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1.
Gastroenterology ; 162(7):S-1379, 2022.
Article in English | EMBASE | ID: covidwho-1967453

ABSTRACT

Purpose During the first peak of the COVID-19 pandemic in spring 2020, the American College of Surgeons released triage recommendations for cancer care to assist with resource allocation during a global healthcare crisis.1 Our study investigates the relationship between pandemic restrictions and pancreatic cancer diagnosis and care at a single institution. Methods Our paper reports a retrospective single-center analysis of newly diagnosed pancreatic cancer from 2016-2020. Patient data was collected from our institutional cancer registry. Data was stratified into pre-pandemic years (2016-2019) and the pandemic year (2020) with further separation into fiscal quarters (Q1-Q4). Comparison of case numbers, staging, type of treatment and time to treatment was performed. Time-to-treatment was defined as the time from the date of initial diagnosis to date of treatment, for both any treatment overall and for each specific treatment type. Statistical analysis was performed using Chi-square and independent t-tests Results No changes were seen in the number of patients diagnosed with pancreatic cancer from 2016-2019 (mean=117.5 cases/year) versus 2020 (104 cases, p=0.475). There was no change in clinical overall staging comparing pre-pandemic (stage 1, n=81;stage 2, n=45;stage 3, n=55, stage4, n=184) to pandemic years (stage 1, n=28;stage 2;n=10;stage 3, n=11;stage 4, n=43;p=0.145). There were 220 patients treated by surgery, 306 by chemotherapy, 67 by radiation and 3 by immunotherapy. There were 46 patients (18.78%) who received chemotherapy during Q3 in the pre-pandemic years compared to 19 patients (31.14%) in Q3 of 2020 (p<0.001, Table 1). No difference was seen between pre-pandemic and pandemic years for both neoadjuvant (p=0.347) or adjuvant chemotherapy (p=0.217). There was no difference between pre-pandemic versus pandemic years for the other treatment modalities, including neoadjuvant or adjuvant radiation. The average time-to-first-treatment in pre-pandemic years was 36.71 days compared to 41.46 days in 2020 (p=0.31). Conclusion The number of patients receiving chemotherapy treatment increased immediately after the peak pandemic months without any change in neoadjuvant or adjuvant treatment. No change was seen in case numbers, disease stage, time-to-treatment overall and all specific modalities during peak of the pandemic. This lack of change shows the diligence of both healthcare workers and the patients involved in treating pancreatic cancer. References 1. Kato H, Asano Y, Arakawa S, et al. Surgery for pancreatic tumors in the midst of COVID-19 pandemic. World J Clin Cases. 2021;9(18):4460-4466. doi:10.12998/wjcc.v9.i18.4460 (Table Presented)

2.
Journal of Clinical Urology ; 15(1):70-71, 2022.
Article in English | EMBASE | ID: covidwho-1957021

ABSTRACT

Introduction: COVID-19 has caused disruption to medical services, which may have led to delayed cancer diagnoses. This study aims to compare the number and stage of new cancer diagnoses before and during the COVID-19 pandemic. Methods: A hospital-based cancer registry of patients who were diagnosed with Urological (ie, Kidney, Uppertract, Bladder, Prostate, Testis and Penis) between January 2019 and February 2020 Pre-COVID) and March 2020 and September 2021 (During COVID). Monthly numbers of patients with newly diagnosed cancer were compared in Pre-COVID and During-COVID groups. Results: 849 patients (753 men [89%];96 women [11%]) (n = 385 Pre-COVID [45%];n = 464 during-COVID [55%] were included. During-COVID there was a significant 11.2% reduction in monthly new cancer diagnoses (Monthly new diagnoses: Pre-COVID of 27.5 [SD 5.54];During-COVID 24.4 [SD 6.97];p < 0.001). The number of cases & T-staging at diagnosis in the pre- COVID-19 period and the During-COVID period were compared (Figure 1) There is a significant increase in the TNM stage at diagnosis of bladder cancer (Pre-COVID 0.85 [SD 1.0] vs During COVID 1.2 [SD 1.0]) and Upper Tract (Pre-COVID 2.5 [SD 1.1] vs During-COVID 3.5 [SD 0.7] in patients diagnoses during the COVID-19 pandemic compared to beforehand. No difference was found for Prostate, Kidney, Testicular or Penile cancers. Conclusions and Relevance There has been a significant 11% reduction in the total number of monthly urological cancers diagnoses during COVID. Patients with Upper tract and Bladder cancer were diagnosed at a significantly higher stage during the COVID-19 pandemic than beforehand.

3.
Annals of Oncology ; 33:S239, 2022.
Article in English | EMBASE | ID: covidwho-1936040

ABSTRACT

Background: During the COVID-19 pandemic, a profound decrease in the number of cancer diagnoses was observed. For patients with esophagogastric cancer, a diagnostic delay may have resulted in more advanced disease at the time of diagnosis. Also, downscaling of oncological care during COVID-19 may have resulted in postponed or different treatments. Therefore, we aimed to investigate the effects of the COVID-19 pandemic in 2020 on the stage at diagnosis and oncological care of esophagogastric cancer. Methods: Patients who were diagnosed in 2020 and included in the Netherlands Cancer Registry were allocated to 5 periods that correspond to the severity of the COVID-19 pandemic in the Netherlands. These were compared to patients diagnosed in the same period in the years 2017-2019. The number of diagnoses, tumor characteristics, type of treatment, time until the start of treatment and, in case of resection, the time between neoadjuvant therapy and resection were evaluated for esophageal cancer (EC) and gastric cancer (GC) separately. Results: The 2020 cohort in the Netherlands consisted of 2388 EC patients and 1429 GC patients. The absolute number of diagnoses decreased most prominently in the months March and April of 2020 for both EC and GC. The total number of EC diagnoses in 2020 decreased significantly compared to 2017-2019 (n=2522, p=0.027), whereas the total number of GC diagnoses did not decrease (n=1442, p=0.270). In the weeks after the first COVID-19 case in the Netherlands and before the COVID-19 lockdown, the percentage of incurable diagnoses increased from 52.5% to 67.7% for GC (p=0.011) and did not increase for EC (33.0% to 40.8%, p = 0.092). The percentage of patients with potentially curable EC receiving neoadjuvant chemoradiotherapy with resection decreased from 35.0% in 2017-2019 to 27.4% in 2020 (p < 0.001), whereas the percentage of patients receiving neoadjuvant chemoradiation without resection increased from 9.5% in 2017-2019 to 13.9% in 2020 (p < 0.001). The percentage of patients receiving definitive chemoradiation did not change significantly (p=0.119). For GC patients, no significant changes in type of treatment were found. The time between neoadjuvant chemotherapy and gastric resection decreased in 2020 with four days (p=0.006), while the time between neoadjuvant therapy and esophageal resection increased with 5 days (p=0.005). For both tumor types, the time between diagnosis and start of treatment was significantly shorter for patients diagnosed during and after the COVID-19 lockdown. Conclusions: We found a significant decrease in the number of EC diagnoses in 2020 and a shift in the type of treatment in potentially curable EC patients, with fewer resections being performed. Yet, it is unclear whether this is the result of the COVID-19 pandemic or due to an ongoing trial which implements watchful waiting after chemoradiotherapy. The oncological care for GC patients did not change during the COVID-19 pandemic. The shorter time between diagnosis and start of treatment may have been the result of a sense of urgency, since it was unknown in what way COVID-19 might affect the continuity of care in the upcoming future. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosures: All authors have declared no conflicts of interest.

