Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 37
Filter
1.
NeuroQuantology ; 20(10):7029-7035, 2022.
Article in English | EMBASE | ID: covidwho-2067310

ABSTRACT

Period poverty is defined as lack of access to hygiene products, financial constraints and difficulties in disposing of menstrual management waste materials. The outbreak of COVID-19 that hit the world is now adding more difficulties to people in Malaysian society who are affected in terms of menstrual management. Period poverty has put pressure on the urban poor especially during the spread of the COVID-19 pandemic over the past two years, forcing many women to put aside the desire to buy sanitary products because they have to prioritize other necessities. This study aims to identify the problems of period poverty occurring among the urban poor in Malaysia during the pandemic. As a literature highlight review, the approach of this research is qualitative using the method of document analysis. The research finds that period poverty has hit the urban poor badly during this ongoing pandemic and it invites health problems when old papers and newspapers are used as sanitary pads such as urinary tract and perinatal infections.

2.
World Journal of Traditional Chinese Medicine ; 8(4):463-490, 2022.
Article in English | EMBASE | ID: covidwho-2066828

ABSTRACT

Curcumae Longae Rhizoma (CLR) is the rhizome of Curcuma longa L. Pharmacological studies show that CLR can be used to treat cervical cancer, lung cancer, lupus nephritis, and other conditions. In this paper, we review botany, traditional application, phytochemistry, pharmacological activity, and pharmacokinetics of CLR. The literature from 1981 to date was entirely collected from online databases, such as Web of Science, Google Scholar, China Academic Journals full-text database (CNKI), Wiley, Springer, PubMed, and ScienceDirect. The data were also obtained from ancient books, theses and dissertations, and Flora Reipublicae Popularis Sinicae. There are a total of 275 compounds that have been isolated from CLR, including phenolic compounds, volatile oils, and others. The therapeutic effect of turmeric has been expanded from breaking blood and activating qi in the traditional sense to antitumor, anti-inflammatory, antioxidation, neuroprotection, antibacterial, hypolipidemic effects, and other benefits. However, the active ingredients and mechanisms of action related to relieving disease remain ill defined, which requires more in-depth research and verification at a clinical level.

3.
Chest ; 162(4):A1304, 2022.
Article in English | EMBASE | ID: covidwho-2060800

ABSTRACT

SESSION TITLE: Difficult Diffuse Lung Disease SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Common Variable Immunodeficiency (CVID) is one of the most common humoral immunodeficiency disorders and usually manifests as infectious complications. However, noninfectious complications such Granulomatous-Lymphocytic Interstitial Lung Disease (GLILD) can convey a much poorer prognosis in patients with CVID. In this case report, we present a patient with GLILD who presented with cough and shortness of breath. CASE PRESENTATION: A 66 year old female with past medical history of provoked DVT (off anticoagulation), cervical cancer (s/p resection) presented to pulmonology clinic with complaints of chronic cough and shortness of breath on exertion. She had a negative smoking history and no occupational exposures. She was up to date on vaccinations and COVID was negative. Vitals were stable and physical exam was normal including clear breath sounds. CXR revealed emphysema and hazy opacities in the lung bases. PFTs demonstrated moderate obstructive pattern with no response to bronchodilator, normal lung volumes, and DLCO of 76%. Due to lack of improvement in her cough, CT Chest was done which revealed diffuse pulmonary nodules, bronchiectasis with possible atelectasis or scarring in the RML and lingula, and a prominent subcarinal lymph node. EBUS TBNA of station 7 returned negative for malignancy. Culture showed polymicrobial growth with negative AFB and fungi. Patient was treated without antibiotics, but due to family history of immunodeficiency, immunoglobulin panel was sent which returned low IgG subclasses. She then received IVIG. However, given the centrilobular nodules and lack of response to IVIG, repeat bronchoscopy with TBBx and BAL was performed. BAL revealed lymphocytic predominance and tissue biopsy showed non-caseating granulomas and negative cultures. Eventually patient was diagnosed with GLILD and started on 6 weeks of prednisone 40 mg daily along with PJP prophylaxis. However, her symptoms remained same and rituximab was prescribed with improvement in the symptoms. DISCUSSION: Although recurrent sinopulmonary infections are common in CVID patients, if clinical response to IVIG is minimal to none, GLILD should be considered on the differential. Centrilobular nodules and ground glass opacities should raise suspicion of GLILD and tissue sample should be obtained in these patients to confirm the diagnosis. Appropriate treatment with prednisone or rituximab along with IVIG improves GLILD patient symptoms and yields better outcomes in terms of morbidity and quality of life. CONCLUSIONS: Appropriate treatment with prednisone or rituximab along with IVIG improves GLILD patient symptoms and yields better outcomes in terms of morbidity and quality of life. Reference #1: Hurst JR, Verma N, Lowe D, Baxendale HE, Jolles S, Kelleher P, et al. British lung foundation/United Kingdom primary immunodeficiency network consensus statement on the definition, diagnosis, and management of granulomatous-lymphocytic interstitial lung disease in common variable immunodeficiency disorders. J Allergy Clin Immunol Pract. (2017) 5:938– 45. doi: 10.1016/j.jaip.2017.01.021 DISCLOSURES: No relevant relationships by Benjamin Butler No relevant relationships by Abdulmetin Dursun No relevant relationships by Badri Giri No relevant relationships by Emily Smallwood

