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Background: To understand the impact of the COVID-19 pandemic on National Health Services (NHS) cancer service delivery, care and patients, we examined the impact of changes in cancer service delivery, treatment intensity and delay by evaluating oncological outcomes of genitourinary (GU) cancer patients receiving systemic anticancer treatment (SACT) during 1st March and 8th July 2020. Methods: We used data from patients with GU cancers (i.e. prostate, urothelial, kidney and testicular) treated with SACT at Guy's Cancer Centre during the first wave of the COVID-19 pandemic in the UK: demographics (sex, age, ethnicity, ECOG performance status (PS), comorbidities, smoking history, socio-economic status (SES)) and disease characteristics (stage, treatment type and setting, lines of treatment), as well as results from SARS-CoV-2 PCR testing. Classification of COVID-19 severity was based on the World Health Organisation (WHO) guidelines. Results: A total of 457 GU cancer patients received SACT during the study period: 68% prostate cancer, 23% renal cancer, 7% urothelial cancer, 2% testicular cancer. Mean age was 69 years (SD: 11.2). 91% were males, 82% were classified as low SES and out of the 291 patients we had ethnicity data on 199 (68%) were White British. The majority of patients had a PS of 1 and 95% of all patients had stage IV disease and hence received palliative SACT, with 58% being in the second line setting. Half of the patients received hormone therapy, 17% received chemotherapy, 20% received targeted therapy, 13% received immunotherapy (IO) and 1% received combination IO and targeted treatment. Only 5 (1%) patients tested SARS-CoV-2 positive: 2 had prostate cancer, 2 renal and 1 bladder cancer. Mean age was 66 years (SD: 5.6). They were all male, 2 White British, 1 Black African and 2 of unknown ethnicity and were all classified as low SES. Average PS was 2. Of these 5 patients 3 had at least two comorbidities (i.ehypertension, diabetes mellitus, renal impairment, frailty) and were receiving multiple medications. All had stage IV disease and received palliative SACT. 3 were on hormone therapy alone and 2 on chemotherapy. 2 of the patients presented symptoms within less than 7 days from PCR diagnosis, 1 within 7 to 14 days and 1 after 14 days. All 5 COVID-19 positive patients required hospitalization, 4 suffered severe pneumonia, 1 died from COVID-19 and 2 died from cancer related causes. In comparison, the mortality rate for the COVID-19 negative patients was 3.3%. Conclusion: Despite the impact of COVID-19 in health provision, a large number of our GU patients at Guy's Cancer Centre safely received SACT. Our results suggest that the continuation of SACT during the COVID-19 pandemic did not increase the risk of COVID-19 in our patient cohort (SARS-CoV-2 infection rate: 1%). Of note, the infection rate was lower than observed in a similar study in our centre for gastrointestinal cancer patients (SARS-CoV-2 infection rate: 3.4%). In light of the above, decisions against SACT or SACT intensity should carefully be evaluated.
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(Background) Endoscopic procedures are interventions that have been defined as carrying a high-risk of infection with COVID-19. Most endoscopy units restrict their activity based on pre-endoscopic diagnosis. (Objective) To determine the consequences of endoscopic restrictions as a result of the COVID-19 pandemic and their impact on digestive cancer diagnosis. (Design) A comparison of upper digestive endoscopies and colonoscopies with gastrointestinal cancers diagnosed between three endoscopic centers, two of which restricted their procedures and one that did not but performed the procedures under a strict protocol. (Setting) A retrospective analysis was performed collecting data between 15 March 2019 and 15 August 2020. Two-factor ANOVA and a Tukey's a posteriori test were used as statistical tests. (Main outcome measures) There was variation in gastrointestinal cancer diagnosis between 2019 and 2020, considering the endoscopic procedures performed each year. (Result) There was a significant decrease in the total endoscopic procedures performed between 2019 and 2020 (p < 0.001), the result of reduced testing at the two centers (p < 0.001) with pre-endoscopic restrictions, which was not compensated for by a slight increase in procedures at the center without restrictions (p = 0.139). Regarding the total cancers diagnosed, while a significant decrease was observed for the two centers with pre-endoscopic restrictions (p = 0.007), a significant increase was registered in the center that maintained its endoscopic productivity (p < 0.001). After 851 procedures (537 upper digestive endoscopies and 314 colonoscopies) there was no evidence of COVID-19 infection in the endoscopic staff. (Conclusion) Endoscopic restrictions based on preendoscopic diagnosis should be reassessed in consideration of local pandemic situations, and a balance should be sought between COVID-19 infection risk and the detrimental delay of potential cancer diagnosis.
