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1.
International Journal of Gynecological Cancer ; 32(Supplement 2):A458-A459, 2022.
Article in English | EMBASE | ID: covidwho-2161913

ABSTRACT

Introduction/Background The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. The aim of CovidSurg-Gynaecological Cancer study 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. Methodology A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary outcome The incidence of pandemic-related changes in care Secondary outcomes 30-day postoperative morbidity and mortality rates A composite outcome of unresectable disease or disease progression, emergency surgery and death Results We included 3973 patients (52 countries;7 world regions;27% from low-and-middle-income countries). 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) rates, 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 the use of neoadjuvant chemotherapy (p<0.0001), 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 MDT decisions for surgery Conclusion 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 operations. This global data on the magnitude of care changes and their consequences could be used to leverage resources for the ongoing mitigating strategies worldwide.

2.
Annals of Oncology ; 33:S798-S799, 2022.
Article in English | EMBASE | ID: covidwho-2041537

ABSTRACT

Background: Dostarlimab is a programmed death 1 (PD-1) inhibitor approved in the EU as a monotherapy in patients (pts) with dMMR/MSI-H AR EC that has progressed on or after platinum-based chemotherapy;and in the US as a monotherapy in pts with dMMR AR EC that has progressed on or after platinum-based chemotherapy or dMMR solid tumors that have progressed on or after prior treatment, with no satisfactory alternative treatment options. We report on PFS and OS in 2 expansion cohorts of the GARNET trial that enrolled pts with EC. Methods: GARNET is a multicenter, open-label, single-arm phase 1 study. Pts were assigned to cohort A1 (dMMR/MSI-H EC) or A2 (MMRp/MSS EC) based on local immunohistochemistry assessment. Pts received 500 mg of dostarlimab IV every 3 weeks for 4 cycles, then 1000 mg every 6 weeks until disease progression, discontinuation, or withdrawal. PFS and OS are secondary efficacy endpoints. Results: 153 pts with dMMR/MSI-H and 161 pts with MMRp/MSS EC were enrolled and treated. The efficacy-evaluable population included 143 pts with dMMR/MSI-H EC and 156 pts with MMRp/MSS EC with measurable disease at baseline and ≥6 mo of follow-up. Median follow-up was 27.6 mo for dMMR/MSI-H and 33.0 mo for MMRp/MSS EC (Table). For pts with dMMR/MSI-H EC, median PFS (mPFS) was 6.0 mo, with 3-year estimated PFS rate of 40.1%. With 37.3% of pts experiencing an event, mOS was not reached;estimated 3-year OS was >50%. For pts with MMRp/MSS EC, mPFS was 2.7 mo. mOS was 16.9 mo with 68.9% of pts experiencing an event. Safety has been previously reported. [Formula presented] Conclusions: Dostarlimab demonstrated durable antitumor activity in dMMR/MSI-H and MMRp/MSS AR EC. dMMR/MSI-H was associated with longer PFS and OS than MMRp/MSS as expected. Clinical trial identification: NCT02715284. Editorial acknowledgement: Writing and editorial support, funded by GlaxoSmithKline (Waltham, MA, USA) and coordinated by Heather Ostendorff-Bach, PhD, of GlaxoSmithKline, was provided by Shannon Morgan-Pelosi, PhD, and Jennifer Robertson, PhD, of Ashfield MedComms, an Ashfield Health company (Middletown, CT, USA). Legal entity responsible for the study: GlaxoSmithKline. Funding: GlaxoSmithKline. Disclosure: A.V. Tinker: Financial Interests, Institutional, Sponsor/Funding: AstraZeneca;Financial Interests, Personal, Other: AstraZeneca, Eisai, GlaxoSmithKline. B. Pothuri: Financial Interests, Institutional, Funding: AstraZeneca, Celsion, Clovis Oncology, Eisai, Genentech/Roche, Karyopharm, Merck, Mersana, Takeda Pharmaceuticals, Tesaro/GSK;Financial Interests, Personal, Other: Arquer Diagnostics, AstraZeneca, Atossa, Clovis Oncology, Deciphera, Elevar Therapeutics, Imab, Mersana, Tesaro/GSK, Merck, Sutro Biopharma, Tora, GOG Partners;Financial Interests, Personal, Advisory Board: Arquer Diagnostics, AstraZeneca, Atossa, Deciphera, Clovis Oncology, Eisai, Elevar Therapeutics, Imab, Merck, Mersana, Sutro Biopharma, Tesaro/GSK, Toray;Financial Interests, Personal, Leadership Role: GOG Partners, NYOB Society Secretary, SGO Clinical Practice Committee Chair, SGO COVID-19 Taskforce Co-Chair. L. Gilbert: Financial Interests, Institutional, Funding: Alkermes, AstraZeneca, Clovis, Esperas, IMV, ImmunoGen Inc, Karyopharm, Merck Sharp & Dohme, Mersana, Novocure GmbH, OncoQuest Pharmaceuticals, Pfizer, Roche, Tesaro;Financial Interests, Personal, Other: Merck, Alkermes, AstraZeneca, Eisai, Eisai-Merck, GlaxoSmithKline. R. Sabatier: Financial Interests, Institutional, Funding: AstraZeneca, Eisai;Financial Interests, Personal, Other: AstraZeneca, GlaxoSmithKline, Novartis, Pfizer, Roche;Non-Financial Interests, Personal, Other: AstraZeneca, Bristol Myers Squibb, GlaxoSmithKline, Pfizer, Roche. J. Brown: Financial Interests, Personal, Advisory Role: Caris, Clovis, Eisai, GlaxoSmithKline;Financial Interests, Personal, Funding: GlaxoSmithKline, Genentech. S. Ghamande: Financial Interests, Personal, Advisory Role: Seattle Genetics;Financial Interests, Personal, Speaker’s Bureau: GlaxoSmithKline;Financial Interests, Institutional, Funding: Abbv e, Advaxis, Bristol Myers Squibb, Clovis, Genentech, GlaxoSmithKline, Merck, Roche, Seattle