Personalized approach to the management of a patient with COVID-19 with a complicated comorbid background

The aim of the work is to form the principles of a personalized approach to the management of patients with COVID-19 with a complicated comorbid background. Material and methods. The article describes a clinical case of successful recovery of an 87-year-old patient from a new coronavirus infection COVID-19, complicated by pneumonia involving 36% of the lung parenchyma area. Along with age, the situation was aggravated by the comorbid status of the patient: the presence of chronic lymphocytic leukemia, hypertension, mechanical prostheses of the mitral and aortic valves, postinfarction cardiosclerosis, paroxysmal atrial fibrillation, type 2 diabetes mellitus, stage 4 CKD, anemic syndrome, and subclinical hypothyroidism. Results. The C-reactive protein level at admission was 114.46 mg/L. The patient refused hospitalization. Baricitinib 4 mg, favipiravir according to the scheme, vitamin D 2000 units were prescribed for the previously taken therapy. Already after 3 days, C-reactive protein decreased by 4.6 times, and by the 8th day by 15.5 times and amounted to 7.38 mg/ml. The temperature returned to normal on day 2 from the start of baricitinib. In dynamics, a decrease in creatinine level to 177.0 mumol/l was noted, the glomerular filtration rate increased to 30 ml/min/1.73 m2, which corresponded to stage 3b of CKD (a pronounced decrease in glomerular filtration rate). Conclusion. Despite the age of the patient, many comorbidities, each of which could be fatal, the timely use of baricitinib on an outpatient basis made it possible to stop the progressive course of the disease.Copyright © Eco-Vector, 2023. All rights reserved.

Improving the treatment pathway in small cell lung cancer

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.

Management of Allergic Fungal Rhinosinusitis Associated with Vision Loss During COVID-19 Era.

The ongoing COVID-19 pandemic has given rise to unique challenges related to healthcare management. The problems have arisen due to the direct effect of COVID 19 infection and treatment or as repercussions of administrative efforts being undertaken to check the rapid spread of the epidemic. The management of some of the diseases has been hampered with the implementation of the policies like lockdown and transportation difficulties. This paper presents a series of four patients (6 eyes with vision loss) of an otherwise benign entity, Allergic Fungal Rhinosinusitis (AFRS), causing visual deterioration, managed amid the pandemic. AFRS has been known to cause vision loss by pressure over the optic nerve or its blood supply; however, a timely surgical intervention in the form of functional endoscopic sinus surgery to remove the disease and decompress the optic nerve, results in favourable outcomes in most patients. A delay in diagnosis and treatment may result in irreparable damage with the resulting inability to salvage the vision. In our series, we observed that vision recovery could be achieved in 66.7% of the affected eyes (four out of six eyes), while a poor visual outcome was observed in two (33%). The poor visual outcome was observed for the eyes with a prolonged visual impairment (4-6 months) at the time of presentation. We would appeal to the physicians to be cognizant of the adverse outcomes associated with the delayed surgical intervention of AFRS in the current pandemic scenario.

Real-World Experience on the Use of COVID-19 Vaccination in Multiple Sclerosis Patients Treated with Cladribine Tablets Participating in the ADVEVA Patient Support Program within the Gulf and Latin American Regions

