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BACKGROUND: The study purpose is to compare outcomes associated with completion of genetic testing between telemedicine and in-person gastrointestinal cancer risk assessment appointments during the COVID-19 pandemic. METHODS: Data was collected on patients with scheduled appointments between July 2020 and June 2021 in a gastrointestinal cancer risk evaluation program (GI-CREP) that utilized both telemedicine and in-person visits throughout the COVID-19 pandemic, and a survey was administered. RESULTS: A total of 293 patients had a GI-CREP appointment scheduled and completion rates of in-person versus telemedicine appointments were similar. Individuals diagnosed with cancer and those with Medicaid insurance had lower rates of appointment completion. Although telehealth was the preferred visit modality, there were no differences in recommending genetic testing nor in the consent rate for genetic testing between in-person and telemedicine visits. However, of patients who consented for genetic testing, more than three times more patients seen via telemedicine did not complete genetic testing compared to those seen in-person (18.3% versus 5.2%, p = 0.008). Furthermore, telemedicine visits had a longer turnaround time for genetic test reporting (32 days versus 13 days, p < 0.001). CONCLUSIONS: Compared to in-person GI-CREP appointments, telemedicine was associated with lower rates of genetic testing completion, and longer turnaround time for results.
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Seborrhoeic keratosis is a benign brownish-black skin lesion that is almost always seen in middle-aged and elderly populations. The sudden onset and rapid increase in size and/ or number of seborrhoeic keratoses is called the Leser-Trelat sign, suggesting a paraneoplastic manifestation of internal malignancy. However, eruptive seborrhoeic keratoses are also described in some nonmalignant conditions such as human papillomavirus infection and HIV infection. Herein, we report a case with Leser-Trelat sign in a patient following COVID-19 infection. A 50-year-old man presented to our dermatology clinic complaining of the sudden appearance of multiple warty-like lesions on his back, which had occurred 2 months after recovery from COVID-19 infection. According to his medical history, the patient presented with cough, fever and dyspnoea about 2 months prior to the appearance of his skin lesions. He was referred to a health centre, where a nasopharyngeal swab was taken, and his polymerase chain reaction test for COVID-19 was positive. In addition, bilateral patchy ground-glass infiltration was reported in his high-resolution computed tomography (HRCT) scan, all in favour of COVID- 19 infection. The patient was then treated with acetaminophen, dexamethasone (intramuscular injection), salmeterol and a fluticasone inhaler, and his symptoms improved. Two months after recovery from his mild COVID-19 infection, several small asymptomatic pigmented verrucous papules appeared on his back. Physical examination revealed multiple rough, oval-shaped, brownish papules of varying size. Dermatoscopy of the lesions was also performed. Both clinical and dermoscopic findings were in favour of seborrhoeic keratosis. In order to reach a final diagnosis, a skin biopsy was performed, and microscopic examination of the biopsy specimen showed hyperkeratosis and well-defined epidermal hyperplasia composed mainly of the proliferation of benignlooking basaloid cells and fewer squamoid cells and horn cysts and increased melanin, mostly at the dermoepidermal junction. The dermis showed no significant change. Based on the above findings, the patient was diagnosed with eruptive seborrhoeic keratosis. To determine the possible cause of this eruption, the patient was further evaluated. In his past medical history, he was generally healthy before his COVID-19 infection and had no history of comorbidities. The patient underwent a workup to rule out any internal malignancies. Laboratory tests revealed normal results and included a complete blood count, liver and kidney function tests, electrolytes, prostate-specific antigen and urine analysis. Gastrointestinal endoscopy and colonoscopy ruled out any gastrointestinal malignancy. Chest X-ray and HRCT revealed no malignant lesion. In addition, the patient's abdominopelvic sonography was normal. The patient had no family history of similar skin lesions and gave no history of any chronic inflammatory skin diseases or viral conditions. Therefore, the appearance of the Leser-Trelat sign after COVID- 19 infection was a possibility in this patient. The role of transforming growth factor-alpha and tumour necrosis-alpha in eruptive seborrhoeic keratoses, as well as in COVID-19 infection, can be a common area of interest to explore in the aetiology of this entity.