Genetics, Takeda. C. Mathews: Financial Interests, Institutional, Research Grant: Astellas, AstraZeneca, Deciphera, Moderna, GSK, Regeneron, Seattle Genetics;Financial Interests, Personal, Advisory Board: IMAB biopharma. D. O'Malley: Financial Interests, Personal, Advisory Board: AstraZeneca, Tesaro/GSK, Immunogen, Ambry, Janssen/J&J, Abbvie, Regeneron, Amgen, Novocure, Genentech/Roche, GOGFoundation, Iovance, Eisai, Agenus, Merck, SeaGen, Novartis, Mersana, Clovis, Elevar, Takeda, Toray, INXMED, SDP Oncology (BBI), Arquer Diagnostics, Roche Diagnostics MSA, Sorrento, Corcept Therapeutics, Celsion Corp;Financial Interests, Personal, Funding: AstraZeneca, Tesaro/GSK, Immunogen, Janssen/J&J, Abbvie, Regeneron, Amgen, Novocure, Genentech/Roche, VentiRx, Array Biopharma, EMD Serono, Ergomed, Ajinomoto Inc, Ludwig Cancer Research, Stemcentrx, Inc, Cerulean Pharma, GOGFoundation, Bristol-Myers Squibb Co, Serono Inc, TRACON Pharmaceuticals, Yale University, New Mexico Cancer Care Alliance, INC Research, Inc, inVentiv Health Clinical, Iovance, PRA Intl, Eisai, Agenus, Merck, GenMab, SeaGen, Mersana, Clovis, SDP Oncology (BBI);Financial Interests, Personal, Other: Myriad Genetics, Tarveda. V. Boni: Financial Interests, Personal, Advisory Board: OncoArt, Guidepoint Global;Financial Interests, Personal, Speaker’s Bureau: Solti;Financial Interests, Personal, Other: START, Loxo, IDEAYA Biosciences;Financial Interests, Institutional, Research Grant: Sanofi, Seattle Genetics, Loxo, Novartis, CytomX Therapeutics, Pumo Biotechnology, Kura Oncology, GlaxoSmithKline, Roche/Genentech, Bristol-Myers Squibb, Menarini, Synthon, Janssen Oncology, Merck, Lilly, Merus, Pfizer, Bayer, Incyte, Merus, Zenith Epigenetics, Genmab, AstraZeneca, Seattle Genetics, Adaptimmune, Alkermes, Amgen, Array BioPharma, Boehringer Ingelheim, BioNTech AG, Boston Biomedical. A. Gravina: Financial Interests, Personal, Other: Gentili, Pfizer. S. Banerjee: Financial Interests, Personal, Advisory Board: Amgen, Genmab, Immunogen, Mersana, Merck Sereno, MSD, Roche, Tesaro, AstraZeneca, GSK, Oncxerna;Financial Interests, Personal, Invited Speaker: Clovis, Pfizer, Tesaro, AstraZeneca, GSK, Takeda, Amgen, Medscape, Research to Practice, Peerview;Financial Interests, Personal, Stocks/Shares: PerciHealth;Financial Interests, Institutional, Research Grant: AstraZeneca, GSK, Tesaro;Non-Financial Interests, Principal Investigator, Phase II clinical trial Global lead, ENGOTov60/GOG3052/RAMP201: Verastem;Non-Financial Interests, Principal Investigator, ENGOT-GYN1/ATARI phase II international trial (academic sponsored): Astrazeneca;Non-Financial Interests, Advisory Role: Epsilogen;Non-Financial Interests, Other, Member of membership committee: ESGO;Non-Financial Interests, Advisory Role, Medical advisor to UK ovarian cancer charity: Ovacome Charity;Non-Financial Interests, Other, Received research funding from UK based charity I have provided medical advice (non-remunerated): Lady GardenFoundation Charity. R. Miller: Financial Interests, Personal, Other: AZD, Clovis Oncology, Ellipses, GlaxoSmithKline, MSD, Shionogi, AZD, GlaxoSmithKline;Financial Interests, Personal, Speaker’s Bureau: AZD, Clovis Oncology, GSK, Roche. J. Pikiel: Financial Interests, Personal, Other: Amgen, Clovis Oncology, GlaxoSmithKline, Incyte, Novartis, Odonate Therapeutics, Pfizer, Regeneron, Roche. M.R. Mirza: Financial Interests, Personal, Advisory Board: AstraZeneca, Biocad, GSK, Karyopharm, Merck, Roche, Zailab;Financial Interests, Personal, Invited Speaker: AstraZeneca, GSK, Karyopharm;Financial Interests, Personal, Stocks/Shares: Karyopharm;Financial Interests, Institutional, Research Grant: GSK, AstraZeneca, ultimovacs, Apexigen;Financial Interests, Institutional, Invited Speaker: Deciphera;Non-Financial Interests, Advisory Role: Ultimovacs, Apexigen. T. Duan: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. G. Antony: Financial Interests, Personal, Fu l or part-time Employment: GlaxoSmithKline. S. Zildjian: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. E. Zografos: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. J. Veneris: Financial Interests, Personal, Full or part-time Employment: GlaxoSmithKline. A. Oaknin: Financial Interests, Personal, Advisory Board: AstraZeneca, Clovis Oncology, Deciphera Pharmaceuticals, Genmab, GSK, Immunogen, Mersana Therapeutics, PharmaMar, Roche, Tesaro, Merck Sharps & Dohme de España, SA, Agenus, Sutro, Corcept Therapeutics, EMD Serono, Novocure, prIME Oncology, Sattucklabs, Itheos, Eisai, F. Hoffmann-La Roche,;Financial Interests, Personal, Other, Travel and accomodation: AstraZeneca, PharmaMar, Roche;Financial Interests, Institutional, Funding: Abbvie Deutschland, Advaxis Inc., Aeterna Zentaris, Amgen, Aprea Therapeutics AB, Clovis Oncology Inc, EISAI limited LTD, F. Hoffmann –La Roche LTD, Regeneron Pharmaceuticals, Immunogen Inc, Merck, Sharp & Dohme de España SA, Millennium Pharmaceuticals Inc, PharmaMar SA, Tesaro Inc., Bristol Myers Squibb;Non-Financial Interests, Leadership Role, Executive Board member as a Co-Chair: GEICO;Non-Financial Interests, Leadership Role, Phase II Committee and Cervix Cancer Committee Representative on behalf of GEICO: GCIG;Non-Financial Interests, Officer, Chair of Gynaecological Track ESMO 2019. Scientific Track Member Gynaecological Cancers ESMO 2018, ESMO 2020, ESMO 2022. Member of Gynaecological Cancers Faculty and Subject Editor Gyn ESMO Guidelines.: ESMO;Non-Financial Interests, Member: ESMO, ASCO, GCIG, SEOM, GOG.