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Background: Primary care physicians (PCPs) provide essential support for cancer patients. Both primary and cancer care have been affected by the COVID-19 pandemic. In the US, cancer related encounters and screening decreased over 40% and 80% respectively in January to April 2020 compared to 2019 (London et al JCO Clin Cancer Inform 2020). However, the impact of the pandemic on primary care access for cancer patients remains unclear. Methods: This was a population-based, retrospective cohort study using administrative healthcare databases held at ICES in Ontario, Canada. Patients with a new gastrointestinal (GI) malignancy diagnosed within the year prior to the pandemic, between July 1 and Sept 30, 2019 (COVID-19 cohort), were compared to patients diagnosed in years unaffected by the pandemic, between July 1 - Sept 30, 2018 and July 1 - Sept 30, 2017 (pre-pandemic cohort). Both groups were followed for 12 months after initial cancer diagnosis. In the COVID-19 cohort, this allowed for at least 4 months of follow-up data occurring during the pandemic. The primary outcome was number of in-person and telemedicine visits with a PCP. Secondary outcomes were number of in-person and telemedicine visits with a medical oncologist, number of emergency department (ED) visits, and number of unplanned hospitalizations. Outcomes, reported as number of visits per person-year, were compared between the COVID-19 and pre-pandemic cohorts. Results: 2833 individuals diagnosed with a new GI malignancy in the COVID-19 cohort were compared to 5698 individuals in the pre-pandemic cohort. The number of in-person visits to PCPs per person-year significantly decreased from 7.13 [95% CI 7.05 - 7.20] in the pre-pandemic cohort to 4.75 [4.66 - 4.83] in the COVID-19 cohort. Telemedicine visits to PCPs increased from 0.06 [0.05 - 0.07] to 2.07 [2.01 - 2.12]. Combined in-person and telemedicine visits to PCPs decreased from 7.19 [7.11 - 7.26] to 6.82 [6.71 - 6.92]. In-person visits to medical oncologists decreased from 3.73 [3.68 - 3.79] to 2.87 [2.80 - 2.94], and telemedicine visits increased from 0.10 [0.10 - 0.11] to 0.95 [0.91 - 0.99]. Combined in-person and telemedicine visits to medical oncologists remained stable (3.84 [3.78 - 3.89] vs. 3.82 [3.74 - 3.90]). The number of ED visits per person-year decreased from 1.04 [1.01 - 1.07] in the pre-pandemic cohort to 0.93 [0.89 - 0.97] in the COVID-19 cohort. Unplanned hospitalizations did not show a significant change (0.56 [0.54 - 0.58] vs. 0.53 [0.50 - 0.56]). Conclusions: PCP visits for patients with newly diagnosed GI malignancies overall decreased during the pandemic, with a dramatic shift from in-person to telemedicine visits. Visits to medical oncologists also shifted from in-person to telemedicine, but the overall combined visits remained the same. While the number of ED visits decreased, the shift in ambulatory practices did not seem to impact the number of unplanned hospitalizations.
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Background: People with cancer are at higher risk of serious illness and death from COVID-19 infection. We investigated the differences in COVID-19 vaccine uptake and attitudes in people with various solid organ and hematological malignancies. Methods: An online survey of adult patients with cancer attending eight health services across four states in Australia, was conducted from June to September 2021. Demographics, cancer history and vaccination status were recorded. Only completed surveys were analysed. Variables were compared with chi-squared and multivariable analysis using logistic regression. Vaccine hesitancy was assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford Vaccine Confidence and Complacency Scale, and the Monash Disease Vaccine Acceptance Scale. T-test analysis was used to examine relationships between the scales and groups. Results: There were 2997 evaluable responses;53.2% female, 61.8% from metropolitan areas, 27.5% with metastatic solid organ disease and 50.6% on current anti-cancer treatment. Patients with GI cancers comprised 13.5% (n = 405), compared with hematological 28.4%, breast 24.6%, genitourinary 14.1% and other cancer types 19.4%. Vaccination rates were significantly lower for respondents with GI cancers compared to other cancer types (71.6% v 79.3%;p< 0.001). Significant differences in the GI cancer population compared to all others were: more males (p < 0.001), lower level of education (p= 0.001), fewer reporting English as first language (p = 0.02) and shorter time since cancer diagnosis (p < 0.001). These remainedsignificant after logistic regression. Among GI cancer respondents, factors associated with being vaccinated compared to unvaccinated included: older age (p < 0.001), higher education level (p = 0.03) and English as first language (p = 0.01). There was no significant difference in the scales measuring vaccine hesitancy, confidence and complacency, for the GI cancer population compared to other cancers. As expected, there were significant differences in all scales comparing vaccinated to unvaccinated respondents with GI cancers. Conclusions: In our large, contemporary survey, Australians with GI cancers report lower COVID19 vaccine uptake compared with patients with other cancer types. We identified demographic and disease related characteristics that contribute to these differences. Interventions and targeted communication are required for people with GI cancers to maximise vaccination uptake in this medically vulnerable group.