4.
Australian Journal of Primary Health ; 28(4):xlix, 2022.
Article in English | EMBASE | ID: covidwho-2058330

ABSTRACT

Background: While the UK's Royal College of General Practitioners developed guidance concerning the delivery of essential services during the COVID pandemic, no such guidance was available in Australia and little is known about the experiences or approaches taken by general practitioners (GPs) for the delivery of care in Australia. Aims/Objectives: To describe GPs' experiences and approaches to delivering essential clinical services (ECS) during COVID lockdowns. Method(s): A survey of GPs who had practiced during lockdowns in Melbourne and Sydney. Questions focused on changes made to care delivery including what services were continued: (1) regardless of outbreak scale, (2) if capacity allowed, or (3) postponed. Finding(s): Of 274 completed surveys, 95% of participants reported increased use of telehealth for diagnosis, investigation, and management of clinical conditions, and 97% for follow-up. Time-sensitive services such as provision of care for symptoms consistent with cancer or those with immediate health impact (e.g., immunisations, prolia injections) were generally continued even if requiring face-to face delivery. Consultations involving screening or health assessments or those necessitating face-to-face care but not clinically urgent (e.g., low risk cervical cancer screening and IUD insertions), were more likely to be postponed, as were visits to homebound and nursing home patients. Implications: The almost universal uptake of telehealth by GPs supported continuity of service provision during lockdown. Australian GPs acted autonomously to triage and provide ECS face to face through the lockdowns. To optimise future preparedness, local guidance for safe delivery of ECS must be developed considering contextual factors relevant to the Australian primary healthcare system.

5.
Australian Journal of Primary Health ; 28(4):xxii-xxiii, 2022.
Article in English | EMBASE | ID: covidwho-2057968

ABSTRACT

Background: Primary health care nurses (PHCNs) deliver women's sexual and reproductive health (SRH) services, and telehealth services are within their scope of practice. Despite the WHO resolution about eHealth in 2005 and increased use of telehealth during COVID-19, the extent to which PHC nurses have used telehealth technology to deliver SRH care in the international literature is not clear. Aim/Objectives: To explore how telehealth is used by PHCNs in the delivery of women's SRH care. Method(s): A scoping review of peer-reviewed primary research papers was undertaken following a Joanna Briggs Institute approach. Seven databases were searched including papers from 2005-December 2021 and published in English language. A grey literature search was used to identify current national or international policy or strategy documents about nurse roles in telehealth. Extracted data were then entered in NVivo and conceptual categories were mapped from descriptive summaries. Finding(s): Our database search yielded 745 papers and of these, eight papers met our inclusion criteria and were included in the review. The search of grey literature yielded 21 documents that met our inclusion criteria. Papers were largely from the United Kingdom (n=5), part of interventional trials (n=5) or used synchronous telehealth methods (n=5). Papers about patient perspectives described acceptability of SRH telehealth services (n=4). Grey literature revealed policy support for telehealth implementation as an approach to improving patient-centred care, were largely from the northern hemisphere (n=15) or outlined case studies of nurse use of telehealth (n=11). From all included documents, SRH care most commonly addressed pregnancy (n=6), cervical cancer screening (n=4), sexual health (n=3), and abortion (n=2). Implications: Evidence about the use of telehealth by PHCNs for SRH care is lacking. Opportunities exist to address women's health policy and service gaps, and better describe and optimise PHCN involvement in telehealth care.

