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1.
Neurology ; 93(23 Supplement 2):S29, 2022.
Article in English | EMBASE | ID: covidwho-2196702

ABSTRACT

Objective To describe clinical and paraclinical features of non-paraneoplastic NIFmediated disease associated with concurrent SARS-CoV-2 infection. Background Neurologic syndromes associated with neuronal intermediate filament (NIF) immunoglobulin G (IgG) most often are characterized by encephalopathy, cerebellar ataxia, or myelopathy. NIF-IgG has been strongly correlated with the presence of an underlying malignancy, with neuroendocrine tumors being most prevalent. Despite the intracellular target of this antibody, patients with NIF-IgG mediated disease tend to improve clinically with immunotherapy. While some cases have been described in a parainfectious context, this is the first such case in the context of a SARS-CoV-2 infection. Design/Methods NA. Results We reported a case of non-paraneoplastic NIF-mediated disease in the setting of SARS-CoV-2 infection. The patient presented with first time seizure. He was found to have frequent left temporal lobe spikes then two left temporal lobe seizures on neurotelemetry. Brain MRI displayed abnormal signal throughout the left hippocampus and mesial temporal lobe, without contrast enhancement. LP was subsequently performed. CSF showed elevated protein, 14-3-3, T-tau, interleukin 13, interleukin 2 receptor, and interleukin 6. The meningitis/encephalitis panel, and HSV-1/2 IgG were negative. Serum autoimmune encephalitis panel revealed a high-positive titer for anti-NIF 1:960, with concurrent NIF heavy chain cell-based assay positive. He improved with three days of IV steroids and treatment with levetiracetam and lacosamide. He has since been seizure free. Conclusions NIF-mediated diseases usually present with encephalopathy, cerebellar ataxia, or myelopathy and are generally seen in the setting of malignancy. Our case illustrated an example of NIF-mediated disease presenting as seizure in the setting of infection. This highlights the importance of consideration of parainfectious autoimmunity.

2.
Neurology ; 93(23 Supplement 2):S67-S68, 2022.
Article in English | EMBASE | ID: covidwho-2196701

ABSTRACT

Objective To report a case of Anti-Contactin-Associated Protein-like2 (CASPR-2) autoimmunity in a patient with low-grade Chronic Lymphocytic Leukemia (CLL) following COVID-19 vaccination and infection. Background Anti-CASPR2 antibody disorder has been associated with neoplastic disorders like thymoma. Recent reports enlist COVID-19 as apotential trigger of CASPR2 autoimmunity. While the clinical presentations are similar, management differs based on the underlying etiology. Design/Methods We review a case of anti-CASPR2-antibody associated disorder with concurrent low grade CLL and recent history of COVID-19 vaccination and infection. Additionally, we review the literature and discuss the therapeutic challenges. Results A 73-years old male presented with five months of progressive fatigue, weight loss, diffuse sweating, muscle cramps, and neuropathic pain. He eventually developed bilateral upper and lower facial weakness. Patient contracted a mild COVID-19 infection two months prior and COVID- 19 vaccination one month prior to his symptom onset. His exam was remarkable for bilateral facial weakness, diffuse fasciculations and sensory neuropathy on his trunk and extremities. His diagnostic work up including bone marrow biopsy was consistent with a chronic lymphocytic leukemia (CLL)-like immunophenotype. Cerebrospinal fluid (CSF) analysis was remarkable for five WBC (lymph-dominant) and protein of 74 mg/dl. Serum paraneoplastic panel revealed positive CASPR2 antibody with a titer of 1:100. Magnetic Resonance Imaging (MRI) of the brain showed enhancement of bilateral cranial nerve VII. After lack of clinical response to IV methylprednisone (1 gram for 5 days), patient was treated with a single cycle of IV immunoglobulin (IVIG). He had complete recovery of his symptoms except for residual facial weakness. He remains stable at his six months post-treatment follow-up. Conclusions Anti-CASPR2 associated autoimmunity following COVID-19 infection or in the setting of CLL has previously been reported. However, cranial neuropathy in association with CASPR2 antibody has never been. A trial of IVIG could be beneficial in patients with viral-spike protein-induced autoimmunity and CLL who do not otherwise meet the criteria for CLL treatment.

