Black/African/ Caribbean/Black British (Black). Comparisons were made between time periods by analysis of the ratio of percentages 2020-2021 (COVID-19 Pandemic) vs 2018-2019 (Baseline). Results For each ethnic group the age-standardised percentage of cancer deaths at home significantly increased (P < 0.05) from 2018-2019 to 2020-2021 . Asian: 33.5%, 47.5% . Black: 28.8%, 39.0% . White: 30.7%, 41.2% The ratio of standardised percentage of deaths at home (95% CI) was . Asian: 1.42 (1.36,1.48 ) . Black: 1.35 (1.27, 1.44) . White 1.34 (1.33, 1.35) Conclusions Cancer deaths at home increased by > 10 percentage points during the pandemic for Asians, Blacks and Whites. Significant differences between ethnic groups before the pandemic (2018-19) persisted with Asians more likely than Whites, and Blacks less likely than Whites to die at home. The largest increase was for Asians, the group with the highest pre-pandemic home deaths. Impact These ethnic differences merit investigation regarding cultural preferences, access issues and quality of PC experience. Community health and PC teams need additional resources and training in culturally sensitive care to support the increased number of ethnically diverse cancer patients dying at home.

Virtual Clinical Outcome Ascertainment in a Prostate Cancer Treatment Trial

Introduction/Objective: The COVID-19 pandemic stopped site visits for clinical outcome data collection in March 2020. We utilized several remote methods to collect data and assessed their relative effectiveness. Background(s): The ProtecT randomized trial (Prostate cancer testing and treatment trial) aimed to determine the effectiveness of active monitoring (surveillance), radiation and surgery for localized disease. The primary outcome is prostate cancer mortality with clinical secondary outcomes of disease progression and metastasis. There was no difference in the primary outcome at 10 years (published in 2016) between groups (differences in metastasis and functional problems) so followup was extended to 15 years (November 2020). Method(s): The 10-year analysis used annual paper case report forms (CRFs) completed by research nurses based at UK hospitals. In extended follow-up, it was intended that National Health Service routine data would identify participants with potential disease progression. Prior to the pandemic the research nurse reviewed electronic health records at eight English hospitals and completed an eCRF in REDCap software. It became unlikely that site visits were going to be possible in 2020. A shortened eCRF was created focussed on essential outcome data and site staff agreed to help collect clinical data in July 2020. Result(s): Ethical approval for extending the study end date and the sponsor updating GDPR terms of site agreements were delayed by COVID-19 research taking priority. This also prevented the research nurse updating their NHS Research Passport for Honorary Contracts to access sites. Approvals were gained in December 2020. At four sites, local staff completed REDCap eCRFs with support from the data manager and research nurse by email and virtual calls. The research nurse gained remote access to hospital electronic health records at three sites by April 2021, which required extensive research governance approvals, training on hospital IT systems and their software on multiple laptops. At one site, from December 2020, 2-h virtual calls were held with local staff who interrogated electronic medical records as trial staff completed REDCap eCRFs. On average, 15 note reviews were conducted each call which were planned around clinical commitments. Secondary clinical outcomes were collected remotely for 94% of participants in follow-up (1395/1474). There was no difference in the three methods: remote hospital record access 594/601 (98.8%);local staff completion 575/600 (95.8%);and online calls 215/221 (97.3%) although less data cleaning was required as data queries were resolved during calls. Benefits also included savings on time traveling to sites and accommodation and local clinical staff could access a wider range of health records and information outside their hospital. However, enabling remote data capture delayed data analysis by 6 months. Conclusion(s): In a prostate cancer treatment trial remote data capture of clinical outcomes was successful as site visits became impossible due to the pandemic. Online methods were tailored to sites requirements but required substantial preparation and governance approvals.

An overview of Respiratory Research funding in Europe and UK between 2012 to 2022

Background: Respiratory diseases account for leading cause of death worldwide. Literature reveal respiratory research is inadequately funded despite the global mortality and morbidity. Studies and analysis have also identified disease groups get funded disproportionately. Aim(s): To explore differential funding within respiratory research funding in UK and Europe and identify volume of funding for COVID-19. Methodology: A review of research funding data for respiratory diseases (2012-2022) undertaken. We reviewed funding from UK & European funding bodies. Funding was expressed in million Euros. The respiratory disease groups identified as in table 1. Result(s): 288 studies identified and asthma had the highest number of studies, with the second highest funding allocation. Interstingly, the highest funding was Tuberculosis, the least for sleep apneoa. COVID-19 related research with 10% of the funding. Diseases with highest mortality like Lung cancer, COPD and ILD received less than 17% of the funding. COVID-19 has attracted 10% of the funding recently. Table1, shows individual studies and funding allocation. Conclusion(s): We observed heterogeneity in the funding allocation for respiratory disease groups and mismatch with mortality caused by the respiratory subgroups. Unsurprisingly, there seems to have been increase in COVID research funding recently.