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Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.
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INTRODUCTION: Patients with gastrointestinal (GI) cancers have an increased risk of serious complications and death from SARS-CoV-2 infection. The immunogenicity of vaccines in patients with GI cancers receiving anti-cancer therapies is unclear. We conducted a prospective study to evaluate the prevalence of neutralizing antibodies in a cohort of GI cancer patients receiving chemotherapy following SARS-CoV-2 vaccination. MATERIALS AND METHODS: Between September 2020 and April 2021, patients with cancer undergoing chemotherapy were enrolled. At baseline (day 0), days 28, 56, and 84, we assessed serum antibodies to SARS-CoV-2 spike (anti-S) and anti-nucleocapsid (anti-NP) and concomitantly assessed virus neutralization using a pseudovirus neutralization assay. Patients received either the Pfizer/BioNTech BNT162b2, or the Oxford/AstraZeneca ChAdOx1 vaccine. RESULTS: All 152 patients enrolled had a prior diagnosis of cancer; colorectal (n = 80, 52.6%), oesophagogastric (n = 38, 25.0%), and hepato pancreatic biliary (n = 22, 12.5%). Nearly all were receiving systemic anti-cancer therapy (99.3%). Of the 51 patients who did not receive a vaccination prior to, or during the study, 5 patients had detectable anti-NP antibodies. Ninety-nine patients received at least one dose of vaccine prior to, or during the study. Within 19 days following the first dose of vaccine, 30.0% had anti-S detected in serum which increased to 70.2% at days 20-39. In the 19 days following a second dose, anti-S positivity was 84.2% (32/38). However, pseudovirus neutralization titers (pVNT80) decreased from days 20 to 39. CONCLUSION: Despite the immunosuppressive effects of chemotherapy, 2 doses of SARS-CoV-2 vaccines are able to elicit a protective immune response in patients' ongoing treatment for gastrointestinal cancers. Decreases in pseudoviral neutralization were observed after 20-39 days, re-affirming the current recommendation for vaccine booster doses. CLINICAL TRIAL REGISTRATION NUMBER: NCT04427280.
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Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Method(s): The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hamatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Result(s): The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusion(s): Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population.
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BACKGROUND: Cancer patients are highly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Few studies have examined racial disparities of clinical prognosis among gastrointestinal (GI) cancer patients with COVID-19, especially after the approval of COVID-19 vaccines. METHODS: We conducted a retrospective study based on the University of California COVID Research Data Set (UC CORDS). Patients aged ≥ 18 with GI cancer as well as SARS-CoV-2 infection between March 10, 2020, and May 8, 2022, were included. We examined racial disparities using multivariable logistic regression. RESULTS: Among the 1054 GI cancer cases included, 117 (11.1%) patients were Asian and Pacific Islander, 51 (4.8%) were Black patients, 377 (35.8%) were Hispanic patients, 403 (38.2%) were White patients, and 106 (10.1%) belonged to other or unknown races. Fully adjusted logistic models revealed a significantly increased risk of COVID-19-related hospitalization or emergency room visits among the Black (OR = 2.26, 95% CI = 1.08-4.70), the Hispanic (OR = 2.24, 95% CI = 1.48-3.39), and the patients of other or unknown races (OR = 1.80, 95% CI = 1.00-3.26) compared with the White patients. No significant racial disparities in 30-day all-cause mortality and mechanical ventilation rate were found. Vaccination, age, cancer type, recent cancer diagnoses in UC CORDS, metastatic cancer or secondary malignant neoplasm, and Charlson comorbidity index score were associated with the prognosis of GI cancer patients with COVID-19. CONCLUSIONS: GI cancer patients belonging to racial minorities experience worse COVID-19 outcomes. Vaccination status is a crucial factor associated with GI cancer patients' prognosis among different race/ethnicity groups. Targeted communication in the context of cancer is needed to encourage vaccination uptake in this vulnerable population.