3.
Gynecologic Oncology ; 166:S255, 2022.
Article in English | EMBASE | ID: covidwho-2031760

ABSTRACT

Objectives: To determine the rate and identify factors associated with potentially avoidable admissions following a minimally invasive hysterectomy. Methods: Patients who underwent a minimally invasive hysterectomy for a suspected or known gynecologic malignancy between January 2019 to July 2021 were identified in our institution's prospectively curated quality improvement surgical database. Preoperatively, patients were assessed for planned same-day discharge versus a planned admission. Reasons for those who were admitted despite a planned same-day discharge were characterized as the following: anesthesia-related, comorbid conditions, intraoperative factors, social factors, system issues, and uncontrolled pain. For planned admissions, reasons for admission were categorized as necessary and potentially unavoidable. Descriptive statistics were used to summarize the cohort. Results: A total of 380 patients were identified, of which 267 (70%) patients had a planned same-day discharge, and 113 (30%) had an anticipated admission. Same-day surgery discharge rates increased over time (Figure 1). Two hundred and thirty-five patients (88%) were successfully discharged the same day. Of these patients, 17 (7%) presented to the emergency department (ED) within 30 days, and the re-admission rate in this group was 12% (n=2). Thirty-two patients did not successfully discharge on the same day, and five patients (15%) presented to the ED for evaluation within 30 days. Most unplanned admissions were anesthesia-related (n=15, 47%), followed by system issues (n=7, 22%), such as failure to recognize comorbid conditions in the preoperative period, intraoperative factors (n=5, 16%), postoperative pain (n=3, 9%), and social factors (n=2, 6%). Among the 113 anticipated admissions, 78 (69%) patients were deemed necessary due to multi-factorial comorbid conditions or surgical complexity. However, 35 (31%) patients could have been optimized for same-day discharge;reasons for which included patients with comorbid conditions that could have been optimized preopera- tively, such as poorly controlled diabetes (n=13, 12%), system issues, (n= 8, 7%), social factors (n= 7, 6%), anesthesia-related (n= 4, 4%), and surgical complexity (n=3, 3%). [Formula presented] Conclusions: Most patients were successfully discharged the same day, and of those who were deemed unsuitable for same-day discharge, nearly half could have been optimized for same-day discharge. Unplanned admissions in the anticipated same-day discharge cohort were primarily due to anesthesia-related concerns in the immediate postoperative period and where patient comorbid conditions could have been better optimized in the preoperative period. Recognizing potential areas for improvement and further optimizing same-day discharge will allow hospital systems to continue providing care for gynecologic oncology patients during COVID-19 surges.

4.
Gynecologic Oncology ; 166:S252, 2022.
Article in English | EMBASE | ID: covidwho-2031759

ABSTRACT

Objectives: Financial toxicity (FT) impacts approximately 50% of patients with gynecologic malignancies. Still, little is known about factors that predispose patients receiving radiation therapy to financial distress or what impact the COVID-19 pandemic had on their financial well-being. We evaluated FT in patients with gynecologic cancer treated with radiation before and after the start of the COVID- 19 pandemic. Methods: Patients from an urban, academic gynecologic radiation oncology practice completed a survey one month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included demographic questions, the Comprehensive Score for Financial Toxicity (COST) tool, and the EQ-5D to measure the quality of life (QOL). Pandemic-related questions were added during the second survey period (pandemic cohort). As with our prior work, high FT was defined as a COST score of ≤23. We assessed the correlation of COST scores with QOL. We used logbinomial regression to examine associations between FT and costcoping strategies, adjusting for age and insurance. Results: Of 97 respondents (92% response rate), 49% completed the survey before, and 51% completed it after the pandemic started. Among the participants, 76% identified as White, 11% as Black, and 8% as Asian. Most patients had uterine (64%), followed by cervical (24%) and vaginal (6%) cancer. Two-thirds (60%) received external beam radiation with or without brachytherapy;the remaining 40% had brachytherapy alone. The median COST score was 15 (IQR: 7-19) in the high FT group (n=27) and 33 (IQR: 28-36) in the low FT group (n=70). High FT correlated with worse QOL (r=-0.37, p<0.01) and was associated with younger age and type of insurance (both p <0.03). Patients with high FT were more likely to move from full- to parttime employment (22% vs 1%, p<0.01), six (95% CI: 1.0-36) times more likely to delay/avoid medical care, 14 (95% CI: 3-64) times more likely to borrow money, and seven (95% CI: 2-27) times as likely to reduce spending on basic goods. Patients with high FT were more likely to report that decreased ability to work (48% vs 13%), medical bills (41% vs 13%), and transportation or parking (15% vs 3%) mostly contributed to their financial stress (p<0.05 for all). The pandemic cohort had fewer patients with high FT than the pre-pandemic cohort (20% vs 35%, p=0.10) and a higher median COST score (32 [IQR: 25-35] vs 27 [IQR: 19-34], p=0.07). The use of cost-coping strategies did not differ between cohorts. Conclusions: Privately insured, younger patients who received radiation for gynecologic cancer were at risk for FT. High FT correlated with worse QOL and was associated with delays or avoidance of medical care and other cost-coping strategies. The prevalence of high FT was not statistically different before and during the pandemic, though we observed less FT in the pandemic cohort. More work is needed regarding the impact of the COVID-19 pandemic on the financial well-being of patients with cancer.

5.
Gynecologic Oncology ; 166:S173-S174, 2022.
Article in English | EMBASE | ID: covidwho-2031757

ABSTRACT

Objectives: We aimed to better understand how treatment-related financial burden affects gynecologic cancer patients and identify targets for future interventions to reduce financial toxicity. Methods: Patients with invasive gynecologic cancer diagnoses were invited to participate in a qualitative focus group study. Each participant first completed an online, secure survey that included questions regarding diagnosis, mode of treatment, employment status, and income. The Comprehensive Score for Financial Toxicity (COST) tool was used to measure economic burden (COST score 0-44), with lower scores demonstrating worse financial toxicity. Each participant then took part in one of four virtual semi-structured focus groups through a secure video platform with a social worker and a study staff member. Three investigators independently analyzed the transcripts for common themes and reconciled disagreement through consensus. Results: Of the 13 participants, over 60% had private insurance, and 54% had moderate to high financial toxicity (COST scores <23). The five most commonly discussed themes included the extent of insurance coverage, out-of-pocket health expenses, changes in employment status, inefficient care coordination, and opportunity costs. Other themes that were discussed included stress associated with diagnosis, delays in care, confusion with medical bills, and impacts of COVID-19. Three participants suggested consolidation of bills to decrease obscurity with billing, and two attributed a slower recovery process to financial stress. Participants with worse financial toxicity (COST score <23) reported strain associated with opportunity costs, confusion with billing, and employment status changes more often than those with mild financial toxicity (COST score ≥23). Concerns about insurance coverage were universally reported, irrespective of participant financial toxicity score. Conclusions: Financial toxicity is an increasingly recognized obstacle for patients with gynecologic cancer, though efforts to alleviate patient burdens are lacking. The findings of this study suggest that patient-centered interventions to optimize insurance coverage and enhance care coordination could reduce financial toxicity. This is important given that both targets are potentially immediately actionable and could have downstream effects on health outcomes. Meanwhile, advocacy efforts to improve work leave policies and reduce out-of-pocket health expenditures through insurance reform are broader system-level interventions that also should be considered to curtail financial toxicity.

