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Bruton tyrosine kinase inhibitors (BTKis) were approved for use at the end of 2013 and have since been used for indications including chronic lymphocytic leukaemia (CLL), Waldenstrom's macroglobulinaemia and mantle cell lymphoma. The use of BTKis has increased significantly in the UK since they achieved NICE (National Institute for Health and Care Excellence) approval for frontline treatment of CLL in 2021. However, they are associated with significant adverse cardiovascular events. In September 2021 the British Journal of Haematology published good practice guidelines for the management of cardiovascular complications of BTKis. Our aim was to see whether these guidelines had been adhered to for patients taking BTKis. Method(s): Data was collected for all patients being prescribed BTKis (ibrutinib and acalabrutinib) in the South Tees NHS Trust in July 2022. Patients' medical records were used to assess whether their management adhered to the good practice guidelines. Data was collated for 67 patients in total. Result(s): The data showed that although all patients were consented for the risk of atrial fibrillation only 6% were consented for hypertension and only 1.5% for ventricular arrhythmias and sudden cardiac death. The guidelines recommend a baseline ECG (electrocardiogram) on commencement of treatment;however, only 7% had this completed and 0% had the minimum monitoring recommendation of 6-monthly ECGs. Thirty patients (45%) had an indication for a baseline echocardiogram;however, only one had this completed. For patients reporting symptoms of syncope, dizziness or palpitations only 50% had an ECG completed. Three patients developed worsening heart failure. The recommendations suggest referral to a cardio-oncologist;however, due to lack of availability of this service the referrals were instead made to the usual cardiologist. Conclusion(s): Although there was a lack of compliance with guideline recommendations, it should be considered that most usual checks were affected by COVID-19 outbreaks and a drop in face-to- face clinics, which were replaced by phone clinics and home delivery of medications. However, the premade consent forms for BTKis need to be updated to include consent for ventricular arrhythmias and sudden cardiac death. There also needs to be routine procedures in place to ensure that regular blood pressure testing and ECG monitoring occurs and that there is prompt recognition of cardiovascular complications. Action and implementation: To ensure improved compliance with these guidelines we plan to update our consent forms and create a proforma for clinic use to ensure that clinicians are aware of the various monitoring criteria required.
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Objectives: The COVID-19 pandemic has disrupted healthcare delivery for patients with cancer. This research assessed the impact of COVID-19 on the delivery of cancer care in the US during the pandemic and evaluated emerging treatment trends in the post-COVID-19 setting. Method(s): A series of Community Oncology Research Evaluations (CORE) meetings were conducted across the US between December 2021 and May 2022. During these meetings, community oncologists undertook a survey focused on the impact of COVID-19 in the community-practice setting. Result(s): 242 community oncologists participated in the survey. Over 80% of the physicians estimated that up to 20% of patients with cancer have gone undiagnosed due to their reluctance to visit a healthcare provider during the pandemic. More than half (51%) of community oncologists reported a decrease of up to 50% in in-office patient visits versus before COVID-19, with most physicians (71%) indicating that some delivery of care changed to a virtual setting in up to 20% of patients. Most physicians (86%) reported no change in their willingness to assess new therapies. Most common strategies to manage cancer during the pandemic included the use of telemedicine for stable patients receiving oral chemotherapy (55%), use of extended dosing schedules (39%), and switching route of chemotherapy administration from intravenous to oral or subcutaneous (38%). Once COVID-19 is under control, these strategies are expected to remain in place. Nearly half of the community oncologists (48%) plan to continue using telemedicine for managing disease in stable patients receiving oral chemotherapy, over a quarter intend to continue using extended dosing schedules, and 19% plan to use oral or subcutaneous chemotherapy when appropriate. Conclusion(s): COVID-19 had a detrimental impact on cancer diagnosis and delivery of therapy. Community oncologists reported a seemingly permanent shift in care patterns including telemedicine, extended dosing schedules, and switching chemotherapy administration route.Copyright © 2023