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Background: The COVID-19 pandemic led to significant cancellations of major surgery to maximise critical care capacity. Our unit instituted the 'RM Partners Cancer Hub' based at the Royal Marsden Hospital in London, which allowed cancer surgery from multiple NHS Trusts to continue in a 'COVID-lite' setting. We present the outcomes for Upper GastroIntestinal (UGI) surgery managed via this approach over the course of the pandemic. Method(s): From April 2020 to April 2021, the Royal Marsden Hospital formed the 'RM Partners Cancer Hub'. This was designed to co-ordinate resources and deliver as much oncological treatment and cancer surgery as feasible for patients across the RM Partners West London Cancer Alliance. An UGI clinical case prioritisation strategy, along with strict infection control pathways and pre-operative screening protocols were adopted. Result(s): Overall, 231 patients underwent surgery for confirmed UGI cancer via the RM Partners Cancer Hub, with 213 completed resections and combined 90-day mortality rate of 3.5%. Good short-term survival outcomes were demonstrated with 2-year Disease Free Survival (DFS) and Overall Survival (OS) for oesophageal (DFS 70.8%;OS 72.9%), gastric (DFS 66.7%;OS 83.3%) and pancreatic cancer resections (DFS 68.0%, OS 88.0%). One patient developed peri-operative COVID-19 during the RM Partners Cancer Hub operation;they made a full recovery with no lasting clinical sequelae. Conclusion(s): The 'RM Partners Cancer Hub' approach provided a workable model for delivering multidisciplinary UGI cancer care and surgery with favourable 2-year DFS and OS when compared to nationally published pre- and post-pandemic data. It also established a template for cancer service during periods of marked disruption to healthcare service delivery and should be a useful guide in the future planning of safe operating pathways.
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Coronavirus disease 2019 (COVID-19) pandemic has had a major impact every aspect of life all over the world with severe consequences. This study aimed to evaluate the impact of COVID-19 pandemic on the number of gastrointestinal endoscopy procedures and resulting cancer detection rate at our center. This was a retrospective and single-center study. The 6-month period from March 11 to September 11, 2020 (lockdown period) was compared with the same months of 2018 and 2019 (pre-pandemic period) in terms of the number of endoscopic procedures performed at our gastroenterology unit, malignancy detection rate and clinicopathological characteristics of patients. The data were analyzed using the SPSS Statistics 22.0 software package. A 33% reduction was observed in the number of endoscopic procedures during the pandemic compared to pre-pandemic years and the difference was significant (p<0.001). Despite the decrease in endoscopic activity, cancer detection increased during the pandemic (p=0.057). Male sex and age 65 years or older were non-significantly more common among patients diagnosed with cancer on endoscopic biopsy during the pandemic compared to the pre-pandemic era but the difference was non-significant (p=0.983, p=0.241). Patients diagnosed with cancer during the pandemic were more likely to present at an advanced stage. The most common cancers were those originating from the colon and rectum and adenocarcinoma was the most prevalent pathological diagnosis. The distributions of tumor location and pathological diagnosis of the patients were not significantly different among the years (p=0,494, p=0,849). In conclusion, a reduction was found in the overall number of endoscopic procedures during the lockdown. However, despite the decrease in the number of procedures, cancer detection rate and the rate of admission at advanced stages were increased at a non-significant level. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.