Background: National Multiple Sclerosis Society and other international guidelines suggest that full COVID-19 vaccination status should be completed two to four weeks before starting Year 2 of treatment with cladribine tablets (CladT). CladT is administered twice over two years, Year 1 and Year 2. There is a special interest in real-world evidence on whether vaccination status may affect initiation of CladT treatment in Year 2. The objective of this analysis was to describe the proportion of patients treated with CladT who received COVID-19 vaccination, and whether this influenced the timing of initiating treatment with CladT in Year 2. Material(s) and Method(s): A vaccination questionnaire-based survey was sent to patients treated with CladT who were enrolled in the ADVEVA patient support program (PSP), upon their consent. The survey was carried out in the Gulf region (GULF) from Jun 2021 to Sept 2021, and in the Latin American region (LATAM) from Jan 2022 to Mar 2022. Demographics, COVID-19 vaccination status, type of vaccine(s), number of doses received, and dates of vaccination were collected. In each region, patient data from the survey were linked to data routinely collected by the PSP, with cut-off dates as mentioned. Fully vaccinated status was defined as having received 2 doses of mRNA vaccine, 1 dose of Johnson & Johnson vaccine or other vaccines approved by the World Health Organization, plus 14 days. Descriptive analyses were performed and time to Year 2 treatment initiation among those with at least 18 months' follow-up was estimated by vaccination status. Result(s): The survey participation rate in GULF was 87% (91 out of 105) and 19% in LATAM (152 out of 789). In total, 62 (68%) patients in GULF and 144 (95%) in LATAM were fully vaccinated against COVID-19. In both regions, among those with at least 18 months' follow-up (GULF, n=59;LATAM, n=81), all patients initiated Year 2 of treatment with CladT, regardless of vaccination status. In GULF, the mean (standard deviation) time to treatment initiation in Year 2 was 13.8(1.6) months among fully vaccinated patients (44%) and 13.3(3.5) months among those not fully vaccinated (21%). In LATAM, the mean time was 12.8(1.4) months among those fully vaccinated (52%) and 12.4(0.02) months among those not fully vaccinated (1.3%). In each region, only 1 patient initiated Year 2 treatment after at least 18 months from the start of Year 1. Conclusion(s): Most patients were fully vaccinated against COVID-19 in GULF and in LATAM, which was consistent with vaccination coverage and guidelines in both regions. In LATAM, low participation rates might lead to selection bias which limits interpretation of results. In these regions, with limited data, COVID-19 vaccination status did not appear to alter the time of treatment initiation with CladT in Year 2. Almost all patients followed the label recommendations in terms of timing of Year 2 treatment initiation.Copyright © 2022

COVID-19 and the Psychosocial Impact of Breast Health Delays

INTRODUCTION: Reallocation of resources during the COVID-19 pandemic resulted in delays for breast health care. Data are sparse regarding the impact of these delays on psychosocial outcomes. METHOD(S): Women seeking breast health care across a multi-site breast program in a large metropolitan area were assessed for psychosocial outcomes including depression, stress, and anxiety as it related to delays in care. Psychosocial outcomes were evaluated utilizing validated instruments (PROMIS, PHQ-9). Outcomes were stratified by treatment group (healthy, breast cancer, survivor) and Kaplan-Meier curves created for breast cancer patients to evaluate the relationship of time to treatment stratified by dichotomous psychosocial outcomes. Demographic and clinical data was ed from the electronic medical record. RESULT(S): 85 women enrolled in the study including 30 (35%) breast cancer patients, 24 (28%) healthy women, and 31 (36%) breast cancer survivors. Overall, 58% reported a delay in breast health care including surgery, radiation, chemotherapy, medical oncology treatments, clinical appointments, breast imaging and/or biopsies, survivorship follow-up, support groups, and/or screening. Compared to women in the no delay group, a greater proportion of women reporting a delay had high anxiety (78% vs. 58%;p = 0.06), high perceived stress (45% vs. 28%;p = 0.17), high loneliness (67% vs. 32%;p = 0.003), moderate or higher depression (16% vs. 8.3%;p = 0.34), and no or low emotional support (58% vs. 28%;p = 0.008). Among breast cancer patients, the first treatment modality was surgery in 73% and the median time to treatment was 33 days. The median time to treatment was 40 days for breast cancer patients reporting a delay compared to 28 days for patients reporting no delay. Longer time to treatment was observed among breast cancer patients with high versus low anxiety, perceived stress, loneliness, and depression and for patients with low versus high emotional support. CONCLUSION(S): Women with and without breast cancer reporting a delay had worse measures for anxiety, depression, perceived stress, loneliness, and emotional support. Longer time to treatment was experienced by breast cancer patients with worse psychosocial measures. Risk stratification of women seeking breast health care during the COVID-19 pandemic is needed to identify and support those at risk for adverse psychosocial outcomes. (Table Presented).

Navigating health systems for burn care: Patient journeys and delays in Uttar Pradesh, India.

BACKGROUND: India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India. METHODS: We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework. RESULTS: Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restrictions influenced all three delays. CONCLUSIONS: Burn care pathways are adversely affected by barriers to timely access. We propose using the modified 3-delays framework to analyse delays in burns care. There is a need to strengthen referral linkage systems, ensure financial risk protection, and integrate burn care at all levels of health care delivery systems.