6.
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.

7.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009610

ABSTRACT

Background: Cancer incidence has increased among adolescents and young adults (AYA) over the last two decades. Younger patients often present with late diagnosis, aggressive disease, and are more likely to receive chemotherapy during cancer treatment. We investigated admission outcomes and postdischarge survival of AYA who were hospitalized after urgent admission. Methods: Retrospective cohort of patients with solid tumor diagnosis and age between 18 and 39 years, hospitalized after urgent admission to a tertiary, publicly-funded, cancer hospital in São Paulo, Brazil, from February 1st to December 31th 2021. We excluded patients with positive COVID-19 RT-PCR. We collected data on gender, cancer diagnosis, length of hospital stay, in-hospital mortality, chemotherapy infusion either before and during hospitalization;and last-follow up date and status. AYA admissions were compared to older adults (≥ 40 years [non-AYA]) admissions with chi-squared test. Overall survival (OS) after discharge between groups was analyzed with the log-rank test. Results: Of 4011 admissions, 312 were AYA. The median age was 34 (IQR 29-38) and most patients were female (63%). Compared to older adults (N = 3699), a higher proportion of AYA patients had breast cancer (25% vs 15%), central nervous system cancer (8.4% vs 2.6%), cervical cancer (12% vs 2.7%) and germinative cancer (4.5% vs 0.3%). The median length of hospital stay was 6 days (IQR 4-10). AYA were more likely to be under chemotherapy treatment during (11% versus 4%, p = 0.001) and within 30 days before hospitalization (32% vs 20%, p = 0.001). The overall in-hospital mortality rate was lower among AYA compared to older adults during the same period (12% vs 20%, p = 0.01). However, of those who died, a higher proportion were prescribed chemotherapy infusion before (38% vs 19%, p = 0.004) and during (15% vs 3.3%, p = 0.003) hospitalization;and a higher number of patients deceased on intensive-care unit beds, although the difference was not statistically significant (46% versus 36%, p = 0.2). Despite similar rates of 30-days readmissions (29% versus 26%, p = 0.3), AYA had better prognosis after discharge (mOS 295 days versus 181 days, p = 0.002). Conclusions: AYA patients had better hospitalization outcomes and were more likely to receive aggressive care near the end of life. Despite similar rates of early (≤ 30 days) readmissions, AYA had higher median overall survival after discharge compared to older adults. These finding should be taken into consideration when discussing hospitalization goals during admission of AYA with cancer.