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Background: Surgery is the standard treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. We aimed to evaluate the implementation of a multimodal prehabilitation program in gastrointestinal cancer surgery patients. Method(s): Single-arm implementation trial using a pre-post study design. Colorectal or UGI cancer patients scheduled for curative intent surgery at Concord Hospital, with >=14 days pre-surgery were recruited. Intervention delivered face-toface or by telehealth (COVID adaptations): 2-4-week program consisting of: i) supervised exercise (minimum 1/week);ii) dietary education session and daily high protein supplement;iii) weekly nursing support. Assessments: baseline, pre-surgery, and 30-days post-surgery. Primary Outcome: implementation using RE-AIM (Reach/Efficacy/Adoption/Implementation/ Maintenance) framework. Secondary outcomes included functional capacity, nutritional and psychological status changes. Result(s): Total 198 were screened over 16 months;100 (51%) were eligible. Reach/representativeness: 77/100 recruited (64 colorectal, 13 UGI). Mean (SD) age 67 (12.4) years;46 (60%) males. Median intervention duration 16 days (IQR:8). Adoption: 91% (70/77) referrals directly from surgeons. Implementation: 72/77 completed the intervention (34% of assessments and intervention sessions delivered by telehealth). Five withdrew: psychological stress (n = 2), medical (n = 1), disease progression (n = 1), noncompliance COVID precautions (n = 1). Adherence to all modalities was 34% (64% exercise, 81% nutrition, 63% nursing). Adherence rate for 31/35 patients was affected by staff unavailability. Efficacy: Functional capacity (mean 6-minute walk test) change from baseline to pre-surgery 464.4-471.7m(p=.775);and baseline to after surgery 464.4 to 482m(p = .052). No significant changes were seen in nutritional and psychological outcomes. Patient satisfaction:96%strongly recommended prehabilitation. Clinician satisfaction was high. Conclusion(s): Our results show a brief prehabilitation intervention (exercise, nutrition, psychological support) can be successfully implemented in a real-world setting;with a trend to improvement in functional capacity. Prehabilitation is an opportunity to optimize patients' function before gastrointestinal cancer surgery.
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Background: The COVID-19 pandemic has led to deviations in all sectors of cancer care. We present multidisciplinarily approved recommendations for ethically and empirically based prioritisation of procedures in times of scarce resources for patients with colorectal and pancreatic cancer. Methods: The CancerCOVID consortium conducted qualitative and quantitative studies on ethical challenges and psychosocial stress of patients and health care professionals in cancer care. For empirical analyses we obtained data from AOK Plus, the main health insurance in Saxony, AIO (Arbeitsgemeinschaft internistische Onkologie) cancer centers, the institute of Pathology Bochum, the ColoPredict Registry and data of outpatient care from the BNHO (Berufsverband der Hämatologen und Onkologen) and Onkotrakt AG. A selective literature review of international data and guidelines focussing on the effects of the pandemic on cancer care and allocation of resources was conducted. Structured group discussions on justified criteria for prioritisation were held with experts from oncology, ethics, law and health research. Recommendations for prioritisation were formulated as S1 guideline with approval of 9 AWMF Medical Societies, 22 multidisciplinary experts and patient representatives. Results: The main principle for decisions on prioritisation in times of scarce resources is the minimisation of individual and aggregated harm. In case of relevant risk of harm from a possible low priority classification or postponement prioritization decisions should be made individually for the respective patients according to the multiple-eyes principle. Decision making should involve different disciplines and professions depending on local infrastructure. We concretised recommendations for 5 areas in cancer care. Conclusions: Guidelines based on a broad multidisciplinary consensus can give ethically and empirically based support in medical decision making when resources are scarce. This can provide relief for decision-makers and facilitate transparency and trust of patients and population. Legal entity responsible for the study: The authors. Funding: Bundesministerium für Bildung und Forschung;Germany Förderkennzeichen: 01KI20521A-C. Disclosure: A. Reinacher-Schick: Financial Interests, Personal, Invited Speaker: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, MCI Group, AstraZeneca;Financial Interests, Personal, Advisory Board: Amgen, Roche, Merck Serono, Bristol-Myers Squibb, MSD, AstraZeneca, Pierre Fabre;Financial Interests, Personal, Other, Travel support: Roche;Financial Interests, Institutional, Research Grant: BNT, Roche, Ipsen. O. Schoffer: Financial Interests, Personal, Advisory Role: Novartis. A. Kraeft: Financial Interests, Personal, Writing Engagements: Astra. A. Tannapfel: Financial Interests, Institutional, Research Grant: Roche, Biontech. J. Schmitt: Financial Interests, Institutional, Funding: Sanofi, Pfizer, Novartis. All other authors have declared no conflicts of interest.