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Coronavirus disease-19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic and is giving rise to a serious health threat globally. SARS-CoV-2 infection ranges from asymptomatic carrier state to severe illness requiring intensive care unit (ICU) management. It is postulated that with COVID-19 infection, children are less prone to develop severe symptoms as compared with adults. The data on immunocompromised children affected with COVID-19 infection is limited and not many publications are there on the effects of 2nd wave of COVID-19 infection in pediatric hematology/oncology patients till date. In our experience during second wave, 17 patients were found to be positive for SARS-CoV-2 with a male: female ratio of 2.4: 1 and median age of 8 years (range 1-18 years). Out of these 17 patients, 10 (58.8%) patients required hospital admission whereas the remaining were managed at home. Only 1 patient required ventilatory support and there was no mortality. Though the number of pediatric patients with COVID-19 infection were more during the second wave but majority had mild to moderate symptoms and were easily managed.Copyright © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics
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Introduction: Lorlatinib is a third-generation tyrosine kinase inhibitor that inhibits anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1). Although 2-10% of patients with non-small cell lung cancer developed hyperglycemia in phase 2 and 3 studies of lorlatinib, only one case has subsequently reported hyperglycemia >500 mg/dL, and no cases of diabetic ketoacidosis (DKA) have been previously reported. Phase 1 trials in neuroblastoma are ongoing. Case Description: A 34-year-old woman with ALK-mutated paraspinal neuroblastoma presented with DKA 14 months after initiation of lorlatinib. Prior to starting lorlatinib, her hemoglobin A1c had been 5.0% (n: < 5.7%). After 12 months of therapy, her A1c increased to 7.8%, prompting the initiation of metformin 500 mg daily. However, two months later she was admitted for DKA with a blood glucose of 591 mg/dL (n: 65-99 mg/dL), CO2 17 mmol/L (n: 20-30 mmol/L), anion gap 18 (n: 8-12), moderate serum ketones, and 3+ ketonuria. Her A1c was 14.8%, C-peptide was 1.2 ng/mL (n: 1.1-4.3 ng/mL), and her glutamic acid decarboxylase-65 and islet antigen-2 autoantibodies were negative. She was also found to be incidentally positive for COVID-19 but was asymptomatic without any oxygen requirement. The patient's DKA was successfully treated with IV insulin infusion, and she was discharged after 3 days with insulin glargine 27 units twice daily and insulin aspart 16 units with meals. One month later, her hemoglobin A1c had improved to 9.4%, and the patient's oncologist discontinued lorlatinib due to sustained remission of her neuroblastoma and her complication of DKA. After stopping lorlatinib, her blood glucose rapidly improved, and she self-discontinued all her insulin in the following 3 weeks. One month later, she was seen in endocrine clinic only taking metformin 500 mg twice daily with fasting and post-prandial blood glucose ranging 86-107 mg/dL. Discussion(s): This is the first reported case of DKA associated with lorlatinib. This case highlights the importance of close glucose monitoring and the risk of severe hyperglycemia and DKA while on lorlatinib therapy. Discontinuation of lorlatinib results in rapid improvement of glycemic control, and glucose-lowering treatments should be promptly deescalated to avoid hypoglycemia.Copyright © 2023