4.
Bladder Cancer ; 8(2):139-154, 2022.
Article in English | EMBASE | ID: covidwho-1896643

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted. OBJECTIVE: To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands. METHODS: The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1st-May 31st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression. RESULTS: During the first COVID wave (week 9-22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17-22 (OR=0.62, 95% CI=0.40-0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020. CONCLUSIONS: The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.

5.
Libri Oncologici ; 50(SUPPL 1):107-108, 2022.
Article in English | EMBASE | ID: covidwho-1894296

ABSTRACT

Introduction: Since the start of COVID-19 pandemic almost six million people succumbed to the illness, with more that 430 million people infected [1],[2]. To mitigate the spread of the virus, various public health measures were deployed, affecting all spheres of the society, including healthcare in every level, without sparing cancer patients worldwide. The 'lockdown' period initiated during the first wave of pandemic limited the access to diagnostics and treatment of colorectal cancer, exposing the vulnerable population of colorectal cancer patients to additional risk[3]. Previous publications report the decrease in number of patients diagnosed with colorectal cancer, in diagnostic procedures, and treatment initiation. Given the fact the incidence of colorectal cancer is in constant rise, these factors hurt not only patients but healthcare system in general [4]. It is estimated that the decrease in diagnostic will be in the range absolute of 5,4-26% [5]. Official records for the period of 2020-2022. published by Croatian Cancer registry are expected between 2024-2026. The goal of this collaboration was to define the effect of epidemiologic measures deployed to contain the virus spread on the number of newly registered colorectal patients in three general hospitals in Dalmatia and the university hospital center in Split. Methods: This retrospective observational study was conducted at the Department of oncology and nuclear medicine at the General hospital in Zadar, Department of internal medicine at General hospital Šibenik and Department of oncology at General hospital Dubrovnik as well as the Department of oncology and radiotherapy at the University hospital in Split. Analysis included patient history files of patients being registered at the Departments between January 1st, 2018. to December 31st, 2020. Results:Analysis included a three-years period and consisted of evaluating 1864 patients. The numbers of patients diagnosed with colorectal cancer was 648 (2018), 605 (2019) and 611 (2020). The most significant drop in 2020 compared to the average of the two preceeding years was observed in the area gravitating the University hospital center (-7,7%), and the General hospital Šibenik (-3%). On the area of Dubrovnik-Neretva County and Zadar County an increase of number of patients was observed (+18% and + 33%, respectively). Conclusion: Number of newly reported colorectal cancer patients was in slight decline in 2020, compared to the average in the pre-pandemic years. The decline in Dalmatia was -2,5% in absolute, which contrasts with projected incidence of colorectal in Croatia and the world. It is also discordant to the previously published papers. This unique and thus far the biggest collaboration of oncology institutions in Dalmatia offered a comprised data on incidence of colorectal cancer in real time, while the nationwide (Croatian Cancer registry) data are expected within 2.4 years (based on previous publishing practice). True impact of the public health measures on patients characteristics, tumor characteristics and disease stage at diagnosis will be reported in the upcoming period.

6.
Libri Oncologici ; 50(SUPPL 1):135-136, 2022.
Article in English | EMBASE | ID: covidwho-1894077

ABSTRACT

Introduction: Prostate cancer is the most common cancer in men[1]. The incidence of prostate cancer in Croatia is in steady increase[2]. One of the possible reasons in the early screening via PSA screening, but also, global aging of the population. Pandemic has greatly affected all levels of healthcare, including, unfortunately, cancer patients. The 'lockdown' period during the first wave of pandemic limited patients' access to diagnostics and subsequently, timely treatment [3]. Several observational studies reported temporary suspensions of early detection programs, and, in the countries where such suspensions did not occur, a lesser number of patients underwent screening programs [4],[5]. The number of patients increased afterwards, to the pre-pandemic level[6]. Based on the current publishing practice, Croatian Cancer registry bulletin for Croatia in the period 2022-2022 are expected in 2024 at soonest. The goal of this collaboration was to test the impact of epidemiologic measures on the number of newly registered prostate cancer patients within three dalmatian general hospitals and the University hospital center in Split. Methods: Retrospective observational study was conducted at the Department of internal medicine at the General hospital of Šibenik- Knin County, Department of oncology at the General hospital Zadar, Department of oncology at the General hospital Dubrovnik, and the Department of oncology and radiotherapy at the University hospital in Split. Analysis involved newly diagnosed prostate cancer patients' medical charts in the period of January 1st, 2018, till December 31st, 2020. Results: Analysis encompassed a three-year period, and 1644 patients' medicals files were examined. The number of newly diagnosed prostate cancer patients in 2018 was 634, 524 in 2019 and 486 in 2020. Most patients were from the area surrounding University hospital Split (865), followed by the Zadar County (506). General hospitals in Šibenik and Dubrovnik had fewer patients (136 and 137, respectively). The most significant decrease in number of newly diagnosed patients in 2020 compared to the average of the two pre-pandemic years was in the area belonging to General hospital Dubrovnik (-36%), followed by General hospital Zadar (-31%), University Hospital of Split (-7%), while the number of newly diagnosed patients in General hospital Šibenik-Knin County was increased (+7%). Conclusion: The number of newly diagnosed prostate cancer patients in Dalmatia decreased during the first wave of pandemics compared to the average of the previous years. The decrease was 23% in absolute, contradicting the increase of incidence expected both in Croatia and worldwide. Public health measures, and previously reported patients' unwillingness to participate in the screening programs during the pandemics decreased the number of newly diagnosed prostate cancer patients. True consequences of these measures, described through patients' and tumors' characteristics, disease stage at diagnosis and the treatment initiation are to be analyzed.