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BackgroundThis worldwide new COVID-19 pandemic has a great impact on our gastrointestinal oncology clinical practice, many restrictions for elective and emergency management, especially on GI cancer already been applied in every referred hospital. Current guidelines suggest postponing elective surgery for those cases. But in some instances, we must perform surgery for some reasons, including untreatable pain or impending obstruction. Enhanced recovery after surgery might have an important role in increasing the favorable outcome for these patients.MethodsThis prospective study was done for the last 4 months from March 2020. All resectable GI cancer patients have been included in this study, ERAS protocols have been applicated for perioperative management. The main outcome was the length of stay, readmission rate, post-operative complications and in hospital mortality. Prior neoadjuvant chemotherapy will be excluded from this study.ResultsDuring the last 4 months, we reported 45 cases of resectable GI cancer, 28 cases needed emergency surgery and the others had an elective resection. ERAS protocols have been applied during this pandemic. Right colectomy, Anterior resection and Low Anterior resection with primary anastomosis were the most common surgeries performed. The other procedures were retroperitoneal tumor resection. The main length of stay was 4.5 days, and no leak anastomosis was reported. 1 patient has not survived the prolonged sepsis condition from the closed-loop obstruction of rectal cancer.ConclusionsERAS protocol for GI cancer during the COVID-19 pandemic was safe, and feasible, and it would reduce the length of stay and be applicable for this prolonged pandemic.
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Background: Coronavirus disease 2019 (COVID-19), caused by betacoronavirus SARS-CoV-2, is associated with an increased risk of severe infection or death in cancer patients compared to the general population. The CANVAX trial recently demonstrated that short term immune responses to SARS-CoV-2 vaccines are modestly impaired in patients with cancer- particularly those who receive myelosuppressive chemotherapy. Because little is known regarding longitudinal antibody or T-cell responses in cancer patients who receive cytotoxic chemotherapy or non-myelosuppressive targeted systemic therapy, the aim of this longitudinal study is to assess immune B and T cell responses to SARS-CoV-2 over a 12-month period in solid tumor patients who receive chemotherapy or non-immunosuppressive therapy compared to healthy individuals without cancer. Methods: This is an ongoing prospective non-interventional clinical trial (NCT05238467). Approximately 100 patients will be enrolled into three different arms. Accrual began in May 2021 and 37 patients have been enrolled. Eligible patients must not have prior COVID-19 infection < 6 months from study enrollment and have a diagnosis of a solid tumor (breast, genitourinary, or gastrointestinal cancers), who either: received myelosuppressive chemotherapy within 60 days prior to initial or booster COVID vaccination, or who started on chemotherapy within 30 to 60 days after the initial or booster COVID vaccination (Arm A);or received non-immunosuppressive treatments (Arm B);or have no history of cancer or prior history of cancer but beyond 12 months from completion of curative cancer treatment (Arm C, control cohort). Whole blood will be collected in accordance with standard operating procedures. Blood samples analyzed for the presence of antibodies against the major antigenic components of SARS-CoV-2 including the spike glycoprotein (S), receptor binding domain (R) and nucleocapsid phosphoprotein (N). Antibody levels will be quantified utilizing quantitative ELISA. T-cell responses will also be quantified. The primary endpoint is seroprotection rate with an antibody titer protective (1:40) at any point: baseline, 2, 6, and 12 months. The secondary endpoint is to evaluate differences in longitudinal immunological responses to SARSCoV- 2 over a 12-month period. The difference of the seroprotection rate among 3 cohorts of participants will be examined using chi-square test. Moreover, the effect of treatment (chemotherapy, endocrine, TKIs) on seroprotection will be estimated using multivariable logistic regression controlling the effects of confounders, such as age, gender and cancer type. COVID antibody titers measured over time (baseline, 8 weeks, 6, 9, 12 months after the second vaccination) will be analyzed using mixedeffect models. .