6.
Gynecologic Oncology ; 166:S156, 2022.
Article in English | EMBASE | ID: covidwho-2031755

ABSTRACT

Objectives: In light of the COVID-19 pandemic, the Society of Gynecologic Oncology (SGO), National Cancer Institute, and Food and Drug Administration published clinical practice statements encouraging the use of telemedicine in clinical trials, which had previously been prohibited. Our study aimed to assess the feasibility and safety of telehealth utilization in clinical trials for gynecologic malignancies. Methods: A retrospective cohort study was performed. Patients who were enrolled in a gynecologic oncology clinical trial at the University of Pennsylvania Health System from March 16, 2020, to August 30, 2020, were included. Receipt of care during the telehealth period (March 16, 2020, to August 30, 2020) was compared to the pre-telehealth period (September 30, 2019, to March 15, 2020). Pairwise comparisons of clinical trial outcomes were performed between the two time periods, using paired t-test, Wilcoxon signed-rank test, simple linear regression, Chi-square, and ANOVA. Results: Thirty-one patients met the inclusion criteria. The mean age was 63.7 years (SD 10.3);84% were non-Hispanic White. The median distance from home zip code to study center was 25.2 miles (IQR: 16-46, range: 1.9-170). Most patients had high-grade serous ovarian carcinoma (84%) and had the disease at an advanced stage (Stage III 48%, Stage IV 38.7%). Trial drugs included 22.6% (n=7) intravenous only, 29% (n=9) oral only, and 48.4% (n=15) combination oral/intravenous therapies. The median duration of enrollment was similar between pre-telehealth (5.2 months, IQR: 3.2-5.6) and telehealth periods (5.6 months, IQR: 3.8-5.6), (p=0.682). During the TELEHEALTH period, significantly more virtual provider visits (p <0.001) and remote laboratory testing (p=0.015) occurred, with similar rates of remote imaging (p=0.551). Delayed provider visits (p = 0.965), laboratory testing (p = 0.989) and imaging (p = 0.999) occurred infrequently in both timeframes. The number of patient touchpoints (portal messages and phone calls) per month did not increase (p = 0.147). Patients who lived farther from the study center were more likely to use remote imaging (p = 0.013);however, the distance was not associated with the use of virtual provider visits (p = 0.309) or remote laboratory testing (p = 0.821). Number of dose reductions (p = 0.112) and toxicity-related treatment delays (p = 0.888) were similar. Increased need for extra imaging was noted in the telehealth period (p=0.007) and was not associated with disease progression (p=0.614). Extra provider visits, emergency department visits, and hospital admissions were infrequent and similar in both timeframes (Table 1). The total number of deviations was increased (p=0.010);however, when adjusted for minor deviations documenting telehealth use or deferment of research-related laboratory testing given the pandemic precautions, there was no difference between timeframes (p = 0.468). The total number of adverse events and severe adverse events did not increase in the telehealth period (p=0.494 and p=0.601, respectively). Conclusions: Utilizing telehealth in clinical trials for gynecologic oncology patients did not increase clinical workload or adverse patient outcomes. Documentation of telehealth use and pause of research-related laboratory collections resulted in a higher number of protocol deviations during the telehealth period. Telehealth should be incorporated into future clinical trials as it appears safe and feasible and may facilitate access for remote, rural, and under-served populations.

7.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009628

ABSTRACT

Background: Some known viral infections can lead to a diagnosis of cancer (e.g: HPV, HIV, EBV, etc.) Anecdotical reports of a Covid 19 infection, and the subsequent diagnosis of a new cancer have been mentioned by few patients (pts). This relationship has not yet been fully documented. Covid 19 infected persons have been identified to have a suppressed adaptive immunity, which one of its principal functions is to maintain occult cancer cells in an equilibrium state. We studied the possible role of a Covid 19 infection and the subsequent diagnosis of a new primary cancer happening during the Covid pandemic (01/2020 - 12/2021). A survey was sent to all new members of Belong.life, a free and anonymous global cancer app for pts and their caregivers. This study took place prior to the omicron variant surge. Methods: 2579 Belong.life members received randomly, in the app various cancer groups, a 10 questions voluntary survey regarding the onset of a Covid 19 infection and the development of a subsequent new primary cancer diagnosis. 262 replied of whom 124 fulfilled the eligibility criteria and confirmed having had a Covid 19 infection followed by a new cancer diagnosis. Data on the 124 pts was analyzed by Belong analysts, according to age, sex, geographical distribution, Covid 19 infection onset and type and timing of the cancer diagnosis. Results: Most pts were USA based (102/124, 82%), and 1/3 were < 49 years, followed by a 1/3 in the 50-59 and > 60 groups. 71% (88/ 124) were females. All had a prior Covid 19 infection and only 14 (11%) required hospitalization. 109/124 (88%) had a primary cancer diagnosis and 15 (12%) had disease recurrence. Breast cancer was diagnosed in 38% (47/124), followed by lung and gynecological cancers (10/124, 8% respectively). Time from Covid 19 infection to primary cancer diagnosis was < 6 months in 57 /124 (46%) and 6-12 months in 40/124 (32%). Breast cancer developed earlier (< 12 months) in 87% of the pts. In total 97/124 (78%) pts had their disease diagnosed within less than a year. Conclusions: Known viruses might precede the onset of a new cancer. The role of corona viruses and subsequent development of a cancer is unknown. Adaptive immunity maintains occult cancer cells in a steady state, while a Covid 19 infection interferes with it, causing a weak and delayed immune response, which could be responsible, after a period, for the onset of a new primary cancer. We are presenting RWD on 124 pts with new primary cancers diagnosed after a Covid 19 infection. This represents a 5% incidence in a random pts group (124/2579) as described above. Further studies should be planned to investigate this real world increased incidence and testing of the diverse immune parameters are also warranted to further understand the intersection pathways of Covid 19 infection and cancer development.