A comparison of pre-radiotherapy extractions prior to and during the pandemic at charing cross hospital

Osteoradionecrosis has considerable morbidity and can adversely affect the quality of life of patients who undergo radiotherapy as part of the treatment for their head and neck cancer. This can be reduced by a thorough dental assessment and extractions of teeth with poor prognosis prior to radiotherapy, ideally at least ten days before radiotherapy commences. Aim and objectives: The dental department at Charing Cross Hospital has an established pathway to assess patients prior to radiotherapy. The aim of the audit was to evaluate whether during the coronavirus pandemic there was timely dental assessment prior to radiotherapy and extractions carried out in sufficient time before start of radiotherapy in accordance with the Royal College of Surgeons 2012 guidelines. Method(s): Data was collected retrospectively from patient records over two eight monthly periods (May 2019 -Jan 2020 prior to the pandemic and April 2020 - November 2020 during the pandemic). Parameters analysed included: the number of patients referred;time interval between referral and assessment;number of patients requiring extractions and time interval between extraction completion and commencement of radiotherapy. Result(s): Seventy-six patients with head and neck cancer were referred for dental assessment over the audit period. The most recent audit showed 96.4% of patients were assessed within ten days of referral. Extractions were undertaken on 63.6% of patients, 92.9% were in excess of ten days before radiotherapy, 42.9% over 20 days. Conclusion(s): National guidelines for extractions are being met in 92.9% of cases and the majority in excess of minimum timing recommended. The dental clinic is providing quality care for this patient group as measured by this audit, showing a positive service outcome.Copyright © 2021 The Authors

Diabetes Care for You: leadership, followership, partnership

The 2022 Mary MacKinnon lecture reminds us of some of the history of the development of out of hospital specialist diabetes services in the United Kingdom. There have been multiple clarion calls across the years to collaborate, share information and values and break down traditional boundaries in the pursuit of improved patient care and outcomes. Along with this, we note the roles of clinical and managerial leadership, followership and partnership in working together with people living with diabetes to co-produce a model of diabetes care and then to ensure through good stewardship of shared resources that the expectations of that change are delivered for our population. We go on to discuss how the Diabetes Care for You team has continued to innovate and provide care during the pandemic and conclude with a vision of the future and a challenge for decision makers to put the needs of the population at the forefront of future planning. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.

Implementation of radiotherapy in a tertiary hospital in Zhejiang province during the epidemic of COVID-19.

Objective: To explore the clinical practice of delivering radiotherapy during the outbreak of 2019 novel coronavirus disease(COVID-19). Method(s): During this epidemic period, available method including but not limited to: strict disinfection, body temperature monitoring and staff training of relevant knowledge, were used to ensure the safety of radiotherapy treatment. Statistical analysis was performed to study the relevant data including proportion of patients receiving radiotherapy for different purposes, time from scanning to the first time of radiation delivery and degree of satisfaction in the view of staffs and patients, respectively. Result(s): A total of 60 patients received radiation therapy in the department of radiotherapy of Zhejiang Provincial People's Hospital (2020-02-11). Compared with the same period in 2019 (after the Spring Festival), the total number of patients receiving radiotherapy was decreased from 72 to 60(83.3%). Among them, the number of patients receiving palliative radiation therapy decreased significantly, while the proportion of radical, preoperative and/or postoperative radiotherapy/radiochemotherapy did not significantly decrease. There was significant difference between two years (chi2=6.967, P<0.05). The median time for newly admitted patients to receive radiotherapy was two days, which was not significantly longer than the interval in 2019 (P>0.05). Staff and patients were generally satisfied with the current prevention measures. Conclusion(s): Using a variety of prevention and control method, and taking full account of medical safety and patient benefits, radiation-related activities can be carried out during the epidemic.Copyright © 2020 by the Chinese Medical Association.

Effects of time to treatment initiation on outcomes for soft tissue sarcomas.

BACKGROUND AND OBJECTIVES: Few studies have investigated the effects of time to treatment initiation (TTI) for soft tissue sarcomas (STS). Our objective was to investigate the risk factors for prolonged TTI and the effects of prolonged TTI on local recurrence free survival (LRFS), distant metastasis free survival (DMFS), and disease specific survival (DSS). METHOD: Patients diagnosed with high-grade STS of the extremities and trunk from 2011 to 2020 were included. TTI was grouped into two groups (treatment provided in less than vs. more than or equal to 30 days). Two-year and 5-year survival probabilities were calculated for LRFS, DMFS, and DSS. Cox regression and Kruskal-Wallis tests in univariate analysis were conducted to find risk factors affecting TTI and the survival outcomes. RESULTS: In the univariate analysis, diagnosis in the later 5-year period of the study, tumor size, and treatment modality were associated with prolonged TTI. TTI ≥30 days was associated with higher DMFS but no association was found with LRFS or DSS. Tumor size, surgical margins, and provision of surgery were associated with DSS. CONCLUSION: Despite the delay in treatment for STS patients caused by the COVID-19 pandemic, our study showed TTI of more than 30 days does not negatively impact patients.