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Background: Early approval of COVID-19 vaccine has significant benefits for cancer patients treated under the COVID-19 pandemic worldwide. However, there has been limited reports that investigated the safety and efficacy of vaccination in cancer patients and the optimal timing of vaccination during chemotherapy. We therefore investigated the effects of vaccination on treatment in cancer patients receiving chemotherapy. Methods: Our retrospective observational study included 52 patients with gastrointestinal (GI) cancer receiving chemotherapy at the medical hospital of Tokyo Medical and Dental University in Tokyo who had two doses of mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) between May 2021 and September 2021. All patients had no history of COVID-19 infection. Treatment- and vaccination-related adverse events were recorded by outpatient interviews and self-reports. All adverse events were evaluated using CTCAE v5.0. Results: Characteristics of patients were as follows (N = 52): median age, 70y (range, 49-89);male/female, 30/22;ECOG PS 0, 75%;local/metastatic, 12/40;mean BMI, 23.4±4.1;comorbidities in 36 (cardiovascular in 24, diabetes in 8, kidney disease in 8, liver disease in 6, lung disease in 1);treatment (cytotoxic in 45, biologics in 23, immune checkpoint inhibitor in 4). Of the 52 patients, 45 received chemotherapy prior to vaccination;days from last dose to first vaccination, median 11 (range, 1-70);days from first to second vaccinations, median 21 (range, 21-41);days from first vaccination to chemotherapy, median 10 (range, 2-34). 11 patients (24.4%) changed treatment schedule: 3 for safety reasons, 4 for myelosuppression and 4 for convenience. 4 patients stopped treatment due to disease progression. Following the first vaccination, 37 patients (82.2%) had adverse events (AEs): injection site pain (n = 35), fatigue (n = 6), fever (n = 3), headache (n = 2), gastrointestinal symptoms (n = 2), redness (n = 1), insomnia (n = 1). There was no treatment- and vaccine-related deaths. Conclusions: Our findings suggest that vaccine-related AEs in GI cancer patients receiving chemotherapy are tolerable, and treatment schedule changes could be minimized. Although careful monitoring is required, COVID-19 vaccination is also recommended for cancer patients toward the convergence of the COVID-19 pandemic.
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The proceedings contain 108 papers. The topics discussed include: toll-like receptor 3 c.1377C/T and -7C/A polymorphisms in COVID-19 infection;a cleft palate with 49, XXXXY karyotype: A case report;a case with atypical autism and hereditary motor sensory neuropathy;investigation of genetic etiology in gastrointestinal cancer patients with next generation sequencing method;a rare disease associated with the CDK13 gene: CHHDFIDD;a case report of pericentric inversion, inv (21) (p12;q22) in repeated pregnancy loss;a case of rare CYP26B1-related craniosynostosis in a Turkish female patient;a novel homozygous mutation in CYP11A1 gene in 46, XX patient with P450scc deficiency;and a novel homozygous variant in SUOX gene causes classic isolated sulfite oxidase deficiency: a case report.
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The proceedings contain 32 papers. The topics discussed include: recent advances in magnesium research - from cell biology to human disease;assessment of changing global human magnesium status - needs for updating methodology and standardization;when magnesium is assessed in clinical setting?;serum magnesium assessment needs for standardization;systematic review and meta-analysis to determine a reference range for ionized magnesium;magnesium transporters: discovering new potential biomarkers in digestive cancers;TRPM7 is protective against hypertension, cardiovascular inflammation and fibrosis induced by aldosterone and salt;dietary magnesium deficiency impairs hippocampus-dependent memories and induces neuroinflammation in mouse;and the effects of combination of green tea, rhodiola, magnesium and B vitamins on brain activity and the effects of a laboratory social stressor in healthy volunteers.