8.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009577

ABSTRACT

Background: The COVID-19 pandemic rapidly altered cancer care delivery globally, providing a compelling opportunity to empirically study how these changes impacted persistent disparities in care. Cervical cancer is one of the most common female cancers worldwide, with approximately 90% of cases and deaths occurring in low- and middle-income countries (LMICs). In Botswana, a LMIC with a particularly high prevalence of HIV and cervical cancer, delays in cervical cancer diagnosis and treatment have been documented but is unknown how these delays may have been mitigated or exacerbated since the pandemic. Methods: The objective of this analysis is to evaluate patterns of cervical cancer diagnosis and treatment initiation before (January 2015-March 2020) and during the pandemic (April 2020-July 2021) using longitudinal clinical and patient-reported data from a cohort of over 1,000 patients receiving care for gynecologic cancers in Botswana. The primary outcome is timeliness of treatment defined by the number of days between first clinical visit and initiation of first-line treatment and categorized dichotomously (> 30 days classified as delay). Primary exposure is the time period (prepandemic and pandemic) defined by the month of first visit. We calculated unadjusted proportion of delays and covariates stratified by time period and used bivariate analysis to examine factors associated with each time period. We used multivariable logistic regression models to examine the association between delay and time period, adjusting for all covariates (age, stage, HIV status, rurality, screening history, and partner status). Results are presented as unadjusted proportions, adjusted odds ratios (AOR), and 95% confidence intervals. Results: Of the 1,200 patients treated for cervical cancer at the multidisciplinary clinic, 990 (82.5%) were diagnosed pre-pandemic and 210 (17.5%) during the pandemic. Among all patients with gynecologic cancers (n = 1,568), the proportion of patients with cervical cancer significantly decreased from 78.6% pre-pandemic to 68.0% during the pandemic (p < 0.001). In comparison to pre-pandemic, patients with cervical cancer during the pandemic were significantly less likely to have attended a screening clinic prior to their treatment (57.6% vs 15.3%;p < 0.001) and significantly more likely to experience treatment delays (61.6% vs 92.9%;p < 0.001). In the multivariable model, patients diagnosed during the pandemic had a 7-fold higher likelihood of treatment delays than those patients diagnosed pre-pandemic (AOR: 7.95;95% CI: 4.45-14.19). Conclusions: The pandemic significantly increased delays in treatment for nearly all patients with cervical cancer in Botswana. Given persistent global disparities in cervical cancer, there is a great need to implement evidence-based strategies for improving screening and timeliness of care in Botswana and other LMICs.

9.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009564

ABSTRACT

Background: Social media platforms such as Twitter are highly utilized to communicate about cancer care. Although surgery is the primary treatment for solid malignancies, little is known about public perceptions or communication behaviors regarding this treatment modality. Further, prolonged lockdowns and widespread delays of planned operations during the COVID-19 pandemic have magnified the importance of virtual communication about surgical cancer care. Methods: Tweets referencing cancer surgery were collected from January 2018 to January 2022 using Twitter's Application Programming Interface. Account metadata was used to predict user demographic information and to compare tweeting metrics across users. Natural language processing models were applied to tweet content to resolve common topics of conversation and to classify tweets by cancer type. Results: There were 442,840 original tweets about cancer surgery by 262,168 users. Individuals accounted for most users (65%) while influencers accounted for the least (1.4%). Influencers made the most median impressions (19,139). Of 240,713 tweets discussing surgery for specific cancers, breast (20%) and neurologic (17%) cancers were most mentioned. When adjusting for national rates of procedures performed, tweets about surgery for neurologic cancers were the most common (231 tweets per 1000 procedures) whereas those for urologic cancers were the least common (15 tweets per 1000 procedures). Discussions about cancer surgery research made up 31% of tweets before the pandemic but only 11% of tweets during the pandemic. During the pandemic, concern regarding COVID-19 related delays was the most tweeted topic (23%). Cancer surgery research was most cited by oncologists, as well as in tweets about hepatopancreatobiliary and colorectal cancers. The cost of surgery was commonly mentioned in tweets about breast and gynecologic cancers and contained the most negative sentiment score (-0.7). Conclusions: Twitter was highly utilized to discuss surgical cancer care during the COVID- 19 pandemic. During the pandemic, conversations shifted focus from research to survivorship and reflected real-time events such as COVID-19-related surgical delays. We identified the financial burden of cancer care as a commonly held concern among patients discussing cancer surgery on social media. Future public health outreach about cancer surgery may be optimized by coordinating with influencers and by targeting topics of concern like cost of surgery and undermentioned content like urologic cancers. Twitter's role as a platform for research dissemination was disrupted by the COVID-19 pandemic, and further tracking is needed regarding online research discussions after the pandemic.

10.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005675

ABSTRACT

Background: The National Cancer Institute (NCI) estimates that approximately one-quarter of adults with cancer are parents to children less than 18 years. Further, it is estimated that 2.85 million minor children in the United States have a parent undergoing cancer treatment. Previous studies have demonstrated that parents with cancer experience significant stress and disruptions to familial life following a cancer diagnosis. In a study of women with breast, gynecologic cancer and other cancers undergoing cancer therapy, 48.7% of women endorsed needing help with childcare and 64.1% needing help with household management. Despite this evidence supporting both a need for childcare among patients with cancer, data regarding the availability of on-site childcare programs and resources at NCI-designated cancer centers is limited. The objective of this cross-sectional study was to assess the availability of childcare resources for parents who are undergoing cancer treatment at NCI-Designated Cancer Centers. Methods: The availability of childcare resources for parents undergoing cancer treatment at all 51 NCI-designated comprehensive cancer centers and 13 NCI-designated cancer was assessed in January 2021 and February 2021. Childcare resources were assessed via online search and telephone calls. Specifically, centers were queried regarding availability of daycare programs for children of patients undergoing treatment and whether resources were available to assist patients in need of childcare. Descriptive statistics were performed. Results: In total, only 1/64 (1.6%) of NCI-designated cancer centers currently offer childcare resources for patients undergoing cancer treatment. This center offers childcare for children ages 2-8, free of charge with multiple outpatient locations. One additional institution previously provided patients with access to daycare, but has closed due to the COVID-19 pandemic. Further, only 1/64 (1.6%) NCI-designated cancer center offers financial assistance grants to aid patients to subsidizing childcare costs during cancer treatment. Conclusions: Institution sponsored options for childcare for patients undergoing cancer treatments are highly limited, even in the best resourced cancer care settings. The COVID-19 pandemic has limited options further, and many hospitals now restrict visitors under the age of 18. Patient grants or institutionally sponsored childcare provider networks may represent an avenue for supporting parents who are facing a cancer diagnosis. Supporting families of patients with cancer has great potential to impact quality of life, economic and psychological stress.