7.
Pediatric Blood and Cancer ; 69(SUPPL 2):S103-S104, 2022.
Article in English | EMBASE | ID: covidwho-1885443

ABSTRACT

Background: Children with cancer and their families from rural and non-urban areas face unique challenges across the continuum of care, from active treatment to survivorship. Oklahoma is a highly rural state with thirty-four percent of residents living in non-urban areas. Therefore, given the known burden of late effects, health equity for this population requires attention to potential geographic disparities in optimal follow-up care in order to mitigate adverse health outcomes. Objectives: The primary purpose of this study was to construct a childhood cancer survivorship cohort in Oklahoma, through the integration of cancer registry, electronic health record, and geospatial data, and identify potential disparities in optimal follow-up care among survivors from non-urban areas. Design/Method: The Oklahoma Childhood Cancer Survivor Cohort was based on all patients <18-years-old at diagnosis captured by the cancer registry between January 1, 2005 and September 24, 2014 (to allow for at least seven years of follow-up data for all survivors). Patients with documented death or relapse, non-analytic cases, and those not seen in the pediatric oncology clinic were excluded. The primary outcome was whether survivors were seen in the pediatric oncology clinic between 2020-2021. To assess the potential impact of the COVID-19 pandemic, clinic attendance from 2018-2019 was also analyzed. The primary predictor of interest was rurality, defined by Rural-Urban Commuting Area coding based on zip code. Other explanatory variables included age, gender, race/ethnicity, late effects risk strata, and primary diagnosis. Results: A total of three-hundred and twenty-one survivors met eligibility criteria, of whom 41.1% (n = 132) were not seen in the pediatric oncology clinic between 2020-2021. There were significant differences (p = 0.036) in optimal follow-up care with 53% of survivors from large towns (n = 64) and 45% of survivors from small town/isolated rural areas (n = 49) without a documented clinic visit compared with 36% of survivors from urban areas (n = 205). There were no significant differences in follow-up by race/ethnicity, gender, age at diagnosis, or late effects risk strata. In the two years preceding the COVID-19 pandemic, 31% of survivors were not seen in the clinic with observed differences among survivors from urban, large town, and small town/isolated rural areas at 25%, 47%, and 26% with suboptimal follow-up, respectively (p = 0.011). Conclusion: Survivors from non-urban areas were less likely to receive optimal follow-up care compared to survivors from urban areas. The COVID-19 pandemic worsened optimal follow-up care and disproportionately affected survivors from large town and small town/isolated rural areas.

8.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816936

ABSTRACT

The COVID-19 pandemic has interrupted oncology services including screening, diagnosis, and treatment. In this study pathology services were investigated as a proxy for cancer screening, diagnosis, and treatment delays to assess the effect of the pandemic on oncology services. In order to quantify the impact of COVID-19 we reviewed all pathology reports from January 1 through November 30 in 2018, 2019, and 2020 from 5 central registries in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program. Using the SEER Data Management System and SAS, pathology reports were counted by cancer site (breast, lung, colorectal, prostate, other), patient age category (<50, 50-64, 65-74, >75 years), bi-weekly collection interval, and registry. Only pathology laboratories with monthly electronic reporting to their central registry throughout the study period were included. The reporting counts from 2020 were compared to those of the prior two years. In comparison to the 2019 baseline volume, March through November 2020 had an 11.2% decrease in pathology volume (48,779 fewer reports) in the 5 central registries. Over 75% of this decrease in volume occurred over a 10-week period, March through May 2020, with 30.2% fewer (37,127 reports) than expected pathology reports during this initial peak of the COVID-19 pandemic. The maximum bi-weekly decrease observed was 41.7% (>10,000 reports) from the 2019 baseline, which occurred in April 2020. During this 10-week period the decrease in volume by age category ranged 29.6-32.2%, cancer site ranged 27.5-39.1% and central registry ranged 26.1-36.8%. Two additional periods of volume decrease also occurred, both of shorter duration and magnitude, mid-July through August and mid-October through mid-November. Since the onset of the pandemic there remains a deficit (>11%) in the expected pathology volume compared to 2019, reflecting the continued impact of COVID-19 across oncology services. The majority of the pathology volume decrease in 2020 occurred during the initial peak of the COVID-19 pandemic. This period of decreased reporting volume along with two smaller decreases align with the 3 peaks of COVID-19 new cases reported by the CDC COVID Data Tracker. Prior to the onset of the pandemic the 2020 volume started at a bi-weekly rate greater than 2019, and the 2019 volume was consistently greater than 2018. Therefore, the 2020 expected values would be greater than those of the 2019 comparison year, i.e., the volume decreases reported would likely represent conservative estimates of the actual volume decrease. Continued longitudinal monitoring and the addition of more registries to this analysis are planned as well as pathology report type categorization (screening, surveillance, or treatment). This study also demonstrates the ability of the NCI SEER program to assist with near real time reporting of cancer data in quantifying the effect on the healthcare system of the COVID-19 pandemic.

9.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816916

ABSTRACT

Objective The COVID-19 pandemic has placed an inexorable strain on endoscopy services worldwide, affecting the diagnosis of esophago-gastric (EG) cancer and Barrett's esophagus (BE). As coronavirus infection rates rose many professional bodies advised that all endoscopy, except emergency and essential procedures, be stopped immediately. We sought to quantify the decline in EG cancer and BE diagnoses following implementation of British Society of Gastroenterology (BSG) guidance related to COVID-19 and the psychosocial effects on BE patients. Methods We examined EG cancer and BE diagnoses in Northern Ireland from March-September 2020 and compared them with the three-year average number of patients during the same time period between 2017-2019 by utilizing Northern Ireland Cancer Registry (NICR) data. The psychosocial impact of COVID-19 was assessed using an online survey, which included validated WHOQOL-BREF and EQ-5D-5L quality of life measures, and was completed by 24 BE patients from April-May 2020. Results During the first six months of the pandemic the proportion of EG cancer and BE diagnoses declined by 26.6% and 59.3%, respectively, compared to expected levels. In April, BE diagnoses fell by 95.5% but by September, whilst EG cancer rates had returned to baseline, BE cases remained suppressed by approximately 20%. We estimate that these declines in diagnosis represent 53 'missed' EG cancer and 236 'missed' BE diagnoses. In the online survey sample, BE patients reported consistently lower quality of life scores than population norms, and highlighted a number of concerns with regard to their health and care. Conclusion The COVID-19 pandemic has resulted in an abrupt decline in EG cancer and BE diagnoses and has profoundly impacted the wellbeing of BE patients. Our study represents the first report of the impact of COVID-19 on the diagnosis of BE. Strategies to mitigate the ongoing effects of the pandemic are urgently required to preserve the ability to rapidly detect and diagnose cancer and pre-malignant conditions.