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Background: The COVID-19 pandemic has led to deteriorated outcomes among immunocompromised patients, significantly impacting cancer patients. However, little is known about the impact of the COVID- 19 pandemic on cancer patients in low and middle-income countries. Therefore, we sought to investigate the characteristics and clinical outcomes of cancer patients with COVID-19 treated at a single institution. Methods: A retrospective chart review was performed for cancer patients treated at King Hussein Cancer Center. Patients who were diagnosed with laboratory-confirmed SARS-CoV-2 infection by Real-time Polymerase chain reaction test between April 2020 and October 2020 were identified. Results: Overall, 327 COVID-19-infected cancer patients were included. At the time of COVID- 19 diagnosis, the median age was 55 years (range, 18-87 years), 146 patients (45%) were males. The most common neoplasms were breast cancer (n = 90, 27.5%), gastrointestinal cancers (n = 60, 18.3%), and lymphoma (n = 36, 11%). The majority of patients had comorbidities (n = 200, 61%), of which hypertension and diabetes mellitus were the most common. Testing reason was presence of symptoms in 183 (56%) patients, previous exposure in 10 (3.1%), and before elective procedure in 142 (43.4%). 118 patients (56.5%) were hospitalized and 18 patients (5.5%) required admission to the intensive care unit (ICU). At the time of the last follow-up, 76% (n = 249) remained alive, and 24% (n = 78) died, among which death was considered to be COVID related in 41 (52.5% of deaths). Mortality was significantly increased in patients with comorbidities (29%, vs 15.7 %;p = 0.008), the use of cardiac medications (34.3% vs. 18.1%;p = 0.001), active cancer status vs. remission (28.2% vs 11.6% p = 0.002), receiving chemotherapy in the last four weeks (27.6% vs 16.4%, p = 0.028), and when testing reason was the presence of symptoms vs exposure and elective (37.7% vs. 10% and 7.7% p = < 0.001) respectively. Chemotherapy was delayed in 109 (33.4%) patients and permanently discontinued in 57 (17.5%) patients. Among patients required hospitalization and needed ICU admission, mortality rates were 55.1% and 88.9% respectively. Conclusions: COVID-19 infection is associated with significant mortality and negatively affects treatment plans in cancer patients. A follow-up study will be needed to evaluate the effect of vaccination on the outcomes.
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Introduction Previously our group had identified 20 features which were associated with the development of upper gastrointestinal (UGI) cancers using a machine learning approach.[1] We sought to refine this model and to validate this in an independent dataset to assess its generalisability in an interim analysis. Methods We selected patients who were recruited for the multicentre Saliva to Predict rIsk of disease using Transcriptomics and epigenetics (SPIT) study to develop our model. Patients were recruited from 2-week wait suspected UGI pathways and additionally enriched with patients with confirmed oesophageal adenocarcinoma admitted as inpatients. We used regularised logistic regression (glmnet) from the caret package in R software to create the model. 60% of the data with 10-fold cross validation was used for training, with the remaining 40% for testing. For validation, we used data from the predicting RIsk of disease uSing detailed Questionnaires (RISQ) study, an ongoing prospective multicentre study using the questionnaire based on the our previous work.1 We evaluated the model using area under the receiver operating characteristic curve (AUC). Results We included 93 cancer and 715 non-cancer patients for training and testing and 21 cancer and 203 non-cancer patients for validation. We further reduced the model to 18 features without significant detriment to model performance. In the training and testing data AUC was 0.86 (95%CI: 0.81- 0.91) and 0.75 (95%CI: 0.67-0.83) respectively. We set a threshold of 0.03 as a cut off based on a cost function where false negatives had a 50-time greater impact than false positive cases (figure 1). For the validation cohort we achieved an AUC of 0.95 (95%CI: 0.90-1.00). This equated to a sensitivity 0.952 and a specificity of 0.897 for detecting cancer. Conclusions Initial results from our model compare favourably with the Edinburgh Dysphagia Scale, which has a sensitivity and specificity of 0.984 and 0.093 respectively.2 It also appears to have a high specificity, potentially helping to reduce unnecessary endoscopies. We aim to further increase the size of the validation cohort to ensure its robustness and generalisability. Our model could be applied to triaging and prioritising endoscopic referral backlogs as a result of COVID- 19.3.