3.
Neurology ; 93(23 Supplement 2):S37-S38, 2022.
Article in English | EMBASE | ID: covidwho-2196695

ABSTRACT

Objective To evaluate the safety and efficacy of efgartigimod in patients with generalized myasthenia gravis (MG) enrolled in the ADAPT+ longterm extension study. Background Treatment with efgartigimod, a human IgG1 antibody Fc-fragment that blocks neonatal Fc receptor, resulted in clinically meaningful improvement (CMI) in MG-specific outcome measures in the ADAPT phase 3 clinical trial. All patients who completed ADAPT were eligible to enroll in its ongoing open-label, 3-year extension study, ADAPT+. Design/Methods Efgartigimod (10 mg/kg IV) was administered in cycles of once-weekly infusions for 4 weeks, with subsequent cycles initiated based on clinical evaluation. Efficacy was assessed during each cycle utilizing Myasthenia Gravis Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scales. Results Ninety-one percent of ADAPT patients (151/167) entered ADAPT+. As of February 2021, 106 AChR-Ab+ and 33 AChR-Ab- patients had received at least 1 dose of open-label efgartigimod (including 66 ADAPT placebo [PBO] patients). The mean (SD) study duration was 363 (114) days, resulting in 138 patient-years of observation. Similar incidence rates per patient year (IR/PY) of serious adverse events were seen in ADAPT (efgartigimod: 0.11;placebo: 0.29) compared to ADAPT+ (0.25). Five deaths (acute myocardial infarction, COVID-19 pneumonia/septic shock, bacterial pneumonia/MG crisis, malignant lung neoplasm, and unknown [multiple cardiovascular risk factors identified on autopsy]) occurred;none were considered related to efgartigimod by the investigator. AEs were predominantly mild or moderate. CMI was observed in AChR-Ab+ patients during each cycle (up to 10 cycles) at magnitudes comparable to improvements observed at week 3 of cycle 1 (mean[SE] improvements: MG-ADL, -5.1[0.34];QMG, -4.7[0.41]). Clinical improvements mirrored maximal reductions in total IgG and AChR-Abs across all cycles. Conclusions This analysis suggests the efficacy of long-term treatment with efgartigimod was consistent across multiple cycles. No new safety signals were identified, despite being conducted before vaccine availability during the COVID-19 pandemic.

4.
Journal of Medical Case Reports ; 16(1) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2196438

ABSTRACT

Background: The risk of developing severe and even fatal coronavirus disease 2019 (COVID-19) increases with various factors such as advanced age and chronic diseases, especially those treated with immunosuppressive drugs. Viral ribonucleic acid (RNA) and viral load detection in extra-pulmonary specimens have been proposed to indicate disease severity. Case presentation: Here we describe a fatal COVID-19 case of an 83-year-old Caucasian male patient with various underlying comorbidities, including cardiovascular and autoimmune disorders, as well as immunosuppression due to lymphoma treatment. Upon admission, the patient was radiologically diagnosed with severe COVID-19. The patient was febrile and presented with diarrhea, continued dyspnea, tachypnea, and low blood oxygen saturation, treated with high-concentration oxygen supplementation and antibacterial therapy. Overall the patient was treated for COVID-19 for 19 days. Blood tests were performed upon admission, on the fifth, 10th, 13th, and 19th day. In addition, nasopharyngeal swab, blood, urine, and fecal samples were collected from the patient on the 14th day for virological and immunological investigations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in all samples collected from this patient, including blood plasma and peripheral blood mononuclear cells (PBMC), with very high viral loads. However, neither virus-specific IgA, IgM, nor IgG antibodies were detectable. Conclusion(s): The various cardiovascular, autoimmune, and oncological disorders, advanced age, and the high levels of inflammatory markers predisposed the patient to severe COVID-19 and determined the fatal outcome of the disease. We believe that the multiple specimen SARS-CoV-2 positivity and extremely high viral loads in nasopharyngeal swab and fecal samples to be the result of COVID-19 severity, the inability of viral clearance and weakened immune response due to advanced age, comorbidities, and the presence of non-Hodgkin's lymphoma and the immunosuppressive treatment for it, highlighting the risks of COVID-19 in such patients. Copyright © 2022, The Author(s).

5.
Proceedings of Singapore Healthcare ; 31(no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2195486

ABSTRACT

Background: Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore. Objective(s): This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance. Method(s): An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance. Result(s): Respondents (n = 278;mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71-10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30-8.97). Conclusion(s): Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients. Copyright © The Author(s) 2022.