11.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005660

ABSTRACT

Background: Limited information exists regarding the severity of short-term outcomes among patients with gynecologic cancer who are infected with SARS-CoV-2. Methods: Patients with gynecologic cancer and laboratory confirmed SARS-CoV-2 infection were identified from the international CCC19 registry. We estimated odds ratios (OR) from ordinal logistic regression for associations with severity of COVID-19 outcomes, defined from least to most severe as hospitalization, intensive care unit (ICU) admittance, mechanical ventilation, and 30-day mortality. Results: Of 842 patients identified, 48% had endometrial cancer, 24% had ovarian cancer, 22% had cervical cancer, and 6% had dual primary/other gynecologic cancers. The majority were from the United States (86%), most were non-Hispanic White (46%), and the median age was 62 years (IQR 52-72). The majority were diagnosed with localized disease (68%);only 18 (2%) and 15 (2%) were fully or partially vaccinated, respectively. In the 3 months prior to COVID-19, 36% had any cancer treatment, with chemotherapy the most common (23%). When diagnosed with COVID-19, most patients were in remission (50%), while 37% had active disease, including 22% with metastatic disease. Most patients presented with typical COVID-19 symptoms (76%);few had a poor ECOG performance status (PS ≥2, 14%). Outcomes included hospitalization (50%), ICU admittance (12%), mechanical ventilation (8%), and death within 30 days of testing positive for SARS-CoV-2 (10%). In unadjusted models, increasing age (OR: 1.03 1.02-1.04) and Black race (OR 1.91, 1.31-2.77) were associated with increased severity of COVID-19 outcomes. Compared to patients in remission for ≥5 years, those with progressive disease had increased severity (OR 1.88, 1.25-2.82), while those in remission for < 5 years or with stable disease had decreased severity of COVID-19 outcomes (OR 0.55, 0.39-0.76). In multivariable models that included adjustment for age, race, and cancer status, additional factors associated with increased COVID-19 outcome severity included cardiac (OR 1.57, 1.13-2.19) and renal (OR 2.00, 1.33-3.00) comorbidities, an ECOG PS ≥2 (OR 5.15, 3.21-8.27), having pneumonia or pneumonitis (OR 4.08, 2.94-5.66), venous thromboembolism (OR 4.67, 2.49-8.75), sepsis (OR 14.2, 9.05-22.1), or a co-infection within ±2 weeks of SARS-CoV-2 (OR: 4.40, 2.91-6.65);asymptomatic SARS-CoV-2 infection was associated with decreased severity of outcomes (OR: 0.25, 0.16-0.38). The overall case fatality rate was 15.7%. Conclusions: Patients with gynecologic cancer experience significant morbidity and mortality related to infection with SARS-CoV-2. Age, race, cancer status, co-morbidities, and COVID-19 complications were associated with more severe COVID-19 outcomes, along the continuum from least to most, of hospitalization, ICU admittance, mechanical ventilation, and 30-day mortality.

12.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005646

ABSTRACT

Background: Telemedicine rapidly increased with the COVID-19 pandemic and may be a way to reduce care disparities. Our aim was to evaluate sociodemographic (race, insurance), patient, health system, and cancer factors associated with use of telemedicine in gynecologic cancers. Methods: We conducted a retrospective cohort study of patients with documented endometrial or ovarian cancer using the nationwide de-identified electronic health record-derived Flatiron Health data. We used multi-level regression models to analyze the association of telemedicine usage during COVID-19 pandemic (2020- 2021) with sociodemographic, patient, health system, and cancer factors overall. Results: Of 13,450 patients with endometrial or ovarian cancer, 14.4 % (95%CI 14.0-16.1) used telemedicine during COVID-19 for their cancer care within the Flatiron Health network. Insurance was not associated with likelihood of telemedicine in any model. Region was significantly associated with telemedicine usage across models with patients living in the Northeast more likely to use telemedicine. Conclusions: In this large cohort study, we found regional disparities across cancer types and oncology settings. Expanding access to telemedicine may improve racial and geographic disparities in gynecologic cancer. (Table Presented).

13.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816900

ABSTRACT

Introduction: The aim of this study was to evaluate the impact of COVID-19 on pathological diagnoses of cancer in Northern Ireland, and assess potential inequalities across subgroups of the population. Methods: Data from the four Northern Ireland pathology labs were used to assess trends in pathological cancer diagnoses from 1st March to 12th September 2020 overall and by cancer site, gender and age. These trends were compared to the same timeframe from 2017-2019. Results: Between 1st March and 12th September 2020 there was a 23% reduction in cancer diagnoses compared to the same time period in the preceding three years. Although some recovery occurred in August and September 2020, this revealed inequalities across certain patient groups. Pathological diagnoses of lung, prostate and gynaecological malignancies remained well below pre-pandemic levels. Males and younger/middle-aged adults, particularly the 50-59 year old patient group, also lagged behind other population demographic groups in terms of returning to expected numbers of pathological cancer diagnoses. Conclusions: There is a critical need to protect cancer diagnostic services in the ongoing pandemic to facilitate timely investigation of potential cancer cases. Targeted public health campaigns may be needed to reduce emerging inequalities in cancer diagnoses as the COVID-19 pandemic continues.

14.
Anaesthesia ; 77(SUPPL 2):28, 2022.
Article in English | EMBASE | ID: covidwho-1666288

ABSTRACT

Methods We planned to introduce the Penthrox® methoxyflurane inhaler device into brachytherapy and started prospectively collecting peri-procedure pain scores (using the 10-point visual analogue scale) whilst the processes of training and drug approval were completed. After which, peri-procedure pain scores were collected prospectively. We also recorded drug idiosyncrasies and patient feedback. Results Data were collected before introducing Penthrox from 10 patients and from 16 patients after introduction. Pre-Penthrox pain scores during needle removal demonstrated a mean score of 8/10, despite pre-procedure administration of intravenous analgesia including morphine. The mean pain score with Penthrox and without any other analgesia was 0.6/10. Penthrox has been well tolerated with patients reporting few adverse side effects. Discussion Pre-COVID-19, patients attending our brachytherapy suite for gynaecological malignancy would have sufficient analgesia for needle insertion and removal with a single-shot intrathecal anaesthetic. The pandemic necessitated the decision to administer two treatments within 1 day, reducing the need to attend hospital on multiple separate visits. This meant the intrathecal analgesia would be less effective by the time of needle removal, thus necessitating other methods of analgesia for the procedure. This included intravenous morphine, Entonox® and, at times, midazolam. Using Penthrox to reduce pain during needle removal was discussed and, following local approval, was introduced to brachytherapy. Penthrox (methroxyflurane) is a halogenated ether with a UK license for emergency relief of moderate to severe pain in adult patients with trauma. It provides generally well-tolerated analgesia, which may negate the need for procedural sedation. Associated potential risks are nephrotoxicity, hepatotoxicity and it is an enzyme inducer. It is well tolerated in suitable patients [1]. The introduction of Penthrox to the brachytherapy service has been successful in significantly reducing the reported pain scores during removal of needles. This has in turn improved procedural conditions through providing a calmer atmosphere in theatre and better operating conditions for the oncologists. Patient satisfaction was also high. To our knowledge, this is the first time Penthrox has been used for this indication outside Australasia.