European Cancer Summit 2022 submission for Special Network: Impact of the Covid-19 Pandemic on CancerImpact of the COVID-19 Pandemic on Cancer Surgery and Cancer Mortality in England

Background: During the pandemic there has been an impact on the number of patients entering the cancer pathway, because of changes in patients presenting and GP referral behaviours. The aim was to understand whether different groups in our society have been disproportionately affected by the pandemic in terms of the care they have received for their cancer. Method(s): The study looked specifically at elective admissions from the Hospital Episode Statistics data for all cancers combined and separately for breast, bowel, lung, and prostate cancers to investigate the number of patients admitted for cancer surgery over time. The ONS Mortality Dataset was used to investigate the place of death for patients who had died from cancer. Mortality rates were calculated to identify whether there was a rise in in-hospital mortality during the pandemic. Deaths were defined as an in-hospital death for a patient admitted with a primary diagnosis of cancer. Age-standardised mortality rates were created across the last five years, broken down by cancer type, sex and deprivation quintile. Result(s): The analysis shows a decrease in patients undergoing surgery at the start of the pandemic for all demographic groups. At the start of the pandemic, the largest decreases for all cancers combined by ethnicity could be seen in White (42.6%) and Asian or Asian British (44.6%). While by age, the largest decrease was seen in women aged 40-49. For lung cancer surgery, there were differences by deprivation quintile during the recovery period, showing a 42.0% increase in the least deprived compared to a 27.6% increase in the most deprived. However, changes at the beginning of the pandemic were similar across all quintiles. Age standardised mortality rates showed an increase in in-hospital deaths following the start of the pandemic. Conclusion(s): While we know that there are inequalities in access to cancer surgery, particularly by age, for the most part, the results of our analysis indicate that the recovery period of the COVID-19 pandemic has not exacerbated these inequalities. However, it is difficult to understand the extent to which any variation in access to cancer services is unwarranted.Copyright © 2023

Study of the Relationships between COVID-19, Associated Diseases, and Vitamins

Background: Some vitamins play a beneficial role in the immune system and certain diseases may be associated with an increase in the number of COVID-19 cases and mortality. Objective(s): In this work, we aim to verify a possible relationship between vitamin A, vitamin D, sunlight, and COVID-19 cases and mortality. We also aim to study the relationship between chronic diseases and COVID-19 in the world. Method(s): We consulted online databases (Johns Hopkins, World Life Expectancy, NASA, and World Health Organization) and used SPSS (v23) for statistical analysis. Result(s): We found that countries with the highest number of cases and deaths by COVID-19 are the countries with the highest death rates from different types of cancer and multiple sclerosis. Besides, the relationship between cancer death rate and COVID-19 is not biased by the life expectancy. We also found that the low solar incidence and low vitamins A and D levels can be related to the number of cases and deaths by COVID-19. Conclusion(s): Our findings suggest a relationship between different cancer types and multiple sclerosis death rates and COVID-19. We also recommend that vitamins D and A may play a protective role in COVID-19 infection.Copyright © 2021 Bentham Science Publishers.

The impact of COVID 19 pandemic on pattern of cancer mortality in Najran, Saudi Arabia: A single-cancer center experience: Cancer mortality during COVID 19

Aim: To explore the association between mortality and Covid infection, age, sex, site of cancer, stage, and the interval between the last dose of chemotherapy given within the last 30 days before death. Material(s) and Method(s): Adult cancer patients who died of cancer in King Khalid Hospital in Najran-Saudi Arabia, were included in this retrospective observational study. We compared mortality patterns in a period of 6 months in 2020 (March to August) with the corresponding period of 2019. Result(s): 50 dead adult cancer patients were included, 24 in 2019 and 26 in 2020. Among them, 21% vs 42% were younger than 65 years of age;61% vs 62% were males, for the years 2019 & 2020 respectively. The top three killers in 2019 were colorectal, gastro-esophageal cancers, and hepatocellular carcinoma, while in 2020 were colorectal, hepatocellular carcinoma, and lymphomas. About 16.7% of patients died within 30 days of receiving anti-cancer treatment in 2019 in comparison with 7.7% in 2020. The difference in the 30-days mortality after receiving anti-cancer treatment was not statistically significant between 2019 and 2020 (p=0.329). Discussion(s): The Year 2020, the time of the COVID-19pandemic, was not associated with a significant increase in the short-term mortality among patients with malignancy in Najran, Saudi Arabia. Our results generally reflect the crucial role of strict preventive national measures in saving lives and warrants further exploration.Copyright © 2022, Derman Medical Publishing. All rights reserved.

DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients' risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57;77.5 % 45 years or younger;36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic's compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidencebased methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. (Table Presented).