10.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816915

ABSTRACT

Introduction: The burden of the COVID-19 pandemic forced the Dutch health care services to discontinue their national screening programs on 16 March 2020 (week 12). For breast cancer, the program invites women aged 50-74 years for biennial screening mammography. From mid-June 2020 (week 25) the breast cancer screening program was resumed, albeit with reduced capacity (max 60%). We aimed to investigate the impact of resuming the screening program on incidence, tumor-, and T-stage of screen- and non-screen-detected ductal carcinoma in situ (DCIS) and invasive breast cancer (IBC) in the Netherlands. Methods: Women, 50-74 years of age, diagnosed with DCIS or IBC in weeks 2-35 of 2018, 2019 and 2020 were selected from the Netherlands Cancer Registry. Weekly incidence of screen- and non-screen-detected tumors was calculated and expressed per 1 million women aged 50-74 years living in the Netherlands. Weeks 2-35 were divided in seven periods, representing separate phases of the pandemic. For each period, incidence of screen- and non-screen-detected tumors was stratified by clinical tumor stage (TNM) and clinical T-stage. Incidence in each period of 2020 was compared with the incidence in the same period of 2018/2019 (averaged). Results: In weeks 2-35, 7,250 patients were diagnosed in 2018, 7,299 in 2019, and 5,300 in 2020. During weeks 2-12 2020 the weekly average incidence of screen-detected tumors was 42/1 million women aged 50-74. In week 13 incidence dropped to 19, and was almost zero during weeks 14-25. Incidence increased to 4 in week 26, when the screening was gradually restarted, and increased to an weekly average of 24 tumors/1 million in weeks 30-35, when screening had restarted in most of the Netherlands. During weeks 14-16, 17-25, 26-29, and 30-35 2020 incidence of screen detected DCIS, stage I-II tumors and T0-2 tumors was lower than in the same period of 2018/2019. Distribution of tumor- and T-stage in newly diagnosed tumors did not differ between the periods (24% DCIS, 57% stage I, 18% stage II, 1% stage III, 1% stage IV;24% T0, 59% T1, 15% T2, 2% T3, 0% T4). During weeks 2-11 2020 the weekly average incidence of non-screen-detected tumors was 38/1 million women aged 50-74. Incidence dropped to 16 in week 14, and increased to an average of 37 tumors per week in weeks 17-35. During weeks 17-25, 26-29, and 30-35 the incidence and distribution of non-screen-detected DCIS, stage I-IV and T0-4 tumors was comparable with 2018/2019 (weekly incidence (distribution): 3 DCIS (9%), 15 stage I (40%), 13 stage II (36%), 3 stage III (7%), 3 stage IV (8%);3 T0 (9%), 17 T1 (45%), 12 T2 (34%), 3 T3 (8%), 2 T4 (5%)). Conclusion: The temporary suspension of the breast cancer screening program reduced the incidence of breast cancer. After resuming screening the incidence did not raise above the incidence in 2018/2019, therefore it is expected that the incidence will rise during the next months. The results to date did not show a shift towards a higher tumor stage or T-stage.

11.
P.A. Herzen Journal of Oncology ; 11(1):34-39, 2022.
Article in Russian | Scopus | ID: covidwho-1789741

ABSTRACT

Objective. To evaluate the impact of the COVID-19 pandemic on the course of cancers and to estimate the achievement of the main indicators of a cancer service in case of the Nizhny Novgorod Region. Subjects and methods. In the Nizhny Novgorod Region, data on the detection and registration of COVID-19 in patients with malignant neoplasms (MNs) were analyzed on the basis of data of the information and analytical system (IAS) «Cancer Registry 6S». Results. As of December 31, 2020, there were a total of 99.477 cancer patients, including 1.470 confirmed COVID-19 cases, accounting for 1.5% of all the registered patients with MNs. Among the cancer patients with COVID-19, the females were 1.6 times more likely to be ill than the males. Analyzing the age structure of cancer patients with COVID-19 revealed that the older ablebodied persons (61.6%) were more likely to get sick than younger ones (38.0%). Cancer concurrent with COVID-19 led to a severe course of COVID-19 in 15.9% of cases and resulted in death of cancer patients in 17.8% of cases. The older able-bodied patients were more likely to die, which accounted for 89.3% of the total number of died cancer patients with COVID-19. In the structure of the causes of death of cancer patients with COVID-19, the latter comes first (51.3%), MNs ranked next (33.0%), circulatory system diseases occupied the third place (13.0%), and other causes ranked fourth (2.7%). According to the 2020 results, the Nizhny Novgorod Region during the COVID-19 pandemic displayed a 0.4% increase in the mortality rate from neoplasms, including that from malignant ones, a 5.0% decrease in the proportion of MNs detected at Stages 1-2, a 22.0% reduction in active detection rates, and a 21.0% rise in neglect rates. Conclusion. Thus, the COVID-19 pandemic negatively affects the course of cancers, by aggravating the condition of cancer patients, which results in a fatal outcome in 17.8% of cases. © 2022, Media Sphera Publishing Group. All rights reserved.