Time to diagnosis and treatment of pulmonary tuberculosis in indigenous peoples: a systematic review.

BACKGROUND: Time to diagnosis and treatment is a major factor in determining the likelihood of tuberculosis (TB) transmission and is an important area of intervention to reduce the reservoir of TB infection and prevent disease and mortality. Although Indigenous peoples experience an elevated incidence of TB, prior systematic reviews have not focused on this group. We summarize and report findings related to time to diagnosis and treatment of pulmonary TB (PTB) among Indigenous peoples, globally. METHODS: A Systematic review was performed using Ovid and PubMed databases. Articles or abstracts estimating time to diagnosis, or treatment of PTB among Indigenous peoples were included with no restriction on sample size with publication dates restricted up to 2019. Studies that focused on outbreaks, solely extrapulmonary TB alone in non-Indigenous populations were excluded. Literature was assessed using the Hawker checklist. Registration Protocol (PROSPERO): CRD42018102463. RESULTS: Twenty-four studies were selected after initial assessment of 2021 records. These included Indigenous groups from five of six geographical regions outlined by the World Health Organization (all except the European Region). The range of time to treatment (24-240 days), and patient delay (20 days-2.5 years) were highly variable across studies and, in at least 60% of the studies, longer in Indigenous compared to non-Indigenous peoples. Risk factors associated with longer patient delays included poor awareness of TB, type of health provider first seen, and self-treatment. CONCLUSION: Time to diagnosis and treatment estimates for Indigenous peoples are generally within previously reported ranges from other systematic reviews focusing on the general population. However among literature examined in this systematic review that stratified by Indigenous and non-Indigenous peoples, patient delay and time to treatment were longer compared to non-Indigenous populations in over half of the studies. Studies included were sparse and highlight an overall gap in literature important to interrupting transmission and preventing new TB cases among Indigenous peoples. Although, risk factors unique to Indigenous populations were not identified, further investigation is needed as social determinants of health among studies conducted in medium and high incidence countries may be shared across both population groups. Trial registration N/a.

Impact of Time-To-Surgery on the Prognosis of Patients with T1 Renal Cell Carcinoma: Implications for the COVID-19 Pandemic.

Background: During the COVID-19 pandemic, elective surgery has to undergo longer wait times, including nephrectomy for T1 renal cell carcinoma (RCC). This study aimed to investigate the time-to-surgery (TTS) of Chinese T1 RCC patients and its influencing factors, and to illustrate the impact of TTS on the prognosis of T1 RCC. Methods: We retrospectively enrolled 762 Chinese patients with pathological T1 RCC that underwent nephrectomy. To discover the impact of TTS on survival outcomes, we explored the possible delay intervals by week using the Kaplan-Meier method and Log-rank test. Cox proportional hazard models with inverse probability-treatment weighting (IPTW) were used to assess the association between TTS and disease-free survival (DFS) and overall survival (OS). Results: The median TTS of T1 RCC patients was 15 days. The Charlson comorbidity index, the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score, and the maximal tumor diameter on presentation were independent influencing factors for TTS. The cut-off point of TTS was selected as 5 weeks according to the Log-rank analysis. For T1a RCC, patients with TTS > 5 weeks had similar DFS (HR = 2.39; 95% CI, 0.82−6.94; p = 0.109) and OS (HR = 1.28; 95% CI, 0.23−7.16; p = 0.779) compared to patients with TTS ≤ 5 weeks. For T1b RCC, patients with TTS > 5 weeks had shorter DFS (HR = 2.90; 95% CI = 1.46−5.75; p = 0.002) and OS (HR = 2.49, 95% CI = 1.09−5.70; p = 0.030) than patients with TTS ≤ 5 weeks. Conclusions: Prolonged TTS had no impact on the prognosis of T1a RCC while surgery delayed for over 5 weeks may lead to worse survival in T1b RCC.

Disparities in Time to Treatment for Breast Cancer: Existing Knowledge and Future Directions in the COVID-19 Era.