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Introduction: Extensive stage small cell lung cancer (ES-SCLC) is the most aggressive form of lung cancer, and delays in treatment result in worse outcomes. The National Lung Cancer Audit1 guidelines advise 70% of patients should receive systemic treatment and 80% within 14 days of pathological diagnosis. We aimed to assess compliance with these recommendations and improve the treatment pathway for patients with ES-SCLC in East London. Method(s): To establish baseline metrics, we reviewed compliance with these guidelines in all patients diagnosed with ES-SCLC in 2019 (pre-COVID pandemic). Two interventions were made: i) admission of all newly diagnosed patients for urgent chemotherapy to improve time to treatment and ii) all newly diagnosed ES-SCLC patients across our network of five hospitals were requested to be reviewed by or transferred under a lung oncologist to improve treatment rates. We re-evaluated data from all ES-SCLC patients diagnosed in 2022 using the same pre-intervention criteria. Result(s): 31 patients in 2019 and 17 patients in 2022 were included. There was no significant difference in baseline characteristics including (median) age (68 vs 70, p=0.64), co-morbidities (1 vs 1, p=0.12), and performance status (1 vs 1, p=0.86) between cohorts. There was a significant decrease in the median [range] time to treatment (13 [4-80] days vs 4 [1-31] days, p=0.03] and an increase in the proportion of patients reviewed by a lung oncologist (74% to 100%, p=0.04). There was also an increase in the proportion of patients receiving treatment (61% vs 77%). [Figure presented] Conclusion(s): Our data suggest that these interventions may improve the proportion of patients receiving treatment and the time to treatment. Larger local audits and correlation with national data is required to evaluate the impact these interventions have on outcomes. Reference: [1] RCP National Lung Cancer Audit Annual Report. 2022. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
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Introduction: Mesothelioma is a rare cancer with over 2500 cases diagnosed annually in UK. The disease is historically associated with poor survival and high symptom burden. Prior to 2022, there was only one NICE approved NHS treatment option and no agreed, long term second line therapy. Clinical trials investigating new therapies often opened in a small number of specialist centres resulting in significant travel for patients. Harrogate District General Hospital is part of the Harrogate & District NHS Foundation Trust (HDFT) and the smallest organisation within the West Yorkshire & Harrogate Cancer Alliance. Method(s): HDFT became a regional recruitment centre for CONFIRM, a double blinded, single agent immunotherapy versus placebo, clinical trial. Initially aimed at the third line setting, involving a 2:1 randomisation, HDFT enrolled patients from across the Yorkshire Region. The team included a Consultant Medical Oncologist, 2 Research Nurses, trial administrator and Regional Mesothelioma UK CNS, helping identify the trial and providing additional support to the research nurses and patients recruited. The team had to employ new strategies to manage the complexities involved. At the time, there was no consensus on alternative NHS treatment options. The window of opportunity to enter was often short making good lines of communication with referring teams essential. Co-ordination of appointments to minimise the burden of travel on this vulnerable group of patients was also vital. Result(s): CONFIRM showed improved overall survival in patients with relapsed malignant pleural and peritoneal mesothelioma [1], possibly influencing change in treatment options when NHS England announced interim drug use approvals during the COVID Pandemic [2]. HDFT recruited 18 patients (5.4% of 322 Nationally). 27 patients were referred and approached, 21 consented, 3 failing screening. Conclusion(s): CONFIRM at HDFT demonstrates that small teams can contribute to national research. References: [1] Fennell et al. (2021) [2][NHS England (2020) Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
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The proceedings contain 208 papers. The topics discussed include: social media use in young adult cancer survivors: a phenomenological approach to understand young adult cancer survivors' experience;creative coping programs to reduce symptoms of psychological distress and build feelings of connection among young adult cancer patients and survivors;engaging AYAs by meeting them where they are: development of an annual AYA Cancer Summit;reconnection in a post-covid world: leveraging social and peer support for young adults with cancer;social isolation and social support among young adult vs. older adult cancer survivors during one year of the COVID-19 pandemic: a propensity score matched analysis;financial concerns in parents who lost a child to cancer;caregivers' reactions to emerging stress biomarkers: a potentially innovative approach to increasing engagement with support;and closure is a myth: the importance of recognizing and managing grief in psycho-oncologists.