12.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779475

ABSTRACT

A recently published study from the National COVID Cohort Collaborative (N3C) revealed that COVID-19 (CoV) positive status in cancer patients (pts) was associated with an increased risk of all-cause mortality at 1 year when compared to CoV negative status. In addition, age ≥65 years, Southern or Western US residence, an adjusted Charlson Comorbidity Index score ≥4, multi-tumor sites, and recent cytotoxic therapy were associated with increased risk of all-cause mortality. The CoV pandemic significantly impacted our hospital's operations in 03/2020. Regardless, the hospital remained operational for cancer pts through the entire pandemic. The objective of this study is to investigate the impact of CoV pandemic on breast cancer (BC) treatment and outcomes in our academic medical center in East Tennessee. A retrospective cohort group was identified from a prospectively monitored Cancer Registry database of 706 pts comparing those diagnosed with BC from 3/1/2019-12/31/2019 (G1=406 pts) to those diagnosed from 3/1/2020-12/31/2020 (G2=300 pts). The impact of CoV pandemic was studied utilizing SPSS statistical software. During the pandemic, 26% fewer pts were treated for BC in our hospital, likely resulting from decreased screening rates. Pts in G2 were significantly younger than in G1 (mean age 61.4 vs 63.5), but no difference was observed in racial and insurance status or diagnosis with invasive BC vs DCIS (Table 1). CoV test results for 20 pts from G1 and all 300 pts in G2 (Table 2) were analyzed. Only 8 pts (2.6%) tested positive for CoV (all in G2). For 5 of these 8 pts, CoV positivity had no impact on their care or survival, since CoV infection happened either before or after their BC diagnosis and therapy. CoV caused delay of the first course of treatment in 9/300 (3%) G2 pts: 3/9 delays were due to CoV infection and 6/9 delays were due to implementation of nation-wide CoV pandemic guidelines for care of BC pts. Of the 6/9 pts who experienced delayed treatment, 5 were diagnosed with BC in 03/2020 and 1 in 06/2020, all in the time period of the national "lock-down". Delayed surgical treatment had no impact on patient outcomes. During the pandemic, the number of days from diagnosis to chemotherapy or hormonal treatment was significantly shorter (p<0.05) in the G2 cohort than in the pre-pandemic G1 cohort. The number of days to surgery or radiation treatment although non-significant was also lower in the G2 cohort. CoV did not impact readmission to our hospital within 30 days of surgery. None of the BC pts died from CoV. One-year overall survival of our BC pts was not negatively impacted by the CoV pandemic. Our results show that during the CoV pandemic, BC pts were receiving chemotherapy and hormonal treatment sooner than in the pre-pandemic time, likely due to effective teamwork while implementing national guidelines for triaging and administering neoadjuvant treatment during the pandemic. In contrast to N3C data, CoV pandemic did not negatively impact outcomes or 1-year overall survival in our patients. Future studies will determine if these findings remain at the 5 and 10-year follow-up period.

13.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779470

ABSTRACT

Introduction: The COVID-19 outbreak led to the suspension of the Dutch breast cancer screening program, increased the reluctance of patients to visit the general practitioner (GP), and led to a lack of capacity at the GP. As a consequence, the incidence of breast cancer diagnoses decreased. Objective: This study aimed to investigate the impact of the COVID-19 outbreak on the incidence of different stages of breast cancer, by screening status. Methods: Women diagnosed between January 1st 2017 and February 28th 2021 with primary breast cancer without a history of breast cancer were selected from the Netherlands Cancer Registry. March 1st 2020 till February 28th 2021 was regarded as the COVID-19 period. Breast cancer incidence within this COVID-19 period was calculated by tumor stage and compared with the incidence in 2017/2019 (reference). Incidence was expressed per 100, 000 women aged 18 year or older, living in the Netherlands at the start of the year. Thereafter, the COVID-19 period was divided into four subperiods, based on COVID-19 related events: March-April 2020, May-June 2020, July-August 2020, September 2020-February 2021. Incidence in each of those periods was calculated by tumor stage and compared with the incidence in 2017/2019. Analyses were further stratified by screening status. Incidence of screenS detected tumors was expressed per 100, 000 women aged 50-74 living in the Netherlands at the start of the year. Results: A total of 15, 916 women were diagnosed in 2017, 15, 574 in 2018, 15, 867 in 2019, 13, 497 in 2020 and 2, 532 up to February 2021. Compared to 2017/2019, the incidence of DCIS and stage I-III tumors was statistically significantly lower during the COVID-19 period (32%, 24%, 9% and 11% respectively) (Table 1), leading to 603, 1539, 520 and 160 missed diagnoses respectively. The incidence of stage IV tumors was 5% higher, however this was not significant. The incidence of DCIS remained significantly lower throughout the four subperiods, while the incidence of stage I-II tumors was comparable with 2017/2019 in September 2020-February 2021 and the incidence of stage III was comparable with 2017/2019 in both July-August 2020 and September 2020-February 2021. The incidence of DCIS and stage I-II non-screen-detected tumors was significantly lower during March-April 2020 and was comparable with 2017/2019 in the subperiods thereafter. The incidence of DCIS and stage I-IV screen-detected tumors was significantly lower during March 2020-February 2021, with the incidence of DCIS and stage I-III tumors being lower during each subperiod and the incidence of stage IV tumors being lower during May-June 2020. Conclusion: The COVID-19 outbreak led to a decrease in the incidence of DCIS and stage I-III tumor diagnoses, which still lags behind in February 2021. Until February 2021 no stage shift was seen.