Purpose of Review: Despite significant advances in detection and treatment for breast cancer, the breast cancer mortality rate for Black women remains 40% higher than that for White women. Timely work-up and treatment improve outcomes, yet no gold standard exists for which to guide providers. Recent Findings: A large body of literature demonstrates disparities in time to treatment for breast cancer, and most studies show that Black women receive treatment later than their White counterparts. The COVID-19 pandemic has been projected to worsen these disparities, but the extent of this impact remains unknown. Summary: In this review, we describe the available evidence on disparities in time to treatment, potential drivers, and possible mitigation strategies. Future research must address how the COVID-19 pandemic has impacted the timely treatment of breast cancer patients, particularly populations vulnerable to disparate outcomes. Improved access to multidisciplinary breast programs, patient navigation services, and establishment of standards for timely treatment are necessary.

Impact of coronavirus disease 2019 on head and neck urgent suspected cancer referral pathways in rural Wales.

OBJECTIVE: To assess the impact of the coronavirus disease 2019 pandemic on head and neck urgent suspected cancer referral pathways in rural areas of Wales. METHOD: A retrospective audit was conducted of 2234 head and neck urgent suspected cancer referrals received from January 2019 to November 2020. RESULTS: The referrals dropped by 35 per cent in 2020 compared to the same period in 2019. The time from general practitioner referral to the first ENT appointment improved during the pandemic (8.0 vs 10.0 days; p < 0.001). Of referrals, 92.1 per cent were seen within a 14-day period in 2020, compared with 79.6 per cent in 2019 (p < 0.001). There were no differences between 2020 and 2019 in terms of: the (confirmed cancer) conversion rate (10.6 per cent vs 9.7 per cent; p = 0.60), general practitioner referral to multidisciplinary team discussion time (35.5 vs 41.5 days; p = 0.40) or general practitioner referral to initiation of treatment time (68.0 vs 78.0 days; p = 0.16). CONCLUSION: Whilst coronavirus disease 2019 reduced the number of overall head and neck urgent suspected cancer referrals, the pathways were generally unchanged, if not slightly improved, in rural Wales.

Plasma-first: accelerating lung cancer diagnosis and molecular profiling through liquid biopsy.

Introduction: Molecular profiling of tumor tissue is the gold standard for treatment decision-making in advanced non-small cell lung cancer (NSCLC). Results may be delayed or unavailable due to insufficient tissue, prolonged wait times for biopsy, pathology assessment and testing. We piloted the use of plasma testing in the initial diagnostic workup for patients with suspected advanced lung cancer. Methods: Patients with ⩽15 pack-year smoking history and suspected advanced lung cancer referred to the lung cancer rapid diagnostic program underwent plasma circulating-tumor DNA testing using a DNA-based mutation panel. Tissue testing was performed per standard of care, including comprehensive next-generation sequencing (NGS). The primary endpoint was time from diagnostic program referral to cancer treatment in stage IV NSCLC patients (Cohort A) compared to a contemporary cohort not enrolled in the study (Cohort B) and an historical pre-COVID cohort referred to the program between 2018 and 2019 (Cohort C). Results: From January to June 2021, 20 patients were enrolled in Cohort A; median age was 70.5 years (range 33-87), 70% were female, 55% Caucasian, 85% never smokers, and 75% were diagnosed with NSCLC. Seven had actionable alterations detected in plasma or tissue (4/7 concordant). Fusions, not tested in plasma, were identified by immunohistochemistry for three patients. Mean result turnaround time was 17.8 days for plasma NGS and 23.6 days for tissue (p = 0.10). Mean time from referral to treatment initiation was significantly shorter in cohort A at 32.6 days (SD 13.1) versus 62.2 days (SD 31.2) in cohort B and 61.5 days (SD 29.1) in cohort C, both p < 0.0001. Conclusion: Liquid biopsy in the initial diagnostic workup of patients with suspected advanced NSCLC can lead to faster molecular results and shorten time to treatment even with smaller DNA panels. An expansion study using comprehensive NGS plasma testing with faster turnaround time is ongoing (NCT04862924).