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COVID-19 is an infectious disease caused by the virus SARS-CoV-2, which was first described at the end of 2019. Since then, it has affected a growing portion of the world's population because of its high transmissibility. Most patients are asymptomatic or present with mild symptoms, but approximately 5-10% of cases can develop more serious manifestations, such as severe acute respiratory syndrome, acute kidney injury, shock, myocardial injury and even death. These features seem to occur more commonly in patients with essential hypertension, diabetes mellitus, obesity and chronic pulmonary disease. However, there are few studies that clarify the natural history of the disease and its broad clinical spectrum owing to the fact that it is a new entity. Since individuals with malignancies tend to present some degree of immunological deficiency and are more prone to opportunistic infections, especially those being treated with immunosuppressive drugs, it is possible that this group has a higher incidence of COVID-19. The current recommendations of oncology specialists advise to postpone treatments and to use less toxic drugs when possible. However, we still do not know how much these measures will affect in cancer mortality. Also, the incidence of COVID-19 in this population remains undetermined. We do not know if infectious symptoms are a good parameter to motivate these therapeutic changes or if there is benefit to test asymptomatic patients. In this context, this research submitted 100 patients with hematological malignancies or solid tumors on chemotherapy at the Ribeirão Preto Medical School of the University of São Paulo's Hospital, asymptomatic for COVID-19, to RT PCR to determine the SARS-CoV-2 infection incidence in this population. Only two patients were diagnosed with COVID-19. Both had gastrointestinal cancer. One of them developed symptoms, but none presented severe manifestations. Both had their treatment postponed initially and reinitiated after the appropriate period of isolation. Hence, we believe that it's reasonable not to test every asymptomatic patient when the resource for that is scarce, prioritizing those at greater risk of infection and those more prone to severe outcomes as long as the appropriate preventive measures are being taken. Disclosures: Calado: Team Telomere, Inc.: Membership on an entity's Board of Directors or advisory committees;Agios: Membership on an entity's Board of Directors or advisory committees;Instituto Butantan: Consultancy;Alexion Brasil: Consultancy;AA&MDS International Foundation: Research Funding;Novartis Brasil: Honoraria.
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Background: Tyrosine kinase inhibitors (TKIs) enable patients with chronic phase chronic myeloid leukemia (CP-CML) to achieve similar overall survival to the general population, but can cause side effects that negatively impact quality of life (QOL) and contribute to distress. Since most CP-CML patients remain on TKIs indefinitely, there is a need to develop targeted interventions to address their physical and psychosocial complications. Mindfulness meditation interventions have improved QOL and decreased distress, depression, anxiety, fatigue, and pain in patients with solid tumors;however, such interventions have not previously been evaluated in patients with CP-CML. In Being Present-CML, we sought to determine if a mindfulness meditation-based program is feasible and acceptable to patients with CP-CML, and to explore its preliminary efficacy. Methods: Being Present-CML is a prospective, single-arm clinical trial of an 8-week, online mindfulness meditation-based intervention effective in patients with gastrointestinal cancers (Atreya, et al. PLoS One, 2018). Participants were recruited from a single academic institution. Eligibility included adult patients with CP-CML taking TKIs. Participants were instructed to independently play audio-guided meditations at least 5 times per week on a secure website and to participate in once weekly, instructor-led meditation classes on Zoom in assigned cohorts. Qigong was incorporated into the classes to target fatigue, a common TKI side effect. Class content was recorded and uploaded to the website for those unable to attend live. Feasibility was assessed through measurement of recruitment and attrition. Adherence was determined by web capture. Acceptability was determined by feedback from study surveys and qualitative interviews. Preliminary efficacy was evaluated using patient-reported outcome measures (PROMs) at baseline (week 0) and post-intervention (week 8) using the NCCN Distress Thermometer (DT) and Patient-Reported Outcomes Measurement Information System (PROMIS) short forms for anxiety, depression, fatigue, pain interference, and sleep disturbance. A DT score ≥4 is consistent with moderate to severe distress. PROMIS scores use T-scores where the mean score for the general population is 50 (standard deviation [SD] +/-10);higher scores indicate worse symptoms. Descriptive statistics and two-tailed paired t-tests (p <0.05) were used to summarize the