6.
Therapeutic Advances in Urology ; 14:12-13, 2022.
Article in English | EMBASE | ID: covidwho-2195428

ABSTRACT

Purpose: We aimed to evaluate the role of plasma fibrinogen and D-dimer as prognostic biomarkers in patients with non-muscle-invasive bladder cancer (NMIBC). Method(s): A prospective study that included 35 patients (30 males) with newly diagnosed NMIBC who underwent complete transurethral resection between September 2020 and December 2021. Patients with history of thromboembolic event or anticoagulant intake or active infection, patients with deranged hepatorenal functions, inflammatory bowel disease, refractory hypertension, or diagnosed with Covid-19 infection within 1 month before surgery or routine follow-up were excluded. Follow-up was done as per NCCN guidelines. Fibrinogen and D-dimer levels were measured within 7 days of surgery or follow-up and analyzed for recurrence-free survival (RFS) and progression-free survival (PFS). Cox regression analyses were adopted to assess the influence of these two parameters on RFS and PFS. Result(s): The mean age was 53.9 years with a median follow-up of 9 months. The cut-off values of fibrinogen and D-dimer were 402.5 mg/dl and 0.55 mug/ml, respectively. Kaplan-Meier analysis demonstrated that high fibrinogen and D-dimer levels were significantly related to poor RFS (p < 0.001) and PFS (p < 0.001). On multivariate analysis, only fibrinogen and D-dimer retained their significance for RFS (p = 0.026 and 0.014, respectively) and PFS (p = 0.027 and 0.042, respectively) but not tumor size. High levels of fibrinogen and D-dimer were also present in patients who had recurrence or progression at follow-up visits compared to the rest of the patients. Conclusion(s): High levels of fibrinogen and D-dimer may indicate worse prognosis in patients with NMIBC, suggesting that these two can be used as prognostic biomarkers.

7.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194396

ABSTRACT

Case Report: A 42-year-old male with no significant past medical history presented to the emergency department (ED) after a three-week history of myalgias, non-productive cough, and progressively worsening dyspnea accompanied by a two-week history of right-sided chest pain that all started four days after receiving his Pfizer COVID-19 booster vaccine. Chest pain was described as constant, non-radiating, and aggravated by positional changes. On ED arrival, the patient was febrile to 102.9degreeF and tachycardic with initial labs significant for leukocytosis of 13.6 Thou/uL, Creactive protein at 17.18 mg/dL, troponins negative x2, and a negative COVID-19 NAAT testing. EKG revealed diffuse T wave inversions and chest x-ray was noncontributory. Transthoracic echocardiogram (TTE) obtained showed a small fibrinous circumferential pericardial effusion with no evidence of cardiac tamponade;however, there was an interventricular septal bounce suggestive of effusive-constrictive pericarditis. This diastolic septal bounce was also seen on cardiac magnetic resonance imaging, along with a pericardial enhancement measuring up to 0.2 cm2 in thickness. With a negative infectious and autoimmune workup, along with low clinical suspicion for tuberculosis or malignancy, the leading differential was the temporal relationship between receiving the Pfizer COVID-19 mRNA booster vaccine and the development of effusive-constrictive pericarditis (ECP). The patient was started on Colchicine 0.6 mg twice daily, Ibuprofen 400 mg three times daily, and subsequently discharged after symptomatic improvement and being afebrile for 72 hours with plans for close cardiology follow-up. Discussion(s): ECP is a rare syndrome characterized by a concurrent decrease in pericardial compliance with pericardial effusion and is seen in 4.5% to 6.9% of patients who present with pericardial effusions. To date, less than five other case reports internationally have delineated a relationship between COVID-19 mRNA vaccines and the development of ECP, making recognition of this etiology challenging. In patients who have a mixed hemodynamic picture with subacute features of both cardiac tamponade and constrictive pericarditis, clinicians should have a high index of suspicion for ECP.

8.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194387

ABSTRACT

Introduction. Patients receiving serial outpatient infusion treatment for lymphoma or breast cancer (BC) with potentially cardio-toxic chemotherapeutic regimens may experience declines in left ventricular ejection fraction (LVEF) and exercise capacity. This study sought to determine if a physical activity intervention (PAI) administered during cancer treatment could attenuate deterioration of exercise capacity and LVEF. Methods. Across two NCI funded cancer centers, we randomized (2:1) 34 participants to a homebased PAI or healthy living education intervention (HLI) within 6 weeks of initiating curative therapies for stage I-IV Hodgkin's, non-Hodgkin's lymphoma, or stage I-III BC (NCT01719562). Training programs were tailored by treatment and functional status and adapted for remote delivery during COVID-19. Exercise capacity was determined via cardiopulmonary exercise test (peak VO2 [ml/kg/min]) and LVEF (%) was determined by magnetic resonance imaging at baseline, 3, and 6 months. Separate linear mixed-effects regression models controlling for baseline values examined changes in peak VO and LVEF by time and treatment group. Results. Demographics were similar between the two arms (PAI vs. HLI, 52.4 [16.3] vs. 56.8 [12.7] years of age [SD];69% vs. 75% white;and 57.7% vs. 50% female). Peak VO 2increased at 3 (+1.15 ml/kg/min [CI: -1.46 - 3.77]) and 6 months (+3.88 ml/kg/min [CI: 0.79 - 6.96]) in the PAI arm, while the HLI arm increased slightly at 3- (+0.67 ml/kg/min [CI: -5.14 - 6.48]) but not 6 months (-0.83 ml/kg/min [CI: -5.99 - 4.33]). LVEF declined slightly at 3 months in the PAI (-2.29% [CI: -4.83 - 0.25]) but not HLI arm (3.05.% [CI: -2.49 - 8.60]), while at 6 months, the PAI arm had returned to baseline LVEF (-0.58% [CI: -4.30 - 3.14]) and the HLI arm declined slightly (-1.76% [CI: -7.23 - 3.71]). Conclusions. This pilot RCT suggests the importance and utility of home-based physical activity during cancer treatment in protecting against expected declines in exercise capacity and LVEF. These results highlight the need for larger randomized trials that examine the effects of lifestyle interventions administered during treatment to improve quality of life and to support long term cardiovascular health in cancer survivors.