8.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009591

ABSTRACT

Background: In a national survey 40.9% of 4,975 adults reported delaying or avoiding care due to concerns over COVID-19. Avoidance of medical care with lockdown and a decrease in access to services carries the possibility of increased morbidity and mortality from metastatic disease due to delays in diagnosis. We examine the trends in cancer diagnosis in admitted adult patients, comparing the incidences of diagnoses before lockdowns, after lockdowns, and as restrictions were lifted. Increase in diagnoses linked with metastatic disease in the late pandemic compared to early when lockdowns occurred would show delays in care due to decreased access from the pandemic, and likely increase in morbidity and mortality. Methods: Data was retrospectively analyzed patients admitted to HCA hospitals March 2020 to December 2021, separated to three periods: pre (Mar 2019-Feb 2020), early (Mar 2020-November 2020) and late pandemic (Dec 2020-December 2021). 66,022 patients with ICD-10 codes matching malignancies of lung, small intestine, colorectal, pancreas, breast, or cervix were included and patients that additionally had ICD-10 codes for metastatic disease were identified. Patients with unlinked metastatic disease codes were removed. Population demographics including sex, race, ethnicity, insurance were also included. Results: There was a decrease in lung cancer diagnoses in the pre-pandemic period from 6,546 to early at 3,248, and an increase in the late period to 4,763. Diagnoses of metastatic disease with lung cancer decreased from 4,143 in pre-pandemic to 3,357 in late pandemic. Colorectal cancer (CRC) patients without metastatic disease pre-pandemic numbered at 5,836;3,717 early pandemic;and 5,672, late pandemic. Diagnoses with metastatic disease decreased from 2,980 to 2,511 in the late period. Pancreatic cancer diagnoses decreased from 1,623 pre-pandemic to 1,508 late pandemic. Associated metastatic disease decreased from 1,181 pre-pandemic to 1,061 late pandemic. Breast cancer diagnoses decreased from 2,241 pre-pandemic to 1,915 late pandemic, and diagnoses with metastatic disease decreased from 2,334 to 1,711. Cervical cancer diagnoses increased from 385 pre-pandemic to 444 late pandemic and diagnoses with metastatic disease decreased from 252 to 187 in the late pandemic. Conclusions: Delays in access to care due to the pandemic are reflected in decreases of diagnoses seen. There was a decrease in lung, colorectal, pancreatic, breast, and cervical cancer diagnoses in the early pandemic period likely due to lockdown and diversion of medical effort. In the late pandemic period, diagnoses of these cancers rose, reflecting loosened restrictions. Our study is not able to determine the impact of delayed diagnosis, but likely results in increased morbidity and mortality. These effects could be mitigated in the future with uninterrupted access to telehealth and cancer screening.

9.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009588

ABSTRACT

Background: Telephone consultation has emerged as an alternative method for outpatient medical follow-up during the COVID-19 pandemic, reinforcing the necessary distancing measures. However, there are multiple factors that the medical team must contend with, which could limit the monitoring of patients. Methods: We retrospectively analyzed the remote medical consultation database of a universitybased oncology referral center in northeast Mexico. The telephone calls were made from the medical center by specialized health personnel. The data obtained correspond to the monitoring conducted over six months. Results: We included 1,140 patients in the analysis, of which 79% were women and 21% were men;the median age was 55 years. All individuals had a pathology-confirmed diagnosis of cancer. The main oncological diagnoses were breast, cervix, and prostate cancer which corresponded to 46, 13, and 7% of the cases, respectively. Ninety-four percent of cases corresponded to cancer surveillance, while the remaining 6% were receiving active oncological treatment, administered orally. Ninety-three percent of the patients were from the city of Monterrey and its metropolitan area, 6% came from the rest of the municipalities of the state of Nuevo Leon, and 1% were from other states of the Mexican Republic. Ninety-eight percent of the patients had a public health insurance as a method of coverage for health services, while 2% received care through private health insurance. At remote follow-up, only 53% of the patients responded to the telephone calls, none of them reported a diagnosis or any symptom of SARS-CoV-2 infection. Among the 536 patients who had a telephone communication failure, 68% did not respond to the call after 4 attempts, while in 32% of these cases the number provided by the patient was incorrect or non-existent. Conclusions: The high rates of failure to establish telephone communication documented in our population of patients with cancer is a worrying phenomenon. As the COVID-19 pandemic progresses worldwide, we must seek to establish measures to optimize logistics for more effective remote communication, to achieve the best possible outcomes.

10.
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.