data. Results: Between October 2020-April 2021, 98 eligible participants were approached to participate in the study;88 (89.8%) patients agreed to learn more, and 37 (37.8%) patients provided consent. The median age was 51 (range 23-72), 51.5% (n=19/37) were male, and 89.1% (n=33/37) were non-Hispanic White. At time of study start, 83.7% (n=31/37) had a BCR-ABL1 PCR transcript ≤1% and a median time since diagnosis of 71 months (range 2-234) (Table 1). Of 37 participants, 29 (78.4%) completed end of study procedures;4 (10.8%) dropped out, and 4 (10.8%) did not complete week 8 surveys. The median number of audio meditations listened to per participant was 34 with an average of 4.3 per week. The median number of weekly classes attended and/or recordings viewed per participant was 7 (range 1-8). At baseline, participants had a median DT score of 5 (range 2-8). Average baseline PROMIS scores were slightly worse than the general population in depression (51.4, SD 8.8), anxiety (55.9, SD 7.8), sleep disturbance (51.8, SD 6.9), fatigue (53.9, SD 10.6), and pain interference (52.2, SD 9.9). By week 8, the median DT score improved to 3 (p=0.003) (Figure 1). Post-study PROMIS scores improved in sleep disturbance (p=0.001) and depression (p=0.01) (Figure 2), but not anxiety (p=0.12), fatigue (p=0.10), or pain interference (p=0.98). Of those who conducted post-study interviews, 77% (n=20/26) reported their symptoms during the study were not influenced by the COVID-19 pandemic. Nearly all participants found the study helpful (Figure 3) and would recommend it to others (median score of 8 on a 1-10 scale;10=extremely likely). Concl sions: Patients with CP-CML taking TKIs found the mindfulness meditation-based intervention to be feasible and acceptable. PROM results suggest promise of clinical benefit in this patient population, including patients with well-controlled disease and a long history of CML. A randomized controlled trial is being planned to validate these findings. [Formula presented] Disclosures: Smith: Astellas Pharma: Consultancy, Research Funding;FUJIFILM: Research Funding;Daiichi Sankyo: Consultancy;Revolutions Medicine: Research Funding;AbbVie: Research Funding;Amgen: Honoraria. Shah: Bristol-Myers Squibb: Research Funding. Atreya: Guardant Health: Research Funding;Pionyr Immunotherapeutics: Membership on an entity's Board of Directors or advisory committees;Array Biopharma: Membership on an entity's Board of Directors or advisory committees;Merck: Research Funding;Bristol-Meyers Squibb: Research Funding;Gossamer Bio: Research Funding;Novartis: Research Funding.
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Background: Teenagers are at age when they start making decisive choices. Without adequate information on correct lifestyles they run health risks, particularly with regard to future cancers. However, they have curiosity, interest and strong desire to learn in medical issues. This trial was developed to promote knowledge of cancer development and prevention program by informing students about correct lifestyles by teaching, playing an educational game, involving them interactively both in presence and on digital platform. Methods: Since September 2019, medical oncologists with teachers from 2 first grade classes in two schools started a shared teaching path. Educational meetings were held for class presenting slides on neoplasms development and wrong lifestyles causing their onset. Slides were illustrated with comics. Students built with comics some of 90 boxes of a pathway similar to game of goose, set in their country in Middle Age. Players were two classes competing throwing dices to reach box number 90,equal to the years of cancer-free life expectancy conquered with correct lifestyle. Each box corresponded to a card like “tarot cards”, prepared to slow down the path, if it represented a wrong conduct or event, and to speed up otherwise. During the second year of class, lessons illustrated H&N with gastrointestinal cancers. Impact of course was evaluated through a questionnaire prepared by a dental hygienist and proposing a healthy snack at least once a week at school. Results: We performed 40 educational meetings of 30 minutes, followed by 20 minutes of play. Six medical oncologists, 1 psychologist, 1 dietician, 1 dental hygienist, 4 teachers actively contributed;4 classes joined the initiative, 92 teenagers participated in 15 in-presence meetings and 25 on online platform during COVID19. All contributed to build and enjoyed the game. They wanted to start following course directions by bringing to school a snack proposed by dietician once a week. Ten of them offered to participate in the peer education course in other classes. Fifty-two questionnaires were completed at the beginning of the course and re-proposed at the conclusion. Students answered: 52/52(100%) knew tumors of oral cavity, 37/52(71%) knew color of precancerous lesions, 42/52(79%) knew risk factors, 48/52(92%) replied they would never start to smoke. Conclusions: Teaching teenagers correct lifestyle preventing cancer by innovative method playing an educational game is achievable and can give results.