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Objectives: To determine if the COVID pandemic affected treatment times for women with locally advanced (FIGO Stages IIb-IVa) cervical cancer. Method(s): Subjects diagnosed with and treated for locally advanced (FIGO Stages IIb-IVa) cervical cancer with chemo/radiotherapy at a large, urban, tertiary hospital between 1/1/19-12/31/21 were identified and the following was collected: Demographics, urban/rural home address, stage, histology, and the dates of diagnostic biopsy, first visit with oncologist, and start and completion of radiotherapy. Result(s): 69 subjects were identified. (59 Black vs 10 white;35 urban vs 34 rural). Median time from biopsy to seeing an oncologist was 14.2 days. Median time from seeing an oncologist to start of radiotherapy was 29.9 days, and median time from start to completion of radiotherapy was 62.9 days. Pre-COVID (P, 2019-2/20) vs during (D, 3/20-), median times in days were: Biopsy until seeing oncologist: 12.7(P) vs 15.2(D);seeing oncologist until start of radiotherapy: 27.3(P) vs 31.6(D);start until completion of radiotherapy: 62.2(P) vs 63.4(D);and biopsy until completion of radiotherapy: 99.9(P) vs 109.3(D). When urban(U) vs rural (R) subjects are compared in the pre-pandemic era, median times were: Biopsy until seeing oncologist: 10.5(U) vs 14.9(R);seeing oncologist until start of radiotherapy: 19.8(U) vs 34.7(R);start until completion of radiotherapy: 58.6(U) vs 65.4(R);and biopsy until completion of radiotherapy: 88.1(U) vs 113.9(R). When urban(U) vs rural (R) subjects are compared in the During-pandemic era, median times in days were: Biopsy until seeing oncologist: 12.9(U) vs 17.8(R);seeing oncologist until start of radiotherapy: 28.3(U) vs 35.4(R);start until completion of radiotherapy: 60.4(U) vs 66.8(R);and biopsy until completion of radiotherapy: 101.0(U) vs 118.9(R). All differences were significant to p<0.001. Conclusion(s): The COVID pandemic was associated with an increased time from diagnosis to completion of treatment for locally advanced cervical cancer. (99.9 vs 109.3 days) Rural subjects experienced longer times in treatment than urban subjects prior to COVID, and this difference was exacerbated by the pandemic: 101(U) v.118.9(R) Rural subjects will require proactive efforts to maintain compliance with treatment.Copyright © 2022 Elsevier Inc.
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Background In the UK it is estimated that 10-15% of lung cancer cases occur in never-smokers. This study demonstrates the changes of the demographic characteristics, including the smoking status, of all the patients referred to the thoracic malignancy unit at Guy's Cancer Centre, South East London, between 2010 and 2021. Methods We included patients with a documented ICD10 diagnosis of bronchus and lung malignancy who were referred to Guy's thoracic malignancy unit from 2010 until 2021. A total of 6861 patients with a diagnosis of lung cancer were identified. We collected baseline demographic and clinical characteristics, including smoking status and socio-economic status for all the patients. Descriptive statistics were utilised to highlight the dynamic changes over the years of the referred patients. Results The number of referrals per year remained overall stable from 2010 until 2019, with a decrease in the number of referrals in 2020 and 2021, most likely due to the COVID-19 pandemic. We observed a gradual increase in the percentage of never smokers among the lung cancer patients: 5%, 8%, 10% and 13% of the referred patients were never smokers in the years 2010, 2015, 2018 and 2021 respectively. Median age remained stable across the years (range 68-71 years). Male percentage was 56%, 55%, 53% and 53% in 2010, 2015, 2018 and 2021 respectively. From the patients that we had a documented ethnic background the proportion of White/Black/Asian/Other or Mixed ethnicity remained stable across the years with a median 87%, 7%, 3%, and 3% respectively. The most common histological diagnosis was adenocarcinoma, followed by squamous cell carcinoma and small cell lung carcinoma. Conclusions The proportion of never-smoking to smoking related lung cancer has gradually increased between 2010 and 2021. There was little variability in age, sex and ethnic background. Never-smoking lung cancer is a distinct biological entity, therefore, further research should focus on the understanding of the aetiology and the risk factors leading to the development of lung cancer, in the absence of a history of tobacco exposure. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.Copyright © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc.