14.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779469

ABSTRACT

Introduction: The COVID-19 pandemic led to a decrease in the incidence of breast cancer diagnoses in the Netherlands. This was due to the encouragement to stay at home, a lack of capacity at the general practitioner (GP) and an increased reluctance of patients to visit the GP. Moreover, from the 16th of March the Dutch breast cancer screening program was halted and gradually restarted from June onwards. Part of the follow-up visits for breast cancer survivors were also postponed or changed to an appointment by phone. However, it is not known how this affected the incidence of second primary breast cancer (SPBC) and pathologically confirmed breast cancer recurrences. Objective: To investigate the effect of the COVID-19 pandemic on the diagnosis of SPBC and breast cancer recurrences. Methods: Women diagnosed with a pathological confirmed SPBC or recurrence (locoregional recurrences (LRR) + distant metastasis (DM)) between January 1st 2017 and February 28th 2021 were selected from the Netherlands Cancer Registry, based on diagnoses of the Nationwide Histopathology and Cytopathology Data Network and Archive (PALGA). Patients with a SPBC or recurrence who had their primary breast tumor diagnosed more than five years ago were excluded. March 1st 2020 till February 28th 2021 was regarded as the S COVID-19 period. Incidence was expressed per 100, 000 women, who were diagnosed with breast cancer less than 5 years ago, and who were still alive. Incidence of SPBCs and recurrences was calculated for the total COVID-19 period and for four subperiods, and compared with the corresponding periods in 2017/2019 (averaged). Results: A total of 393 patients were diagnosed with a SPBCs in 2017, 340 in 2018, 299 in 2019, 342 in 2020 and 71 up to February 2021. A total of 447 patients were diagnosed with a recurrence in 2017, 520 in 2018, 516 in 2019, 529 in 2020 and 80 up to February 2021. During the COVID-19 period a total of 449 patients were diagnosed with a SPBCs per 100, 000 breast cancer survivors, this was comparable to the 445 patients diagnosed per year per 100, 000 breast cancer survivors in 2017/2019 (p=0.91) (Table 1). The incidence of SPBCs was significantly lower during March-May 2020 compared to the same period in 2017/2019 (86 vs. 121) (p=0.03), leading to 50 less SPBCs diagnoses. The incidence was higher during June-August 2020 (124 vs. 95), however this was not significant (p=0.09). The incidence of recurrences in the COVID-19 period, and within all four subperiods, was comparable to the incidence in 2017/2019. Conclusion: The COVID-19 pandemic led to a decrease in the detection of SPBCs at the beginning of the pandemic. However, this drop in incidence was caught up in the period thereafter. This might be related to the restart of the regular follow-up visits (partly in real-life consultations), the call to go to the GP in case of complaints and the improved accessibility of the GPs. The incidence of recurrences did not decrease since it includes also DM, which cause worrisome symptoms for which care is sought.

15.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779468

ABSTRACT

Introduction: The COVID-19 outbreak forced health care services to switch focus to COVID-19 patients, thereby generating pressure on all other health care services, most likely impacting breast cancer care as well. However, the impact of the COVID-19 outbreak on the breast cancer treatment strategy is unknown. Objective: To investigate the impact of the COVID-19 outbreak on the breast cancer treatment strategy. Methods: We selected women diagnosed with breast cancer between January 1st 2018 and June 30th 2020 from the Netherlands Cancer Registry. Women with previous breast cancer or with a synchronous tumor were excluded. The following periods based on COVID-19 related events were analyzed: 2018/2019 (reference), weeks 1-8, weeks 9-12, weeks 13-17, and weeks 18-26 in 2020. Patients were divided into periods based on their date of diagnosis. For patients with DCIS we used logistic regression to investigate the association between period of diagnosis and chance of being treated within six months following diagnosis. For patients with invasive tumors receiving surgery, we used logistic regression to investigate the association between period of diagnosis and chance of receiving a certain type of treatment, adjusting for tumor stage. Furthermore, time length between the following time points were calculated per tumor stage: S 1) diagnosis and first treatment (of any kind), 2) diagnosis and start of neo-adjuvant treatment, 3) diagnosis and operation (no neo-adjuvant treatment was given), 4) end of neo-adjuvant treatment and operation, 5) operation and start of adjuvant systemic treatment, and 6) operation and start of radiotherapy. Time lengths were calculated for each period of 2020 and compared with 2018/2019. Results: A total of 1, 795 DCIS and 11, 785 invasive tumors were diagnosed in 2018, 1, 826 DCIS and 11, 987 invasive tumors in 2019 and 597 DCIS and 4, 566 invasive tumors up to June 2020. Compared to 2018/2019, patients diagnosed with a DCIS were less likely to be treated within six months following diagnosis (ORwks1-8: 0.63, ORwks9-12: 0.50, ORwks18-26: 0.51) (Table). Patients diagnosed with an invasive tumor in weeks 9-12 2020 were less likely to receive neo-adjuvant chemotherapy (ORwks9-12: 0.63), while patients diagnosed thereafter were more likely to receive neo-adjuvant chemotherapy (ORwks13-17: 1.39, ORwks18-26: 1.41). Patients were more likely to receive neo-adjuvant endocrine therapy (ORwks1-8: 1.64, ORwks9-12: 3.14, ORwks13-17: 1.85, ORwks18-26: 1.28), mastectomy (ORwks18-26: 1.32), or adjuvant chemotherapy (ORwks9-12: 1.36), while they were less likely to receive radiotherapy (ORwks18-26: 0.74). Patients receiving a mastectomy for their invasive tumor were more likely to receive an immediate reconstruction (ORwks18-26: 1.57). Compared to 2018/2019, time between diagnosis and first treatment, diagnosis and operation, diagnosis and neo-adjuvant treatment, and operation and adjuvant systemic treatment decreased significantly for patients diagnosed with a stage I-III tumor in weeks 9-12, 13-17 or 18-26. Conclusion: The COVID-19 outbreak affected multiple aspects of the breast cancer treatment strategy and led to a shorter time to therapy, probably due to prioritizing of oncological care and a reduction in the number of patients.

16.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779465

ABSTRACT

Background: During the SARS-CoV-2 pandemic in 2020, the use of routine screening mammography (SM) and diagnostic mammography (DM) was limited for several months in order to reduce patient exposure and redeploy medical personnel. Previous studies suggest such delays result in more late-stage breast cancer diagnoses. We hypothesized that this impact would vary between institutions depending on regional variations in shutdown periods and the ability and willingness of patients to resume screening. Methods: Patients diagnosed with invasive breast cancers from 2016-2020 were identified using the Beth Israel Deaconess Medical Center (BIDMC) and the Duke University Medical Center (DUMC) cancer registries. Rates of mammography were ascertained from billing data. Baseline patient characteristics, demographics, and clinical information were gathered and cross-referenced with the electronic medical record. Late-stage was defined as Anatomic Stage III-IV disease (AJCC 8th edition). Chi-squared analysis was used to examine monthly distributions in stage at presentation for diagnosis in 2016-2019 compared to in 2020 at each institution. Results: There were 5907 patients diagnosed with invasive breast cancer between 2016-2019 (1597 at BIDMC and 4310 at DUMC) and 1075 in 2020 (333 and 742, respectively). Mammography was limited from 3/16/20-6/8/20 at BIDMC and from 3/16/20-4/20/20 Sa t DUMC. There were fewer SM at each institution during their respective shutdown periods in 2020 than in the same months in 2019: BIDMC 1713 versus 8566 (80% reduction) and at DUMC 1649 versus 5698 (71% reduction). Following the pandemic shutdown, SM volume increased in July-December 2020 compared to July-December 2019 (108% at BIDMC and 116% at DUMC). The proportion of patients diagnosed with late-stage disease at BIDMC was greater in 2020 than in 2016-2019, at 12.6% and 6.6%, respectively (p < 0.001);86% of late-stage diagnoses and 68% of all diagnoses in 2020 at BIDMC occurred from July-December following the initial shutdown period. The proportion of patients diagnosed with late-stage disease at DUMC in these two cohorts were 14.3% in 2020 and 16.2%% in 2016-2019 (p = 0.1);50% of late-stage diagnoses and 51% of all diagnoses in 2020 at DUMC occurred in the period following the initial shutdown from July-December. Conclusion: We identified variation between two large academic medical centers in the impact of the SARS-CoV-2 pandemic shutdown on the proportion of late-stage breast cancer diagnoses. These dissimilar outcomes may be the result of differences in referral patterns as well as regional differences in the approach to SM during the pandemic. In particular, a shorter closure time and substantial increase in SM volume following the initial shutdown period in the Southeast region may have prevented an increase in late-stage diagnoses. Further information and analysis may help suggest additional strategies to minimize adverse effects of reduced cancer screening in future public-health emergencies.