Three-years real-world evidence of adjuvant dabrafenib plus trametinib (DT) in patients with resected melanoma in Spain (GEM 1901 - DESCRIBE-AD)

Background: DT combination has shown efficacy in the adjuvant setting for BRAF-mutated melanoma (BMM) patients (pts) in clinical trials. Previous reports from DESCRIBE-AD resulted in promising overall survival (OS) rates at 12 months. Methods: An observational retrospective study was carried out in 25 GEM sites in Spain. Histologically confirmed and resected BMM pts previously treated with DT according to standard clinical practice in the adjuvant setting were included. Only surgical resection was allowed as a prior treatment to DT. DT discontinuation rate and time to treatment discontinuation were the primary objective. Secondary objectives included safety and efficacy of the combination. Here, we report 3-year results for OS. Results: From 10/2020 to 03/2021, 65 pts were included. Median age was 58 years, 55% were male and 60%, 25%, and 14% had an ECOG PS 0/1/Uk respectively, one patient presented ECOG 3. Allocation of stage IIIA, IIIB and IIIC according to TNM AJCC 7th edition was 29%, 26% and 32%, respectively. There were 3 pts diagnosed at stage I/II but considered of risk, and 2 pts with stage IV but completely resected, all considered for adjuvant DT. Ulceration was present in 40%, Breslow ≥2 mm in 71%, and nodes were microscopically and macroscopically affected in 39% and 22% of pts, respectively. Only 9.2% of pts discontinued DT prematurely due to toxicity and 21.2% had dose reductions to manage toxicity. After a median follow-up of 36.2 m (range: 13-51.1), the overall OS rate at 3-years was 83.5% (95% CI: 74.5-93.5). According to AJCC 7 stage at diagnosis, the 3-years OS rate was 95.2% (95% CI: 86.6-100), 75% (56-100), and 76.8% (60.7-97.2) for stage I-II-IIIA, IIIB, and IIIC-IV respectively. Throughout the study period 11 (16.9%) pts died, of which 10 died due to disease progression and one due to COVID-19 infection. Conclusions: Adjuvant treatment with DT for melanoma achieved good treatment compliance and has proven efficacy in the real world. Adjuvant DT has a clinical impact in survival in line with previous clinical trial COMBI-AD. Editorial acknowledgement: We acknowledge Mfar Clinical Research staff for their assistance in the development of this . Legal entity responsible for the study: Grupo Español Multidisciplinar en Melanoma (GEM). Funding: Grupo Español Multidisciplinar en Melanoma (GEM) as Sponsor with Industry partner NOVARTIS. Disclosure: P. Cerezuela-Fuentes: Financial Interests, Personal, Other, Consultancy, conference,congress attendance/infrastructure: BMS, MSD, Pierre Fabre, Roche, Sanofi, SunPharma. J. Martín-Liberal: Financial Interests, Personal, Other, Lecture fees: Astellas, MSD;Financial Interests, Personal, Other, Lecture fees, advisory fees: Bristol Myers Squibb, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi;Non-Financial Interests, Personal, Member, membership or affiliation: ASCO, ESMO, SEOM, GEM, EORTC, SOGUG, GEIS. L.A. Fernández-Morales: Financial Interests, Personal, Invited Speaker, Speak at sponsored meetings: BMS, MSD, Pierre-Fabre, Roche;Financial Interests, Personal, Other, Speak at sponsored meetings and advisory role: Novartis. J. Medina Martinez: Financial Interests, Personal, Other, Speaker, consultancy or advisory role or similar activity: Novartis, Roche, Pierre Fabre, BMS, MSD, Sanofi. M. Quindós: Financial Interests, Personal, Other, speaker, consultancy and advisory: AstraZeneca, GSK, Merck Sharp & Dohme, Novartis, PharmaMar, Roche, Bristol Myers Squibb, Pierre Fabre;Financial Interests, Institutional, Other, Clinical trials: Merck Sharp & Dohme, Roche, Bristol Myers Squibb. A. García Castaño: Non-Financial Interests, Advisory Role: Bristol, MSD, Novartis. T. Puértolas: Financial Interests, Personal, Invited Speaker, Speaker and advisory role: BMS, Novartis;Financial Interests, Personal, Invited Speaker: Roche, MSD, Sun-Pharma;Financial Interests, Personal, Other, Speaker and advisory role: Pierre-Fabre;Financial Interests, Personal, Advisory Role: Sanofi;Financial Interests, Institutional, Other, Clinical trial: Roche, BMS, Apexi en Inc, Aduro Biotech, Alkermes Inc;Non-Financial Interests, Institutional, Other, congresses inscriptions: Lilly, Sun-Pharma, Novartis, Roche, MSD;Non-Financial Interests, Institutional, Leadership Role, Vocal: GEM (Grupo Español Multidisciplinar de Melanoma);Non-Financial Interests, Institutional, Affiliate: SEOM (Sociedad Española de Oncología Médica), GEM (Grupo Español Multidisciplinar de Melanoma). P. Ayala de Miguel: Financial Interests, Personal, Invited Speaker, Public speaking: Novartis, Merck Sharp & Dohme, Sanofi, Pierre-Fabré. B. Campos: Financial Interests, Personal, Other, Speaker or advisory role: Roche, BMS, Sanofi, Novartis, Pierre-Fabre, Sun Pharma;Financial Interests, Personal, Other, Speaker role: AstraZeneca, Merck, ROVI, Leo Pharma. E. Espinosa: Financial Interests, Personal, Advisory Role, Advisory: BMS, MSD;Financial Interests, Personal, Other, Advisory, educational activities: Novartis;Financial Interests, Personal, Invited Speaker, Advisory, educational activities: Pierre Fabre;Financial Interests, Personal, Funding, Funding for translational investigation: Roche;Non-Financial Interests, Personal, Member, Vicepresident: Grupo Español Multidisciplinario de Melanoma. A. Rodríguez-Lescure: Financial Interests, Personal, Advisory Role: Pfizer, Novartis, ROCHE, AstraZeneca, Daiichi Sankyo, Seagen;Financial Interests, Personal, Invited Speaker, Public speaking: Pierre-Fabre;Financial Interests, Institutional, Research Grant, Grant for Clinical Trials: BMS, Lilly, Roche, Novartis, Amgen, Pzifer, Zimeworks, AstraZeneca, G1 Therapeutics, Bayer. L. Espasa Font: Financial Interests, Personal, Full or part-time Employment: Novartis. G. Belaustegui Ferrández: Financial Interests, Personal, Full or part-time Employment: Novartis. All other authors have declared no conflicts of interest.