9.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194348

ABSTRACT

Introduction: This case identifies vagal tone as a paradoxical cause of coronary artery spasm, coinciding with complete heart block. It will additionally identify proper management in these cases. Clinical Presentation: A 53 year old male with a medical history of HIV not of ART, acute, infectious COVID-19 and late, latent syphilis admitted for malaise, found to have DLBCL. Following a routine blood draw the patient experienced acute chest and abdominal pain. Minutes later, while having a bowel movement he experienced syncope with heart rates in the 30s. EKG showed ST elevations in leads II, III, and aVF. Troponin-T was elevated to 0.15. Echocardiogram showed inferior wall hypokinesis. Coronary angiography showed non-obstructive right coronary disease. Cardiac MRI demonstrated no evidence of infiltrative disease or myocarditis. The patient experienced a similar episode the following morning, during blood draw, EKG and telemetry demonstrated complete heart block with ST elevations (image). This suggested vagal mediated AV block with coronary artery spasm (CAS). He was started on the anticholinergic hyoscyamine and amlodipine for vasodilation. Following initiation of therapy, the patient had no further episodes of chest pain or bradycardia. Discussion(s): While acetylcholine causes vasodilation via endothelial NO, interestingly, it can also lead to CAS. In the setting of vascular smooth muscle cell (VSMC) hyper-reactivity or high vagal tone, VSMC muscarinic receptors are activated leading to vasoconstriction. Vagal tone can cause both CAS with resulting STEMI as well as AV blockade resulting in high degree heart block (image). When ischemic symptoms are accompanied by AV block in the setting of high vagal tone, consider vagal mediated CAS. Calcium channel blockers such as amlodipine are used to manage CAS. When the suspected mechanism is vagal tone, management includes avoidance of precipitating factors and or anticholinergic premedication.

10.
Cancer Prevention Research Conference: 2nd Biennial Meeting Translational Advances in Cancer Prevention Agent Development, TACPAD ; 15(12 Supplement 2), 2022.
Article in English | EMBASE | ID: covidwho-2194263

ABSTRACT

Gastric adenocarcinoma (GAC) is the third leading global cause of cancer mortality and leading infection-associated cancer. The high incidence regions are Latin America, East Asia, and Eastern Europe. In the U.S., GAC represents a major cancer disparity, double the incidence rates in all nonwhite populations, the opposite of Barrett's Esophagus and EAC. Immigrants from high incidence regions maintain the risk profile of their nations of origin. In a paradigm shift, recent guidelines now recommend surveillance endoscopy (eg, 3 years) for patients with high-risk gastric premalignant conditions (GPMCs). Clinical trials of chemoprevention agents for patients with GPMCs are lacking. We conducted two independent, NCI DCP funded, phase II placebo-controlled chemoprevention trials in patients with GPMCs (intestinal metaplasia, atrophic gastritis). The oral agents were curcumin and eflornithine (DFMO). A highly bioavailable preparation of curcumin was used. The RCTs were conducted in Puerto Rico and rural Honduras, with important characteristics: (1) representative of Caribbean and Mesoamerican populations and linked to large U.S. immigrant populations;(2) high prevalence of H. pylori infection and GPMCs;(3) absence of turmeric and curcuminoids in the local diets;(4) proven bidirectional collaboration with academic institutions in the U.S. In the curcumin trial (NCT02782949) H. pylori negative patients were randomized to study drug or placebo for 6 months. In the eflornithine study (NCT02794428), H. pylori positive and negative subjects were randomized to study drug or placebo for 18 months, with endoscopy at baseline, and 6. 18, and 24 months. The primary outcomes were based upon changes in histologic parameters at 6 months. Principal study challenges included: (1) International and bilingual regulatory environment;(2) Strengthening of the research infrastructure, particularly in Central America;(3) Participant recruitment, eg, in the curcumin RCT in Honduras wherein only 10-15% are H. pylori negative;(4) The Covid-19 pandemic;(5) Natural disasters (3 hurricanes). In Conclusion(s): Eflornithine and curcumin RCTs have been successfully completed, despite important challenges in implementation and execution. No losses to follow-up were encountered related to the pandemic or natural disasters. The south-south partnership may provide a model for chemoprevention and translational studies in Latino populations with prevalent cancers such as GAC..