17.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779451

ABSTRACT

Background: The COVID-19 pandemic strained healthcare systems worldwide, delaying breast cancer screening and surgery. In 2019, approximately 80% of breast cancers in the U.S. were diagnosed on screening examinations, with 76.4% of eligible Medicare patients undergoing screening at least every two years. Since the start of the pandemic, many women have been reluctant to seek elective screening mammography, even with the lifting of "lock-down". We describe the effect of the COVID-19 pandemic on breast cancer presentation at an academic medical center in a city hit hard by the pandemic. Materials and Methods: The institutional IRB-approved Breast Cancer Registry Database was queried for patients enrolled during two time periods, those undergoing first surgical procedure before the start of the pandemic (4/1/2019-3/31/2020) to those the year after the pandemic started (4/1/2020-3/31/2021). Elective cancer surgery was paused for 3 weeks, ending 4/20/2020, and access to routine breast care was limited for 3 months. Variables included age, method of detection, palpability, histologic subtype and staging, neoadjuvant systemic therapy, cancer specific treatments, and radiation uptake. Results: 349 patients were in the 2019 cohort;246 in the 2020 cohort. No differences in baseline characteristics, including age at presentation, nodal status, or operation type. Fewer cancers were detected on routine mammography post-COVID vs. pre-COVID. Increase in detection of breast cancer through self-Sexams in 2020 was seen compared to 2019. Palpability on presentation also increased. More patients were treated with neo-adjuvant therapy chemotherapy, and 36 of 45 (80%) eligible early-stage breast cancer patients accepted neoadjuvant hormonal therapy during the period that elective cancer surgery was on hold. Patients received radiation therapy less frequently during the pandemic. The proportion of patients diagnosed with invasive ductal cancers was higher in the 2020 cohort and the proportion of patients diagnosed with ductal carcinoma in situ (DCIS) and for invasive lobular cancers (ILC) was lower. Conclusions: Patients at an academic New York City medical center presented with more palpable and invasive breast cancers during the COVID-19 pandemic compared to the preceding year, and fewer patients with DCIS and ILC, cancers typically detected following screening mammography. While stage migration with an increase in diagnosis of late stage cancers has been described, in our population the stage shift occurred in early stage breast cancer, with decreases in DCIS and increases in Stages I-II, with the higher stages III-IV essentially unchanged. This reflects the effect of delay in our previously highly-screened population, with an average screening delay of 3 + months, and many patients missing their yearly screening altogether. While many medical interactions during COVID-19 were via telemedicine, radiation therapy requires daily office visits, and fear of exposure contributed to the lower rate of radiation. Given the increase in invasiveness and stage of breast cancers diagnosed during the COVID-19 pandemic, this study emphasizes the importance of screening for diagnosis and treatment of breast cancer, even in the face of a concurrent health crisis.

18.
Tumori ; : 3008916211073771, 2022 Feb 08.
Article in English | MEDLINE | ID: covidwho-1673723

ABSTRACT

INTRODUCTION: This study assesses the risk of infection and clinical outcomes in a large consecutive population of cancer and non-cancer patients tested for SARS-CoV-2 status. METHODS: Study patients underwent SARS-CoV-2 molecular-testing between 22 February 2020 and 31 July 2020, and were found infected (CoV2+ve) or uninfected. History of malignancy was obtained from regional population-based cancer registries. Cancer-patients were distinguished by time between cancer diagnosis and SARS-CoV-2 testing (<12/⩾12 months). Comorbidities, hospitalization, and death at 15 September 2020 were retrieved from regional population-based databases. The impact of cancer history on SARS-CoV-2 infection and clinical outcomes was calculated by fitting a multivariable logistic regression model, adjusting for sex, age, and comorbidities. RESULTS: Among 552,362 individuals tested for SARS-CoV-2, 55,206 (10.0%) were cancer-patients and 22,564 (4.1%) tested CoV2+ve. Irrespective of time since cancer diagnosis, SARS-CoV-2 infection was significantly lower among cancer patients (1,787; 3.2%) than non-cancer individuals (20,777; 4.2% - Odds Ratio (OR)=0.60; 0.57-0.63). CoV2+ve cancer-patients were older than non-cancer individuals (median age: 77 versus 57 years; p<0.0001), were more frequently men and with comorbidities. Hospitalizations (39.9% versus 22.5%; OR=1.61; 1.44-1.80) and deaths (24.3% versus 9.7%; OR=1.51; 1.32-1.72) were more frequent in cancer-patients. CoV2+ve cancer-patients were at higher risk of death (lung OR=2.90; 1.58-5.24, blood OR=2.73; 1.88-3.93, breast OR=1.77; 1.32-2.35). CONCLUSIONS: The risks of hospitalization and death are significantly higher in CoV2+ve individuals with past or present cancer (particularly malignancies of the lung, hematologic or breast) than in those with no history of cancer.