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Introduction Machine learning methods have been used to develop predictive models in gastroenterology.1 Previously we identified features including age, history of psychological disorders and severity of dysphagia symptoms which were correlated with upper gastrointestinal (UGI) cancers.2 We sought to create a machine learning based model which could be used to predict the presence of UGI in patients referred for endoscopy. Methods Patients were recruited as part of the Saliva to Predict rIsk of disease using Transcriptomics and epigenetics (SPIT) study. Patients were recruited from 2-week wait suspected UGI pathway referrals at 20 hospitals in the United Kingdom. We enriched the cohort with additional patients admitted with confirmed oesophageal adenocarcinoma. 60% of the data was used for model generation with 10-fold cross validation, while the models were tested on the remaining 40% of the data. We used seven methods to generate our models: Linear Discriminant Analysis (lda), Classification and Regression Tree (cart), k-Nearest Neighbour (knn), Support Vector Machines (svm), Random Forest (rf), Logistic Regression (glm) and Regularised Logistic Regression (glmnet). Model performance was assessed using area under the receiver operating characteristic curve (AUC) and DeLong test was used for model comparison. Results 93 cancer and 715 non-cancer patients were included. The best three models with 18 features were glmnet, lda and glm which all achieved an AUC of greater than 0.80 (figure 1). For the testing dataset, AUC was 0.75 (95%CI: 0.67- 0.83), 0.74 (95%CI: 0.66-0.82) and 0.75 (95%CI: 0.68-0.83) (p=ns for all 3 pairwise comparisons) respectively. When applying a cost function, the three models all achieved a sensitivity of 0.973 and a specificity of 0.234 to 0.388 for the testing dataset. Conclusions Our models compare favourably with the Edinburgh Dysphagia Scale, which has a sensitivity and specificity of 0.984 and 0.093 respectively.3 Our models have the advantage of an improved specificity, which could equate to fewer endoscopies being performed for low risk patients. Given rising waiting lists as a direct result of COVID-19, our tool could be used to prioritise patients who should be investigated sooner.4 We plan next to validate our models on a validation cohort to assess its generalisability.
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BACKGROUND/AIM: The coronavirus disease 2019 (COVID-19) pandemic prompted global recommendations to delay non-urgent endoscopic procedures to limit the spread of SARS-COV-2, but such delays had unprecedented impact on the delivery of healthcare. Being a large specialty GI Pathology service, we sought to analyze the effect of the pandemic on the frequency of GI malignancies in our department. PATIENTS AND METHODS: Based on the electronic search of departmental pathology records, we compared the total numbers of cancer diagnoses (primary and metastatic) from various GI biopsy sites during the 12-month pre- and post-pandemic periods. We summarized patient demographics and analyzed pertinent histopathologic data. RESULTS: For all GI biopsy sites, the number of intramucosal/invasive malignancies reported during the one-year pre-COVID-19 pandemic (pre-COVID) and post-COVID-19 pandemic national lockdown (post-COVID) observation periods were 146 and 218, respectively. Among these, 32 and 70 malignancies were reported for the first quarter (representing the earliest post-lockdown period), 29 and 53 for the second, 41 and 54 for the third, and 44 and 41 for the fourth quarter. During the first two quarters of the post-COVID observation period, the increase in malignant diagnoses was most profound, showing 119% post-COVID increase compared to the pre-COVID levels. Of the two main primary histologic types of large intestinal carcinomas [adenocarcinoma (ADC) and squamous cell carcinoma (SCC)], the most profound post-COVID increase was noted in SCCs (136% vs. 58% for ADCs). CONCLUSION: Compared to the pre-pandemic baseline, the COVID-19 pandemic caused a major increase in biopsy diagnoses of GI cancers in our department. The most plausible explanations for this trend include inevitable lockdowns to minimize the spread of SAR-COV2, which affected GI endoscopy procedure schedules/re-schedules as well as patient response and adaptation to emerging post-COVID GI healthcare patterns. The COVID-19 pandemic's long-term impact on the health of GI cancer patients will need to be determined through systematic analyses by multi-disciplinary teams.