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Background: It has been almost three years since the COVID-19 outbreak, yet evidence of its impact on the cancer care landscape remains scant. The present single-center study examines patterns in gynecological cancer diagnoses before and during the pandemic. Method(s): All female patients diagnosed in our academic hospital with gynecological cancer, between January 2017 and December 2020, were retrospectively identified. Pre-defined subgroup analyses were performed in patients who had been newly diagnosed during 2020 and in the pre-pandemic 3-year period. The study was approved by the Institutional Ethical Committee and was conducted in accordance with the Declaration of Helsinki and the International Conference on Harmonization for Good Clinical Practice. Result(s): In total, 1,193 women were included in this case-control study;1,001 (83.91%) were identified in the pre-pandemic period as a control, while 192 (16.09%) cases were allocated in the pandemic group. The two cohorts were similar regarding demographic and clinical characteristics. For the pre-pandemic period, the mean yearly number of patients with newly identified cancer was highest for endometrial (149;44.61%), followed by ovarian (92;27.5%) carcinomas. During the first year of the pandemic, the number of new diagnoses significantly decreased by 42.5% (from 334 to 192) for all types of malignancies combined (one sample t-test p-value= 0.014). Declines ranged from 36.96% to 49% for ovarian and endometrial cancer, respectively. Conclusion(s): This is the first study to appraise a timely snapshot of the effect of COVID-19 on newly diagnosed gynecological tumors in a European Society of Gynaecological Oncology (ESGO)-certified center in Greece, demonstrating an alarmingly sharp decline in the number of new cases during the pandemic. It is of utmost importance the gynecologic oncologists to ensure the continuum of care for their patients. [Formula presented] Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023 European Society for Medical Oncology
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INTRODUCTION: With the onset of the COVID-19 pandemic, many cancer centers pivoted to a completely virtual multidisciplinary tumor board (VTB) format. We previously published a significant rise in number of attendees and cases presented with the transition from in-person to VTB at our institution. The aim of the current study was to measure the satisfaction of participants regarding the virtual format. METHOD(S): We developed a 21-question survey including 10 questions that directly compared virtual to in-person tumor boards using a 5-point Likert scale. The survey was imported into REDCap and sent via email to all tumor board participants. Responses were collected for approximately 4 weeks (reminder email at 2 weeks) and categorized. RESULT(S): There were a total of 83 respondents, 53 of whom (64%) attended both in-person and VTB. Specialties with highest response rates were Surgical Oncology (n=24) and Medical Oncology (n=18), and tumor boards with highest participation in the survey were Breast (n=26) and Gastrointestinal (n=21). Most respondents accessed the virtual platform from the hospital or office (67%) with some participation from home (19%). Most (77%) participants were either satisfied or very satisfied with the VTB format compared with 70% for in-person tumor board. Additionally, the majority of respondents (95%) felt that VTBs had great value for discussions with community-based clinicians. In terms of direct comparison to in-person tumor boards, 40% felt that the level of distraction was higher for VTB. The large majority of respondents felt that they were somewhat more (24%) or significantly more (44%) available for VTB format. Finally, when asked regarding their preference going forward, 52% favored virtual, 6% favored in-person, and 42% favored some sort of hybrid variety type of tumor board. CONCLUSION(S): The majority of multidisciplinary tumor board participants expressed satisfaction with the virtual format and prefer it to in-person meetings going forward. VTB allows increased accessibility, opportunities to engage community oncologists, and the ability to present more cases. Drawbacks to this format included less face-to-face interaction and increased levels of distraction. Our institution is currently considering completely virtual and hybrid options moving forward.
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Background: Cancer(ca) and old age are risk factors for developing severe COVID-19 (C19+) disease, related morbidity and mortality. These patients (pts) were excluded from clinical trials evaluating the safety and efficacy of 3 FDA approved C19 vaccines (vax). Genitourinary (GU) ca-prostate, bladder and kidney ca contribute to the majority of non-skin ca and median age of these pts range from 65-75 yrs. We aimed to study these highly vulnerable pts behavior and outcomes regarding C19 vax in comparison to non-GU ca pts (18-89 years). Method(s): A prospective and observational single center study. Adult ca pts seen in clinics from Nov 2021-Sept 2022 were randomly interviewed using telephone surveys after a verbal consent. Type of ca and therapy data were collected from pts' medical records. The survey included C19 disease status, vax status positive (+) or negative (-), reason for vax status, side effects (s.e), impact on ca Rx or ca progression. Data was entered on REDCap. The primary end point was rate of vaccination in adult ca pts. Secondary end points were to quantify C19 vax acceptance vs. hesitance, identify s.e of C19 vax and effect of C19 vax on outcomes in GU and non-GU Ca pts. Result(s): N=172;GU ca 21 (12.2%) and non-GUca 151 (87.8%). Among GU ca pts- 9 had prostate ca, 7 had bladder ca and 5 had renal ca. C19+ in 4 (19%) GU and 45 (30.2%) non-GU pts. GU pts: 90.5% received C19 vax (Pfizer 47.6%;Moderna 42.9%, J & J 0%);9.5% were not vaxed. Non-GU pts: 85.2% received C19 vax (Pfizer 39.1%;Moderna 43%, J & J 2.6%);14.8% were not vaxed. The top 3 risk factors for serious C19+ were age >65yr (76.2%), heart disease (61.9%) and BMI.30 (42.9%) in GU ca pts and age >65yr (46.4%), BMI.30 (35.1%) and smoking (19.9%) in non-GU ca pts. The top 3 reasons for C19 vax (+) in GU ca pts: protection against C19+ for self (81%), for others (47.6%) and provider recommendation (38.1%). The main reasons for vax hesitancy in C19 vax (-) GU ca pts: concern for allergy to the vax (4.8%) and prior C19 infection (4.8%). The common s.e of C19 vax reported in GU ca pts were injection site inflammation (19%), headache (4.8%), muscle/body aches (4.8%) but no lymphadenopathy. None of GU ca pts reported delay in Rx or progression of the disease due to C-19 vax. Conclusion(s): C19 vax were overall well tolerated and did not impact ca outcomes in pts with GU malignancies. Oncologists should discuss the importance of C19 vax in the context of ca.