ACUTE STROKE MANAGEMENT DURING COVID-19 PANDEMIC

INTRODUCTION: In the coronavirus disease 2019 (COVID-19) pandemic, there may be a decrease in the number of acute stroke intervention and acute treatment, and delays in treatment periods. In this study, it was aimed to compare the clinical features of patients presenting with acute stroke during the COVID-19 pandemic and in the pre-pandemic period. METHODS: Patients hospitalized with the diagnosis of cerebrovascular disease (CVD) between January 01, 2019 and May 31, 2021 were included in the study. Demographic characteristics and stroke risk factors of the patients were recorded. Stroke type and ischemic disease subtypes were determined, and patients' admission National Institutes of Health Stroke Scale (NIHSS) score, symptom-door time, door-consultation time, door-to-door Needle time and door-groin puncture time, intravenous tissue type plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) applications were recorded. Discharge modified Rankin Scale (mRS) and NIHSS scores and mortality rates were evaluated. Patients hospitalized in two separate periods of 14 months each were compared by dividing them into pre-pandemic and pandemic periods. RESULTS: Before COVID-19, 316 patients (female 45.25%, age: 66.75±13.68 years) and during the pandemic period 341 (female 41.94%, age: 68.34±13.55 years) patients were included in the study. During the pandemic period, an increase in the number of hemorrhagic CVD and transient ischemic attacks, a decrease in the number of ischemic stroke and cerebral venous thrombosis (CVT) hospitalizations, a decrease in cardioembolic strokes and an increase in lacuner ischemic CVD subtypes were observed (p<0.01). The number of large vessel atherosclerosis, IV tPA and EVT were found to be similar before and after the pandemic. In the pandemic period, although it did not reach statistical significance compared to the pre-pandemic period, prolongation was recorded in the symptom-door, door-consultation, door-needle and door-groin puncture times (p>0.05). The COVID-19 test was positive after hospitalization in 5 (1.8%) patients with ischemic stroke hospitalized during the pandemic period. During the pandemic period, admission NIHSS, discharge NIHSS and mRS scores and mortality rates were found to be significantly higher between hemorrhagic and ischemic stroke patients (p<0.01). DISCUSSION AND CONCLUSION: The COVID-19 pandemic adversely affects the management of acute stroke. The duration of acute stroke treatment is delayed due to pre-hospital and in-hospital reasons. With the heavy burden of stroke during the pandemic period, poor clinical outcome and high mortality are observed.