11.
Cancer Research Conference: AACR Special Conference: Pancreatic Cancer Boston, MA United States ; 82(22 Supplement), 2022.
Article in English | EMBASE | ID: covidwho-2194261

ABSTRACT

The current under-representation of racial and ethnic minorities and socio-economically disadvantaged participants in clinical trials represents an important problem, because it reduces generalizability of trial results and should urgently be addressed in all diseases. Decentralized trials may improve engagement of under-represented populations with long-standing health disparities and may be relevant to patients with pancreatic cancer who would benefit from at home trial participation. We completed a fully decentralized randomized double-blind phase II clinical trial in New York State for participants with mild-to-moderate COVID-19. Electronic data were collected for 28 days (5 vital readings and 1 survey with 20 questions per day) from 55 non-hospitalized participants. Home monitoring devices, HIPAA compliant data submission technology, and internet access were provided free-of-charge. We enrolled 40% White, 33% Black or African American and 27% Other/Mixed/Unknown participants. Of these, 25% self-identified as Hispanic or Latino. This exceeded national and New York state averages of minority populations, in contrast with the current clinical trial landscape. We found that the local area within a 30-minute return car journey from our main research hospital disproportionately over-represented socio-economically advantaged white inhabitants. We found that decentralization enabled the inclusion of participants living up to a 2-hour journey from this hospital in socio-economically deprived geographies with higher minority race representation. We excluded selection bias, by demonstrating that our trial population represented the differences of social deprivation observed between races at the national and state level (p = 0.003). In addition to trial enrollment, completeness of trial data has an important impact on the veracity of trial results. Half our participants were assigned a dedicated team member to make telephone call reminders if participants had not submitted data by mid-day despite of a pre-ceding automated notification to the supplied electronic device. Daily telephone follow-up significantly reduced missing electronic data in participants living above the median deprivation index (submitted data per day 4 out of 6 vs 6 out of 6: p = 0.03), thereby aiding equitable data collection from traditionally under-represented participant groups. Our findings require further validation and refinement from multiple centers and expansion to patients with reduced mobility and cachexia due to progressing pancreatic cancer. Also, other factors such as language assistance and recruitment methods, need to be addressed in clinical trials to mitigate against their negative impact on equitable recruitment. Nevertheless, for now we identify decentralization combined with engagement telephone calls as readily actionable methods to improve inclusion of under-represented participants in clinical trials.

12.
Cancer Research Conference: AACR Special Conference: Pancreatic Cancer Boston, MA United States ; 82(22 Supplement), 2022.
Article in English | EMBASE | ID: covidwho-2194260

ABSTRACT

Introduction: Pancreatic cancer (PC) is currently the third-leading cause of cancer deaths in the United States. African Americans with PC have an increased incidence and worse survival outcome when compared to other racial groups. During the COVID-19 pandemic, there is evidence that hospital resources were allocated to treating immediate life-threatening conditions. Some of the daily highest case numbers were reported in the state of Florida with several peaks throughout 2020 and 2021. Additionally, the state of Florida has the second-highest rate of new cases of PC within the United States with an incidence of 4860/100,000. Our specific aim is to define the impact of COVID-19 between race, age, income, and gender on the survival time of newly diagnosed patients with pancreatic cancer in Florida. Material(s) and Method(s): Patients with pancreatic adenocarcinoma diagnosed from January 1st, 2017 to October 31st, 2020 were identified through the statewide clinical research and network database called OneFlorida Clinical Consortium by using the ICD10 diagnosis code for pancreatic cancer. Patients were then placed into 3 cohorts based on date of pancreatic cancer diagnosis: pre-pandemic (01/01/2017- 09/30/2019), transition (10/01/2019-02/28/2020), and pandemic (03/1/2020-10/31/2020). Patients with a diagnosis of neuroendocrine carcinoma were excluded. Patients were followed for at least one year unless a death occurred. Summary statistics were reported for demographic variables (age, sex, income, gender). Kaplan-Meier analysis with log-rank test was performed to compare the difference in overall survival time among groups. Result(s): This retrospective study had a total of 934 unique patients available for analysis. Of the 934 patients, 81.3% were in the pre-pandemic cohort (n= 759), 8.2% transition cohort (n=77), and 10.5% pandemic cohort (n=98). There was a decrease in the rate of diagnosis from the pre-pandemic (23 per month) to pandemic cohort (12.2 per month). The demographic distribution of the sample was 23.4% Black, 68.7% White and 7.9% Other. The median age was 67 years (27-89). There were 49.8% women and 50.2% men. The median income was $52,915 ($23,704-$124,821). The differences in overall survival time were not significant for age and gender across the 3 cohorts. Income <;$53,000 had significantly lower survival time across the 3 cohorts. African Americans had significantly lower survival time for pre-pandemic and transition cohort (p<;.005), but Caucasians had the lowest survival time for the pandemic cohort (p <;.005). When stratified for stage, the mean survival (in months) for White vs. Black populations was 37.8 vs. 26.1 for stage I, 37.6 vs. 27.3 for stage II, 28.5 vs.18.77 for stage III, and 20.7 vs. 21.7 for stage IV. Discussion(s): This study demonstrated a decrease in diagnosis & survival rate during the COVID-19 pandemic in Florida. Dissemination of resources should target these disparities in income and race.