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Introduction: We performed matched case-control studies utilizing cohorts of postmenopausal women with ER+ breast cancer receiving adjuvant aromatase inhibitors (AI) on MA.27 [anastrozole, exemestane] or PreFace [letrozole] to assess the association between estrogen suppression after 6 months of treatment and an early breast cancer (EBC) event within 5 years of AI initiation (Clin Cancer Res 2020;26:2986-98). We found a significant 3.0-fold increase in risk of an EBC event for those taking anastrozole with levels of estrone (E1) >=1.3 pg/mL and estradiol (E2) >=0.5 pg/mL, but not for exemestane or letrozole. Given these findings we designed a prospective pharmacodynamic (PD) study to evaluate the impact of anastrozole (1 mg/day: ANA1) on E1 and E2 levels, and among those with inadequate estrogen suppression (IES: E1 >=1.3 pg/mL and E2 >=0.5 pg/mL), to evaluate the safety and PD efficacy of high-dose anastrozole (10 mg/day: ANA10), which has been found to be safe in prior clinical trials (Cancer 1998;83:1142-52). Method(s): Post-menopausal women with stage I-III, ER >=1% positive/HER2-negative breast cancer who were candidates for anastrozole were eligible after completion of locoregional therapy and chemotherapy, as clinically indicated. Women who were pre-menopausal at diagnosis were not eligible. All patients received 8-10 weeks of ANA1, after which those with adequate estrogen suppression (AES: E1< 1.3 pg/mL or E2< 0.5 pg/mL) came off study. Those with IES went on to receive ANA10 for 8-10 weeks, followed by letrozole (2.5 mg/day: LET) for 8-10 weeks. All patients were managed at their treating oncologist's discretion following study discontinuation. E1 and E2 blood levels were measured pre-treatment and after completion of each treatment cycle by a CLIA-approved liquid chromatography with tandem mass spectrometry in the Immunochemical Core Laboratory at Mayo Clinic. With a sample size of 29 patients with IES after ANA1, a one-sided binomial test of proportions with a significance level of 0.05 will have an 87% chance of rejecting the proportion with AES after ANA10 is at most 25% (Ho) when the true proportion is at least 50%. Specifically, the null hypothesis is rejected if the number of women with AES after ANA10 is 12 or more. Data lock was July 6, 2022. Result(s): Of the 161 women enrolled from April 2020 through May 2022, 3 withdrew consent prior to start of ANA1 and 2 were ineligible;thus, 156 women comprised the study cohort. Median patient age was 64 years (range 44-86), 10% of patients were of Hispanic ethnicity and/or non-white race, and 15% received chemotherapy. Six patients remain on ANA1, and 10 discontinued ANA1 due to refusal (7), adverse event (AE) (2), or COVID-19 (1). Forty-one of the remaining 140 patients (29.3% 95%CI: 21.9- 37.6%) had IES with ANA1. Nine of these 41 patients did not go on to ANA10 due to refusal (6) or AE (3). Of the 32 patients who started ANA10, 8 remain on treatment, 5 discontinued due to refusal (3) or AE (1-grade 2 urinary tract infection;1-grade 1 palpitations), and 19 had a blood draw 45 days or more after starting ANA10. No grade 3-5 AEs or grade 2 hot flashes or arthralgias were reported. Of these 19 patients, 14 achieved AES with ANA10 (73.7% 95%CI: 48.8-90.9%). All 19 patients switched to LET of which 3 remain on treatment, 1 is missing E1/E2 data, and 15 had a blood draw 45 days or more after starting LET. Of these 15 patients, 10 maintained AES, 2 acquired AES with LET, and 3 no longer had AES. Anastrozole and letrozole drug levels will be reported at the meeting. Conclusion(s): Approximately 29% of postmenopausal women with ER+/HER2- BC receiving adjuvant anastrozole 1 mg/daily had IES. A majority of these patients achieved AES with dose escalation to ANA10 without tolerability issues. E1 and E2 levels are logical biomarkers given the mechanism of action of anastrozole, and further study utilizing them to determine the optimal dose of anastrozole for a given patient should be performed.