15.
International Journal of Gynecological Cancer ; 31(SUPPL 1):A157-A158, 2021.
Article in English | EMBASE | ID: covidwho-1583065

ABSTRACT

Introduction/Background :After WHO declared Covid-19 as a pandemic, many scientific organizations, including gynecological oncology and gynecological surgery associations, made new recommendations for treatment protocols for certain diseases. Gynecological cancer surgery could not be performed in many hospitals and medical centers , as they could not provide optiamal conditions for their patients and staff. In this process, our hospital, which was a comprehensive cancer center, was defined as Covid-19 free hospital and established as a reference for other institutions regarding priority oncological surgeries by the regional healthcare authorities. Methodology The data of the patients who were operated with the diagnosis of gynecological cancer between March 1, 2020 and March 1, 2021 were scanned through files. Demographics, comorbidities, surgical type, complications and COVID-19 status were reviewed. Statistical analyzes were performed using the SPSS 22.0 (Statistical Program Social Sciences) package program. The study was approved by the ethical committee the Institutional Review Board of Dr. AY Ankara Oncology Training and Research Hospital and the Ministry of Health Scientific Research Platform. Result(s) The study included a total of 74 patients. Mean age was 58 years (range 16-85). Patients were referred with endometrial (32/74, 43,2%), ovarian (36/74, 48,6%), cervical (5/74, 6,8%), or vulvar cancer (1/74, 1,4). All of the patients underwent open-route laparotomy. Mean hospital stay was 12 days (range 6-51). 13 patients had a postoperative complication (13/74, 17,6%). 8 patients tested positive for COVID-19 following a Polymerase Chain Reaction(PCR) test, in the postoperative period, after discharge . PCR test for detection of severe acute respiratory syndrome coronavirus 2 (SARS-COV- 2) was conducted in 73%. The Covid-19 PCR test has been routinely applied 48 hours before the operation, according to the guidelines published by health authorities since June 2021. Conclusion There is no 'one size fits all' approach to cancer treatment during the COVID-19 pandemic, and there are no international guidelines. Screening and treatment decisions should often be made on a case-by-case basis and often depend on the COVID-19 situation in a single community and the availability of resources. Our study results shows that it can be done safely, even in the pandemic, when strict adherence to Covid 19 precautions for both patients and healthcare workers.

16.
International Journal of Gynecological Cancer ; 31(SUPPL 1):A176, 2021.
Article in English | EMBASE | ID: covidwho-1583060

ABSTRACT

Introduction/Background India experienced a deadly second wave of COVID-19 pandemic starting mid-February 2021 with test positivity rate of 25-45 % suggesting high community transmission. Indian COVID-19 vaccination program for 60 years + and above 45 years with co-morbidities began on 1st March 2021. As per COVIDsurg collaborative data, between 0.6% and 1.6% of patients develop COVID-19 infection after elective surgery. Even after use of mitigation measures like pre-surgery RT/PCR and COVID free surgical pathways, COVID-19 is a significant nosocomial infection with 4- and 8-fold increased risk of death in the 30 days following surgery. Our aim was to study vaccine compliance in patients counselled to be vaccinated before surgery, pre-surgery RT/PCR positivity rate, 30-day post-operative SARS Cov-2 rate and peri-operative outcomes. Methodology In this prospective observational study, patients waitlisted for major gynaecological cancer surgeries who were also eligible for COVID-19 vaccination were enrolled. Patients were counselled to get atleast one dose vaccinated 2 weeks before elective surgery. In cases of neo-adjuvant chemotherapy, vaccination was advised atleast 2 weeks after the last dose of chemotherapy. Patients vaccinated with atleast 1 dose - 2 weeks prior to surgery or those with both doses vaccinated atleast a week prior to surgery were eligible for study. Mitigation measures of negative pre-surgery RT/PCR (within 24 hours prior to surgery) and COVID free surgical pathway were used. Result(s) In the overall cohort of 53 patients, 34 got vaccinated suggesting compliance of 64%. In the unvaccinated cohort, 52.6% were pře-surgery RT/PCR +ve against 5.8% vaccinated patients (p = 0.0001). Thirty- day post-operative SARS Cov-2 rate was 44.4% and 0% in the unvaccinated and vaccinated cohort respectively (p = 0.0001). No cases of severe COVID-19 requiring hospitalisation were seen in the vaccinated cohort. There was no 30-day post-operative mortality in either cohorts. Conclusion Counselling regarding COVID-19 vaccination prior to surgery should be an essential part of pre-operative work up. COVID-19 vaccination prior to surgery has two-fold advantage. It prevents the postponement of elective cancer surgeries which are time bound. There is a significant decreased risk of severe COVID-19 infection and related morbidity post-operatively in the vaccinated population. (Figure Presented).