13.
Cancer Research Conference: AACR Special Conference: Colorectal Cancer Portland, OR United States ; 82(23 Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194259

ABSTRACT

Introductory sentence about purpose of the study: The PRECISE study tests the effectiveness of a targeted patient navigation program for follow-up colonoscopy after abnormal fecal testing in community health centers. We present adaptations of the patient navigation program resulting from the impact of the COVID-19 pandemic. Brief description of pertinent experimental procedures: Colorectal cancer (CRC) screening by annual fecal immunochemical test (FIT) is an accessible and cost-effective strategy to lower CRC incidence and mortality. However, this mode of screening depends on follow-up colonoscopy after an abnormal FIT result to prevent CRC or find it in early, treatable forms. Unfortunately, almost half of patients with an abnormal FIT result fail to complete this essential screening component. Patient navigation can provide needed support for patients to complete a follow-up colonoscopy. PRECISE is a collaboration with a large community health center whose patient population is 37% Latino. Eligible patients were aged 50-75, had an abnormal FIT result in the past month, and were due for a follow-up colonoscopy. Patients were randomized to patient navigation or usual care. Patient navigation was delivered by a bilingual (English and Spanish) patient navigator using a six-topic phone-based protocol, adapted from the New Hampshire Colorectal Cancer Screening Program. Summary of new, unpublished data: A total of 985 patients were enrolled in the PRECISE study, 489 randomized to the intervention arm and 496 to the control arm. Due to the COVID-19 pandemic, we made adaptations to the navigator training program and navigation delivery. We converted our in-person training program to a virtual navigation training series combining pre-recorded videos and live webinars. Additionally, we strengthened relationships with GI practices to expedite referrals, improve scheduling processes, and better understand COVID-related policy changes including the conversion of some preprocedure consultations to a phone-based platform and COVID-19 testing requirements prior to the colonoscopy. Finally, we adapted patient navigator messages to address fear and anxiety about getting medical care during the peak COVID-19 pandemic. Preliminary patient navigation outcomes will be available in September 2022. Statement of conclusions: This innovative clinical trial highlights the importance of patient navigation to improve CRC screening in community health centers. Rapid response to COVID-19 provided the opportunity to adapt our navigator program for a virtual setting allowing for 1) the sustainability of patient navigation during the pandemic and 2) the broadening of training resources for patient navigators and community health workers.

14.
International Journal of Gynecological Cancer ; 32(Supplement 3):A10, 2022.
Article in English | EMBASE | ID: covidwho-2193892

ABSTRACT

Objectives The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. Our aim was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally. Methods A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary Outcome: 30-day postoperative SARS-CoV-2 infection rate. Secondary Outcomes: 30-day perioperative mortality and morbidity, COVID-19-related treatment modifications. Results We included 3973 patients (52 countries;7 world regions). Lower-than-reported rate (22/3778;0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%;p<0.0001) and mortality (18.2% vs 0.7%;p<0.0001), compared to the uninfected cohort. In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/ 3784), particularly in those with ovarian cancer (213/1355;15.7%). This delay was associated with a composite of adverse outcomes including disease progression and death (95/ 424;22.4% versus 601/3360;17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions. One in thirteen did not receive their planned operations (189/2430;7.9%), in whom 1 in 20 (5/189;2.7%) died and 1 in 5 (34/189;18%) experienced disease progression or death within 3 months of decisions for surgery. Conclusions One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operationscoordinated mitigating strategies are urgently needed.

15.
Colorectal Disease ; 23(Supplement 2):111, 2021.
Article in English | EMBASE | ID: covidwho-2192492

ABSTRACT

Aim: Despite Covid-19, hospitalsin the England, United Kingdom continued to assess and manage patients referred on two week-wait (2WW) suspected cancer referral pathways. Most index clinic assessments of such patients were conducted viatelephone. We retrospectively evaluated adistrict general hospital experience of managing patients on a 2WW suspected lower gastrointestinal tract (LGIT)cancer referral pathway, initially assessed via telephone Method: Data were obtained using a prospectively maintained database and electronic patient records. LGIT 2WW referrals between 01/06/2020to 31/10/2020 were included. Data were retrospectively collated and analysed using Excel (Microsoft Corporation, USA) Results: A total 757 patients (median age = 70, interquartile range = [59-79], female = 47.2%) were identified. The majority (n = 629,83.1%) were white Caucasian. All patients were initially assessed virtually and only 3 (0.4%) were re-assessed face-to- face for their index appointment. Sixteen (2.1%) missed at least one prior appointment. The most common presenting complaints included change in bowel habit, rectal bleeding, weight loss, anaemia and abdominal pain, and 415 (54.8%), 269 (35.5%) underwent endoscopy and imaging respectively as the first investigation. Forty four (5.8%) patients had malignant pathology with the majority (n = 37,84.1%) being colorectal in origin. Of those diagnosed with a primary colorectal malignancy 25 (67.6%) underwent surgical or endoscopic treatment, 3 (8.1%) were referred to chemoradiotherapy and 8 (21.6%) were referred for palliation. Conclusion(s): Patients referred on the 2WW LGIT pathway continued to be assessed and managed despite Covid-19. Index telephone clinic assessments are perhaps as effective a tool as face-to- face assessments, for patients referred on this pathway. This warrants further investigation.