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Background: Patients affected by cancer are considered particularly susceptible to SARS-CoV-2 infection complications. We aimed to study the effect of COVID on patients with solid tumors at our Oncology Unit at Policlinico San Matteo of Pavia. Material and methods: Data of patients affected by solid tumors and COVID-19 were extracted from medical records between February 21, 2020 and May 15, 2021. COVID diagnosis was confirmed by RT-PCR on nasal swab. Associations between demographic, clinical characteristics and outcomes were measured with HR with 95%CI using Cox regression. Results: Seventy-five patients affected by solid tumors with COVID diagnosis were included in the analysis. The incidence of SARS-CoV-2 infection in our cancer patients was similar to that observed in the global Italian population (5.8 vs 6.2%), but lower compared to the local population of Lombardia (8.2%) and Pavia (7.9%). In 34 patients (45.9%) COVID diagnosis was obtained through screening, in 40 patients (54.1%) because of symptoms or radiologic findings. Median age was 64.4 years (25th-75th 56-75);the majority had an ECOG PS of 0-1 (89.2%), was affected by breast, lung or gastro-intestinal cancer (28.0, 26.7 and 21.3% respectively), had stage IV disease (72.2%) and was on therapy at the time of COVID (76.0%);26 patients (36.1%) were hospitalized;21 patients (28.0%) died, 13 of them (17.3%) for COVID complications. COVID determined a median delay of the oncologic treatment of 14.0 days (25th-75th 0-25). Mortality rate was higher in our cancer population than that observed in the global Italian population (3.0%), in local population of Lombardia (4.0%) and Pavia (5.9%). In the univariable analysis, being older than 66 years (HR: 2.64, 95%CI 1.06-6.55, p=0.029), with ECOG PS ≥ 2 (HR: 5.81, 95%CI 2.18-15.49, p=0.002), >1 comorbidities (HR: 2.72, 95%CI 1.14-6.48, p=0.023), having dyspnea at the time of COVID diagnosis (HR: 6.10, 95%CI 2.37-15.68, p=0.0001), and being hospitalized (HR: 6.75, 95%CI 3.06-36.89, p<0.001) were associated with increased risk of death. In multivariable analysis, ECOG PS ≥ 2, dyspnea, hospitalization and days of treatment delay were associated with increased risk of death. Conclusions: The incidence of SARS-CoV-2 infection in our cancer patients was lower than that observed in the local population of Lombardia and Pavia, while mortality rate was higher. Predictive factors of death in cancer population correlate consistently with those alrealy published about global population.
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Introduction Missed upper gastrointestinal (GI) cancers are associated with poorer survival outcomes. Missed cancer is defined as having had a negative upper GI endoscopy within three years of confirmatory diagnosis. The aims of this study are to quantify cases of missed upper GI cancer at endoscopy from a district general hospital and identify potential predisposing factors to improve future outcomes. Methods In this project, retrospective patient records were obtained from MDT meetings run between 2019 and 2020. For data comparison, similar records from previous cohorts were reviewed. The endoscopy records of these patients were extracted from the CIPTS endoscopy recording system and analysed to see if any patient had an endoscopy within the three years prior to diagnosis of their upper GI cancer. Previous endoscopies were scrutinised for the following factors: indication, visible abnormality, biopsy, endoscopist grade, sedation, presentation type, histology and follow up. Results Of the 280 patients in total, 20 (7.1%) had a negative endoscopy in three years prior to diagnosis. Subgroup analysis of 2019-20 patients showed identified 78 cases of upper GI cancer. We identified five formal cases of missed upper GI cancer in this subgroup. In the 2019-20 cohort the average age in the missed cancer group and non-missed cancer group were 83.8 and 73.2 years, respectively. Factors identified in missed cancer groups from earlier cohorts included emergency bleeding, visible abnormality not biopsied, administrative delay in rescope and lack of recognition of pathology. Conclusions The incidence of missed upper GI cancer diagnosis within this centre is similar to that of recent studies from other centres. Our study has highlighted that advanced age, accurate recognition and biopsy, and timely re-biopsy may be factors influencing missed upper GI cancers. This evidence has highlighted the importance of endoscopy training in the recognition and biopsy of pre neoplastic lesions. Furthermore, we intend to analyse data for the year 2020-21 to monitor the impact of COVID-19 on missed upper GI cancer diagnosis.