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Introduction: Breast cancer is the most common cancer in women and the leading cause of cancerrelated death in women worldwide. The high prevalence of physical and psychosocial suffering among breast cancer patients and their families justifies the need for an early interdisciplinary approach by a palliative care team. The effectiveness of early palliative care for patients with advanced cancer has been demonstrated in many studies. Early referral to outpatient palliative care services improves symptom control, reduces suffering and improves quality of end-of-life care. Aim(s): Evaluation of referral patterns of metastatic breast cancer patients to the outpatient embedded palliative care team. Method(s): We retrospectively retrieved data from electronic medical records of patients who were treated at a private community oncology practice in Brazil who died from metastatic breast cancer during the years of 2018 until 2021.We evaluated the patient's follow-up time by the palliative care team (follow-up > 12 weeks or not) and the year of referral to the service (pre-2020 vs 2020 and later) associated to the service referral type: Late referral (more than 8 weeks of metastatic diagnosis) or early referral. Each group was followed-up by cancer physicians and after referral was also followed-up by a palliative care multidisciplinary team who regularly evaluated cancer patients during their treatments at outpatient setting. During COVID-19 pandemic, some patients were evaluated by telemedicine appointments. We performed univariate comparisons analysis by Fisher's Exact Test. p < 0.1 was deemed as statistically significant. Result(s): Of the 211 patients whose data were assessed, 99 patients were referred to Palliative Care team before 2020 and 112 patients after 2020. 13.1% of patients pre-2020 received early palliative care versus 33.9% of patients in the post-2020 referral group, resulting in a 3.37-fold odds of an early palliative care integration after 2020 (OR 3.37, CI95: 1.61 - 7.45;p< 0.001). Overall, 30.4% of longer follow-up patients were an early referral versus 19.3% of the shorter follow-up, resulting in an 82% greater chance (OR 1.82, CI: 0.92-3.63;p< 0.1) of prolonged assistance with early referral. Conclusion(s): In this analysis, early palliative care integration for patients with metastatic breast cancer has increased after 2019 despite the COVID-19 pandemic, leading to prolonged time of accompaniment by the multidisciplinary palliative care team. This suggests that even in the face of this challenging moment, a mature and consolidated service is offered by the palliative care team. Also, according to previous data in literature, prematurely integration show signs of correlation with better quality of life and death, supporting early palliative care for this group of patients. However, further work is needed to examine the effect of this care model in our cohort.