16.
Colorectal Disease ; 23(Supplement 2):135, 2021.
Article in English | EMBASE | ID: covidwho-2192491

ABSTRACT

Aim: Telephone appointments have replaced face-to- face hospital clinic appointments due to the Covid-19 pandemic. We evaluated the impact of telephone appointments on patients referred on a two week-wait (2WW) suspected lower gastrointestinal tract (LGIT) cancer pathway. Method(s): Two independent patient samples between the 01/06/2019-31/ 10/2019 (face-to- face cohort) and 01/06/2020-31/ 10/2020 (telephone cohort) were identified using a prospectively maintained local database and electronic patient records. Data were retrospectively collated using Excel (Microsoft, USA). Chi-square and Man-Whitney- U statistical tests were performed using SPSS (IBM, USA). Result(s): A total 1531 (median age = 70, interquartile range [IQR] = 60-79, female = 679, 44.4%) were analysed. Of these, 757 (49.4%) were assessed via telephone;the remainder were face-to- face (n = 774,50.6%). The age, gender and ethnicity distributions across the two groups were similar. A total of 92 (6%, telephone = 44, face-to- face = 48) patients had malignant pathology and 64 (4.2%) were colorectal cancer (CRC). Of those with a CRC diagnosis, 46 (3.0%, telephone = 26, face-to- face = 20) underwent surgical or endoscopic treatment with curative intent. There was no significant difference in diagnoses made (P = 0.749) or treatment of CRC (P = 0.785) following telephone versus face-face- appointments. The median waiting times for index appointment, investigation and diagnosis for telephone appointments were significantly lower compared to face-to- face appointments (P < 0.001). There was no significant difference in median time to index treatment for CRC between the two groups (P = 0.156). Conclusion(s): Patients referred to 2WW LGIT clinics were efficiently and safely assessed and manged using telephone clinics during the Covid-19 pandemic. The cost-effectiveness and stakeholder views on permanent use of telephone assessments in these clinics must be evaluated.

17.
Colorectal Disease ; 23(Supplement 2):65, 2021.
Article in English | EMBASE | ID: covidwho-2192488

ABSTRACT

Aim: Colorectal cancer (CRC) is one of the most frequent pathologies worldwide with important complication rates. During the current COVID-19 pandemic, the number and stage of colon tumors have been affected. It's known that COVID+ patients undergoing surgery have a higher rate of complications. However, the existing literature that analyzes the incidence of complications in non-COVID patients with CRC undergoing elective surgery is scarce, thus we perform this review analyzing and presenting our results. Method(s): Retrospective study, we've included patients with colon cancer who underwent scheduled cancer surgery. Groups: Pre-COVID( A): July-2019 to February-2020 and Group-COVID( B): July-2020 to February-2021. Result(s): 172 patients (A:82;B:90) were analyzed, all of them had a negative preoperative PCR-COVID- test. Men:124(72.1%). Age: 72+/-10.1years. LOS: 7(IQR:5-12days). Laparoscopic approach: 142(82.6%). Overall complications: 40.7%. Infectious: 37.2%. SSI: 30.2%. 30-d readmission-rate: 3.5%. Dehiscence: 9.3%. Reintervention: 15.1%. COVID-group presented a greater number of patients with long stay ( > 7days): (62.2% vs. 46.3%;P = 0.03). Use of endoprostheses was higher in the COVID-group (11.1% vs. 2.4%;P = 0.026). In the bivariate analysis, we observed COVID-group presented a higher rate of overall-complications, infectious, SSI, dehiscence and reoperations (51.1% vs. 26.8% P = 0.001;48.9% vs. 24.4% P = 0.001;46.7% vs. 12.2% P = 0.001;15.5% vs. 2.4% P = 0.001;20% vs. 9.7% P = 0.017). No statistically significant differences were found in the 30-d readmission rate (Group A: 2.4%, group B: 4.4% P > 0.05). Conclusion(s): In our environment, during the COVID-19 Pandemic, patients with colon cancer who underwent scheduled cancer surgery, with a negative PCR-COVID test, had higher risk of presenting overall complications and reoperations and, therefore, a longer hospital stay.