19.
Oncology Research and Treatment ; 44(SUPPL 2):10, 2021.
Article in English | EMBASE | ID: covidwho-1623580

ABSTRACT

Introduction: In March 2020, the spread of Sars-Cov2 was declared a global pandemic. Consequently, policy makers have prioritized health care services to treat serious cases. This has affected the care for other vulnerable patients, such as those with cancer. The aim of this survey is to provide insight into how changes in medical care during a pandemic affect cancer patients in terms of psychosocial distress and economic consequences. Methods: Using an anonymized online questionnaire, we examined a convenience sample of cancer patients who contacted DKFZ's cancer information service with questions regarding their disease between July 2020 and June 2021. The questionnaire captures information on cancer type, disease phase and changes in cancer care and includes items assessing distress and financial impact. Results: An interim evaluation with data collected from July 2020 to January 2021 (n=372;35% return rate) showed a median age of 60 years (IQR: 50-68), 76% were women, and breast cancer was the most frequent cancer type (51%). The majority of patients had completed primary treatment (42%), 24% of respondents were still under active primary treatment, and 25% reported a cancer recurrence or were in an advanced phase. Overall 14% (n=51) of patients reported changes in medical care. Changes occurred most often in the context of follow-up care (69%), treatment control checks (29%), and drug-based tumour therapy (20%). 37% of the overall sample agreed or strongly agreed to worrying that the pandemic might affect their quality of care, and 66% missed personal contact with family and friends rather or very much. Regarding finances, 68% reported increased expenditures for health care due to their cancer, 18% additional expenditures due to the pandemic, and 17% a loss of income. Conclusions: Results confirm that cancer patients' well-being and finances, in addition to treatment and care, have been affected by the corona pandemic. Based on this data, a larger trend study is planned with representative samples of patients from an epidemiological cancer registry. In view of the observed changes to cancer care during the pandemic, it is important that health care systems are fully prepared for a crisis, and ascertain equitable care for all patients. Our results underscore cancer patients' vulnerabilities. As the study covers the whole range of effects of the pandemic on patients, results may help to assess needs and prioritize services and support accordingly.

20.
Blood ; 138:1248, 2021.
Article in English | EMBASE | ID: covidwho-1582361

ABSTRACT

Introduction: Patients with therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC) are a known high-risk AML subgroup with historically poor outcomes. In December 2018, CPX-351 (Vyxeos ® Liposomal) received a positive reimbursement decision in England for the treatment of adults with newly diagnosed t-AML or AML-MRC. The objective of this retrospective study was to utilize the Cancer Analysis System (CAS) database available through the National Cancer Registration and Analysis Service (NCRAS) to describe the demographics, clinical characteristics, and treatment pathways for patients with t-AML or AML-MRC in England from 2013 to 2020, including the use of CPX-351. Methods: The NCRAS systematically collects and curates population-level data about cancer diagnoses, treatments, and outcomes across England. Adults (aged ≥18 years) diagnosed with t-AML or AML-MRC between January 2013 and March 2020 were identified either directly using International Classification of Diseases for Oncology, Third Edition(ICD-O-3) codes or indirectly using non-specific ICD-O-2, ICD-O-3, or ICD-10 AML codes in combination with a record of prior systemic anticancer therapy or radiotherapy (t-AML) or a prior diagnosis of MDS or CMML (AML-MRC;other AML-MRC subtypes could not be distinguished from de novo AML). First-line and second-line treatments identified included clinical trials, intensive chemotherapy (IC) treatments (CPX-351;daunorubicin plus cytarabine [DA];fludarabine, cytarabine, idarubicin and granulocyte-colony stimulating factor [FLAG-Ida];or “other IC” consisting of mitoxantrone-based therapy or high-dose cytarabine alone), or less-intensive therapies (azacitidine, low-dose cytarabine [LDAC], or hydroxycarbamide alone). Patients who did not receive active systemic therapy (ie, those who received best supportive care alone) were not included. Results: A total of 2,891 patients with t-AML or AML-MRC were identified. Most patients were male (62%), white (91%), and aged ≥60 years (80%). Overall, 590 (20%) patients received first-line treatment in a clinical trial, 1,474 (51%) received less-intensive therapy, and 827 (29%) received an IC regimen. Patients aged ≥60 years at diagnosis were less likely than those aged <60 years to either enter a clinical trial (18% vs 32%, respectively) or receive IC (22% vs 54%). In patients treated with IC, those who received CPX-351 were slightly older (mean [standard deviation] age: 63.9 years [8.3]) than those who received DA (60.5 years [11.4]) or FLAG-Ida (55.6 years [12.6]);28% of patients treated with CPX-351 were aged <60 years compared to 37% for DA and 55% for FLAG-Ida. When treatment patterns were analyzed per annum, utilization of less-intensive therapies remained stable over time (Figure 1A). Azacitidine was the most common less-intensive therapy both overall (64%) and across all yearly time points, followed overall by LDAC (22%) then hydroxycarbamide alone (14%). In contrast, the IC treatment patterns were more dynamic over time (Figure 1B). DA chemotherapy was the most common IC overall (48%), followed by FLAG-Ida (23%) and other ICs (18%). However, CPX-351 uptake started in 2018 (5% of all IC) and by the end of 2019 had displaced DA chemotherapy as standard-of-care IC (40% vs 22%, respectively). Excluding patients who were alive but had not received subsequent therapy (ie, censored), most patients who received front-line azacitidine or LDAC died without receiving salvage therapy (89% and 92%, respectively). In comparison, non-censored patients who received front-line DA chemotherapy or FLAG-Ida were more likely to receive salvage treatment (52% and 34%, respectively). Key salvage treatments following DA included azacitidine alone and FLAG-based therapy. Key salvage treatments following front-line CPX-351 included FLAG-Ida or DA ± hematopoietic cell transplant and azacitidine. Conclusions: This large population-level, retrospective analysis of CAS data provides a detailed overview of the management of patients with t-AML and AML-MRC. Historically a high proportion of these high-risk patients have received less-intensive treatment. Since 2018, CPX-351 has been rapidly adopted into the IC treatment pathway, displacing DA chemotherapy. These analyses will be repeated after the CAS database has been updated to determine the impact of COVID-19. [Formula presented] Disclosures: Legg: Jazz Pharmaceuticals: Current Employment, Current equity holder in publicly-traded company. Muzwidzwa: IQVIA Inc., which was contracted by Jazz Pharmaceuticals for the conduct of this analysis: Current Employment. Adamson: IQVIA Inc., which was contracted by Jazz Pharmaceuticals for the conduct of this analysis: Current Employment. Wilkes: IQVIA Inc., which was contracted by Jazz Pharmaceuticals for the conduct of this analysis: Current Employment. Medalla: Jazz Pharmaceuticals: Current Employment, Current equity holder in publicly-traded company.

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