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Precision medicine is a therapeutic idea that advocates tailoring treatment to a specific group of individuals rather than a one-size-fits-all approach. Artificial intelligence provides insights through advanced processing and reasoning, allowing the device to reason and learn while also assisting physicians in their outcomes. Precision medicine helps to cure critical diseases like Cancer, Cardiovascular diseases, Covid-19, and etc. This review paper aims on discussing how Artificial intelligence techniques in diagnosing critical diseases and how AI is helpful to patients and clinicians by using different methodologies. © 2022 IEEE.
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Introduction: It is essential to comply with palliative care philosophy during consultations for hospitalisation purposes between specific medical branches and specialised palliative care services (SPCS). We aimed to evaluate the patients who were admitted or consulted to the palliative care service with a palliative care approach. Materials and Method: This descriptive study is based on retrospective review of data. The consultation requests delivered to the SPCS between December 1, 2019 and December 1, 2020 were evaluated through the hospital archive. The number of consultation requests delivered to the SPCS from other departments for hospitalisation purposes, demographic characteristics of patients, their acceptance and rejection rates, and reasons for which these decisions were made were examined. Results: Of the total 394 consultation requests, 53.6% (n = 211) were for males. The acceptance rate was 40.9% (n = 161). The most common primary diagnosis category was gastrointestinal cancers (21.6%), the most common consulting branch was emergency department (44.6%), the most common reason for rejection (53.2%) was the patient’s acute problems and the most common reason for acceptance was the need for nutritional support with a rate of 64.0%.Conclusion: It has been determined that most of the consultations requests were not accepted. It is necessary to use SPCS more effectively.
ABSTRACT
Objective: Debate is ongoing regarding the need for universal endoscopic follow-up to ensure gastric ulcer healing. We aimed to assess the value of follow-up oesophago-gastro-duodenoscopies (OGDs) for gastric ulcer healing and stratify patients according to risk of malignancy by developing a risk score. Design/method: All patients in National Health Service (NHS) Lothian with an index OGD and a diagnosis of gastric ulcer between 1 January 2014 and 31 December 2018 were identified. Data were analysed with logistic regression to identify factors significantly associated with a diagnosis of cancer; a risk score was derived and externally validated. Results: 778 patients were identified and 60.3% (469/778) of patients had a follow-up OGD. 8.6% (66/778) of patients were diagnosed with cancer. No cases of cancer were found on follow-up OGD of a benign appearing ulcer with negative biopsies. Macroscopic suspicion of malignancy was present at index OGD in 100% (3/3) of those diagnosed with cancer on subsequent OGDs. Older age (p=0.014), increased ulcer size (p<0.001) and non-antral location (p=0.030) were significantly associated with malignancy. A risk score (area under the curve (AUC) 0.868, p<0.001, minimum score=0, maximum score=6) was derived from these variables. 78.0% of patients with malignant ulcers scored ≥3, only 15.8% with benign ulcers scored ≥3 (negative predictive value (NPV) 97.4%). External validation yielded an AUC of 0.862 (p<0.001) and NPV of 98.6%; 84.0% of those with malignant ulcers scored ≥3. Conclusion: Ulcers with a combination of macroscopically benign appearances, at least six negative biopsies and a low risk score do not necessarily need endoscopic follow-up.