18.
Colorectal Disease ; 23(Supplement 2):154, 2021.
Article in English | EMBASE | ID: covidwho-2192487

ABSTRACT

Aim: The SARS-Cov- 2 pandemic has been undoubtedly overwhelming for elective colorectal cancer resections. However, early establishment of a green pathway has enabled our trust to operate in a clean, covid-19 free environment and this project aims to demonstrate this pathway. Method(s): Elective colorectal cancer resections have been included in this cohort from January until July 2020. Emergency and benign resections have been excluded from this study. The main procedures that have been performed were laparoscopic right hemicolectomies and high anterior resections. Complication rate was classified using the Clavien-Dindo scale. Patients from March 2020 onwards were operated and nursed post-operatively on a green covid-19 pathway. Result(s): A total of 62 patients were included in this study. Resections were mainly performed laparoscopically (85%) and these were mainly right hemicolectomies (41%) and high anterior resections (31%). There has been a single Covid19 positive resection and that was before the pathway has been established. The median length of stay was 5 days for all resections. The main post-operative complication was ileus and there were no anastomotic leaks. Conclusion(s): Elective colorectal resections during a respiratory pandemic are safe and feasible with appropriately established pathways.

19.
Colorectal Disease ; 23(Supplement 2):88, 2021.
Article in English | EMBASE | ID: covidwho-2192486

ABSTRACT

Aim: The COVID-19 pandemic has had a global impact on cancer care. However, little is known as to what extent this impact has varied between different countries. Denmark was one of the first European nations to introduce national lockdown measures and achieved comparatively good control of the initial wave. We sought to determine the impact of the pandemic's initial wave on colorectal cancer care and investigate what lessons may be learned for future pandemics. Method(s): The Danish national cancer registry was used to identify patients newly diagnosed with colorectal cancer between 01/03/2020 -01/ 08/2020 (pandemic period) and the corresponding dates in 2019 (pre-pandemic period). This registry comprise > 95% of patients diagnosed with colorectal cancers in Denmark. Data regarding clinicopathological demographics and peri-operative outcomes were retrieved and compared between the two cohorts. Result(s): 2,794 patients were identified during the study period. Surgical practices were unaltered during the pandemic, with no alterations in the use of minimally invasive surgery (colon 84% vs 87%, rectum 93% vs 96%) nor in the formation of anastomoses or stomata noted between cohorts. No significant differences in 30-day or 90-day mortality rates were identified and on multivariable analysis treatment during the pandemic period was not found to be independently associated with peri-operative death. However, a marked reduction in total (359/month versus 201/month, P = 0.008) and screening diagnoses (80/month versus 38/month, P = 0.016) was noted during the pandemic. Conclusion(s): The Covid-19 pandemic had limited impact on the technique or outcomes of colorectal cancer care in Denmark, perhaps due to the success of early control of the initial wave when compared to other European nations. However, a concerning reduction in new diagnoses was still noted, highlighting the need to encourage patients to seek medical attention during the current and future pandemic in order to avoid delays in cancer diagnoses.

20.
Colorectal Disease ; 23(Supplement 2):89, 2021.
Article in English | EMBASE | ID: covidwho-2192485

ABSTRACT

Aim: The impact of a delay from treatment decision to surgery in colorectal cancer is unknown. The COVID-19 pandemic has provided a unique opportunity to ethically research the topic. This study aimed to compare the short-term oncological outcomes for colorectal cancer patients undergoing delayed versus non-delayed surgery. Method(s): This international prospective cohort study included consecutive colorectal cancer patients with a treatment decision for curative surgery, from February to July 2020. A delayed surgery was defined as being performed > 4 weeks after treatment decision. Further delays of 6 and 8 weeks after treatment decision were analysed. Surgical delays were analysed only in patients who did not receive neoadjuvant therapy. The primary outcome measure was poor oncological outcome, defined as progression to unresectable disease or positive resection margins. Result(s): Overall, 5453 patients from 47 countries were included, of which 9.6% (522/5453) did not receive the planned operation. Of the operated patients, 15.6% (767/4931) received neoadjuvant therapy. From the patients who went straight to surgery, 38.7% (1611/4164) were delayed beyond four weeks. Delayed patients were more likely to be older, male, more comorbid, have a higher BMI. Rectal cancers and early stage patients were more exposed to delay. After adjustment, delay was not associated with increased risk of a poor oncological outcome (OR = 0.89 (0.68-1.17, P = 0.415). Longer delays also did not show worse outcomes. Conclusion(s): One in ten colorectal cancer patients did not receive their planned operation during the COVID-19 pandemic. Delay to surgery did not impair short-term oncological outcomes and seems safe to be used during future pandemic waves if needed. Further research is needed to assess the long-term effects of surgical delay.

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