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The impact of the COVID19 pandemic on treatment practices for patients diagnosed with early breast cancer: a cross-sectional study from a large comprehensive cancer centre in Italy. Introduction: The Coronavirus Disease 2019 (COVID19) has disrupted health services worldwide. The evidence on the impact of the pandemic on cancer care provision, however, is conflicting. Some reports found that management for patients diagnosed with early breast cancer (EBC) during the pandemic did not differ from pre-pandemic practices;other reports suggested that delays in breast cancer surgery may have occurred. We aimed to audit the management of patients diagnosed with EBC during the pandemic in a large, tertiary-level cancer centre in Italy. Method(s): We conducted a cross-sectional study to track the route to first treatment for patients diagnosed with EBC during 2019, 2020, and 2021. We ed data for all consecutive patients referred to the Veneto Institute of Oncology (Padua, Italy). We defined as point of contact (POC) the date of the first consultation with a breast cancer specialist of the breast unit. We considered patients with a first POC in the 6 months preceding the multidisciplinary (MDT) meeting and initiating a treatment within 6 months from the POC. We chose the 3-month period April-June because in 2020 it was when health services were first acutely disrupted. We analysed the same period for 2019 and 2021. First treatment was defined as either upfront surgery or neoadjuvant chemotherapy (NACT). The time to first treatment was defined as the interval between the first POC and the first treatment. We used the median time to first treatment in 2019 to define the threshold for treatment delay. Result(s): We reviewed medical records for 878 patients for whom an MDT report during 2019-2021 (April through June) was available. Of these, 431 (49%) were eligible: 144 in 2019, 127 in 2020 and 150 in 2021. Median age at first POC was 61 years. The proportion of screen-detected tumours was larger in 2019 and 2021 than in 2020 (59%). Conversely, the proportion of screen-detected tumours was offset by the proportion of palpable tumours in 2020 (44% versus 56%). These differences were statistically significant (chi-square test 11.12, p=0.004). Distribution of tumour and nodal stage was unchanged over time, but in-situ tumours were slightly fewer in 2020 than in 2019 or 2021. The odds ratio for treatment delay (45 days or more) was 0.87 for 2020 versus 2019 (95% CI, 0.5-1.53) and 0.9 for 2021 versus 2019 (95% CI, 0.52-1.55), after adjusting for type of POC, presentation with symptoms, treatment type, tumour stage, nodal stage, and EBC subtype (i.e., luminal, HER2positive, triple-negative). Conclusion(s): There was no evidence for major changes in the management of EBC patients during 2019-2021 and no treatment delays were observed. However, our results show a slight decrease in the absolute number of patients being treated in 2020, offset by an increase in 2021 to levels comparable to 2019. Our findings suggest that disruption of breast cancer screening programmes may have impacted on the characteristics of the patient population, with a larger proportion of women presenting with palpable nodules. Validation on a larger, population-based cohort of patients is warranted to robustly assess the impact of the COVID19 pandemic on treatment practices and outcome for EBC patients.
ABSTRACT
Background: During the COVID-19 pandemic, Twitter has been instrumental in accelerating knowledge dissemination and forging collaborations within the medical community and amongst patient advocates. Tweetchats within Twitter are scheduled conversations on a specific topic. In oncology, Tweetchats have been used by cancer advocates to spread awareness and for patient and caregiver education. A colorectal cancer (CRC) specific tweetchat did not previously exist. This describes the creation, and experiences with a CRC specific tweetchat. Method(s): The #CRCTrialsChat tweetchat was created by a patient advocate for colorectal cancer patients, caregivers and clinicians to meet and exchange clinical trial-related information. Two gastrointestinal (GI) medical oncologists and two radiation oncologists were enlisted as moderators. The topic for each session is chosen by the patient advocate, who creates an outline and divides the content, which is designed to last a one hour session. The idea is to create engaging, technical, but easy to understand content. Each moderator then works on the answers to their assigned section, which is edited to fit tweet character limit. Sessions may also have guest moderators with expertise on a specific topic. Through tweeting, moderators answer specific questions that come up during the session and later. Result(s): To date, we have had four sessions covering the following topics: Clinical trial basics, CRC Updates from ASCO22, ClinicalTrialFinders and BRAF-mutated tumors. The content created has been simple and engaging, the format has functioned smoothly, and the reach of #CRCTrialsChat has been steadily increasing. After the most recent session on BRAF in September 2022, the @CRCTrialsChat has 281 followers, 17K impressions and 14.6K profile visits, a reflection of its excellent content. From a clinician perspective, this is a great format to interact with colleagues, discuss enrolling trials and also become familiar with using Twitter. Conclusion(s): A CRC clinical trial focused tweetchat is an engaging way to deliver trial-related content to an audience of clinicians, patients and caregivers. The current format appears to be an effective way to create and disseminate information. Future sessions will focus on ctDNA, molecular markers such as KRAS and HER2, and rectal cancer trials. Our hope is that #CRCTrialsChat will stimulate continued patient and clinician engagement, increase awareness of clinical trials, enhance trial participation and initiate patient-centric research and collaborations.