17.
Tumori ; 107(2 SUPPL):75, 2021.
Article in English | EMBASE | ID: covidwho-1571613

ABSTRACT

Background: Vaccination against SARS-CoV-2 could be an important preventive strategy against COVID-19 for cancer patients (pts), but its efficacy and safety in these pts is largely unknown. Herein, we report the development of neutralizing antibodies (NAbs) against SARS-CoV-2 in cancer pts after the 1st dose of the mRNA-1273 vaccine. Patients and methods: A cohort of pts with solid tumors from IRCCS MultiMedica and San Giuseppe Hospital, Milan, were enrolled in the VITTORIA (VaccInazione anTi-COVID-19, moniTORaggio Della rIsposta Anticorpale) project, a prospective observational cohort study, conducted by IRCCS MultiMedica, designed to investigate trend of immunoglobulin G (IgG) in serum samples of volunteers who undergo anti-COVID vaccination in Italy. Seroprevalence was assessed through TGS COVID-19 IgG chemiluminescent immunoassays. Cut-off for positivity was defined as >11.5 AU/ml. These pts are vaccinated with mRNA-1273 vaccine and undergo to a maximum of 4 IgG evaluations during time: at the 1st and 2nd vaccine administration and after 2 weeks from each administration. In this preliminary analysis, we evaluated median values (range interquartile (IQR)) of IgG during the first 3 time points and we assessed trend with non-parametric Sign test for dependent samples. Results: 61 pts were enrolled in April 2021. 68.9% were females with a mean age of 63.7?}10.5 yrs. 28 have breast cancer, 7 lung, 15 gastrointestinal, 3 prostate, 2 kidney, 2 head and neck, 4 gynecological cancer. 44.3% were on chemotherapy (CT), while 55.7% on non-CT treatment (i.e target or immunotherapy). Median baseline IgG value was 0.0 AU/ml (IQR 0.0-0.0) and it statistically increased after 2 weeks (4.4 AU/ml, IQR 0.0-14.9, p<0.0001). At 2nd dose, IgG was available until today for 42 pts (68.9%) and the median value was 12.5 AU/ml (IQR 5.4-38.9, p<0.0001). 34.4% had positive IgG value 2 weeks after the 1st dose and 52.4% at 2nd dose. IgG value increases independently from treatment (CT vs non-CT), steroid use and tumor subtype, with a trend towards positivity for non- CT treatment (p=0.067). No serious adverse events vaccine- related were reported and no COVID-19 infection occurs after 1st dose. Conclusions: Our preliminary data indicate that the first dose of mRNA-1273 vaccine leads to initial production of NAbs against SARS-CoV-2 in a cohort of cancer pts. Enrollment is still ongoing and future analysis will be performed to assess the increase and duration of NAbs in pts with solid tumors.

18.
International Journal of Gynecological Cancer ; 31(SUPPL 4):A97, 2021.
Article in English | EMBASE | ID: covidwho-1554392

ABSTRACT

Objectives The spread of COVID-19 pandemic changed the approach in the management of neoplasms. Telemedicine was one of the tools we experienced to maintain the continuity of care for the patients. Our goal is to evaluate the impact of telemedicine in patients management during follow up visits and its emotional impact. Methods We enrolled 79 women with gynecological cancer. SUTAQ questionnaire was used to highlight patients perception about telemedicine. The questionnaire consists of 22 items divided into different subscales: 'Enhanced care'(EC), 'Satisfaction' (ST), 'Privacy and Discomfort'(PD), 'Care personnel concerns' (CPC), ' Increased accessibility' (IA) and ' Telemedicine as a Substitution' (TMS) scales Results Enrolled women had a mean age of 55 years (35 women ≤ 55 years and 44 women ≥ 55 years). The majority of them (61.54%;n=48) achieved a high school diploma or higher while (n=30) had a low educational level (middle school or lower);87.3% (n=69) were employed and 70.89% (n=56) lived with their partner. Younger women had a better perception towards telemedicine for TMS (mean=3.68) compared to older ones (mean=3.05). The difference was statistically significant (p=0.025). The PD subscale was in favor of higher educated women (mean=2.57) compared to lower educated ones (mean=3.28;p=0.042). No significant differences were observed between intensive and non intensive treatment. EC, ST, IA, and PD reached good responsiveness towards telemedicine, irrespectively of care level. Conclusions Telemedicine has been a well-evaluated tool, not only among younger and higher educated women but even by women needing intensive care.

19.
International Journal of Gynecological Cancer ; 31(SUPPL 4):A95, 2021.
Article in English | EMBASE | ID: covidwho-1554073

ABSTRACT

Objectives The COVID-19 pandemic has significantly disrupted medical care. The purpose of this analysis was to determine the impact of the pandemic on gynecologic cancer appointment adherence. Methods All appointments scheduled at an academic gynecologic oncology center from March 2019 to January 2021 were included. Appointments were stratified into two groups - pre-pandemic (March '19 to January '20) and pandemic (March '20 to January '21). Appointments were determined 'missed' if the patient did not show or cancelled. A multivariable logistic regression was performed to determine the odds ratio (OR) of appointment adherence during the pandemic. Results 31,803 appointments were scheduled during the study period (15,834 (49.8%) pre-pandemic and 15,969 (50.2%) during the pandemic). There were significantly more appointments missed during the pandemic than prepandemic - 7266 (45.5%) vs. 6131 (38.7%);p<.0001. The adjusted odds of missing an appointment were significantly higher during the pandemic (OR 1.43 [95% CI 1.36 to 1.51];p<0.0001). There were more return visits missed during the pandemic than before - 6696 (47.0%) vs 5341 (39.5%);p<0.0001. New-patient visit adherence was unchanged. Race, ethnicity, and income were not associated with missed appointments. Conclusions There were increased odds of missing an appointment during the pandemic than during the year prior. This association was mostly explained by return visits as new patient visit adherence was not impacted by the pandemic. Initiatives should be undertaken to determine the effects of pandemic- induced appointment nonadherence.

20.
International Journal of Gynecological Cancer ; 31(SUPPL 4):A95-A96, 2021.
Article in English | EMBASE | ID: covidwho-1554025

ABSTRACT

Objectives COVID-19 pandemic has affected the systems in all hospitals and non-essential elective surgeries were deferred. In this retrospective study we have evaluated results and complications of gynaecological cancer surgeries in a tertiary care hospital during the first 9 months of covid pandemic in our country. Methods We retrospectively analyzed the medical charts of patients who underwent these surgeries from March-December, 2020. Results The study included 116 patients, 48 endometrial, 50 ovarian, 14 cervical and 4 vulval &vaginal cancers. Majority of cancers were early stage (64%). The median age was 58 years (range 22-85years). Surgical approach was laparotomy in 77.6% including 48% complex surgeries. Based on the BGCS framework for prioritization of these surgeries, most of our surgeries belong to priority level 2(89%) and 3(11%). COVID verbal screening (by a questionnaire) was done in 90% of patients starting in Mid-March. Formal COVID testing by PCR for all pre-operative patients was commenced in April and hence 89(77%) of all patients underwent this testing. Only 2 patients were found COVID positive and the surgery was deferred for 4 weeks. Complications based on Clavien- Dindo grade 1, grade 4a and grade 5 were observed in 4 patients. Median hospital stay was 5 days. Out of 12 patients with clinical suspicion of COVID within 30 days of surgery 3 were found to be covid positive, including one requiring ICU admission. Conclusions The results show that with adequate preventive measures cancer surgeries can be performed with low risk of severe complications and post-surgical COVID positivity.

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