11.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009516

ABSTRACT

Background: Implementation of the Affordable Care Act (ACA) has resulted in improvements in cancer outcomes but the extent to which these apply to specific racial and ethnic populations is unknown. We examined changes in health insurance distributions pre- and post-ACA and assessed cancer-specific mortality rates by race and ethnicity. Methods: The population included 167,181 newly diagnosed breast (n = 117,738), colorectal (n = 38,334), and cervix cancer (n = 11,109) patients younger than 65 years and 141,026 patients 65 years or older in the California Cancer Registry. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated using multivariable Cox regression to estimate associations with risk of 5-year cancer-specific death for each cancer site pre- (2007-2010) and post-ACA (2014-2017), and by race and ethnicity (American Indian/Alaska Natives, AIAN;Asian Americans;Hispanics;Native Hawaiian/Pacific Islanders, NHPI;non-Hispanic Blacks, NHB;and non- Hispanic whites, NHW). Difference-in-difference analysis was conducted to compare changes over time between younger (< 65 years) and older (65 years and older) patients. Results: Cancer-specific mortality for patients age < 65 was significantly lower post- vs. pre-ACA for colorectal cancer among Hispanic (HRR = 0.83;95% CI: 0.74-0.93), NHB (HRR = 0.69;95% CI: 0.58-0.81), and NHW (HRR = 0.90 95% CI: 0.84-0.97) but not Asian American (HRR = 0.95;95% CI: 0.82-1.10) patients. The HRR for younger NHB colorectal cancer patients was significantly lower than that for patients 65 years of and older (HRR = 1.09;95% CI, 0.95-1.25, p-interaction < 0.0001). A significantly lower risk of dying from cervix cancer was observed in the post- vs. pre-ACA period among younger NHB women (HRR = 0.68;95% CI: 0.47-0.99), but this was not significantly different than that for older women (HRR = 0.41;95% CI, 0.16-1.01, p-interaction = 0.30). No significant differences in breast cancer-specific mortality were observed for any racial or ethnic group. Conclusions: Findings show decreases in cancer-specific mortality for colorectal and cervix cancers for some racial and ethnic groups following ACA implementation in California. These results shed light on ongoing discussions as additional states consider Medicaid expansion. Future studies should assess shifts between health insurance plans resulting from the economic impact of the 2019 novel coronavirus (COVID-19) pandemic.

12.
Annals of the Rheumatic Diseases ; 81:1873, 2022.
Article in English | EMBASE | ID: covidwho-2009098

ABSTRACT

Background: Systemic lupus erythematosus (SLE) prognosis is determined by a wide range of factors, such as the severity of the disease manifestations, the psychosocial aspects of patients, the proper management of comorbidities, adoption of a healthy lifestyle and adherence to treatment. Studies on chronic diseases highlight the value of patient education to foster treatment adherence and improve prognosis. Objectives: To promote health education to SLE patients and their families providing accessible and comprehensive Scientific information, in order to improve adherence to treatment and the patient's prognosis. Methods: The Waiting Room Project is linked to the Extension Health Care Program for SLE patients and their families of Universidade Federal de Minas Gerais, Brazil, since 2011. A total of 700 patients under SLE treatment at the Rheumatology Unit of the University Hospital are involved. Medical students and rheumatology fellows, altogether, developed high-quality informative texts, with clear content and layman language appropriate for the patient, under the supervision of the rheumatology professors. The texts are illustrated by the team of the Communication Department of the Medical School and medical students, and are printed in a leafet format. The material is handed out to the patients, while they wait for their medical appointment, by the students and the care team. The content of the leafets is discussed, making sure that all the concerns and doubts are properly addressed Results: The Waiting Room Project has produced 17 leafets, addressing different aspects of SLE, comorbidities, and treatment. The texts approach the traditional cardiovascular risk factors (Smoking, Arterial Hypertension, Diabetes, Obesity, Physical Activity), and some medical conditions related to general health and SLE treatment (Sun Protection, Healthy Food, Oral Care, Vaccination, Pregnancy, Osteoporosis). In 2020 and 2021, two leafets about Covid-19 were produced in order to clarify important aspects of this disease, its impact on lupus patients and to solve questions about SLE medications: one regarding the association between Lupus and Covid-19 and another about the treatment of lupus and Covid-19. Other four leafets were produced concerning SLE treatment, including Adherence to Treatment, the use of Antimalarials, Corticos-teroids, and Immunosuppressants. Information about the drugs, general importance on lupus treatment, recommendations and possible adverse events were described. Futhermore, additional content is currently in production with themes such as Intravenous Corticosteroid and Cyclophosphamide, Human Papilloma-virus Infection, Malignant Neoplasm, and specifc cancers frequently affecting women, such as Colorectal Cancer, Cervical Cancer, and Breast Cancer. The leafets are also available online on the Medical School website in Portuguese and in English (medicina.ufmg.br/alo/material-didatico/), on the Minas Gerais Rheumatology Society website (reumatologia.org.br/orientacoes-ao-paciente/), and on the Instagram page @lupusufmg Conclusion: The leafets have been an important source of information and health education for SLE patients and their families, improving student/physician-patient communication. Despite the adversities caused by the coronavirus pandemic, the Waiting Room Project has kept its purpose to make each patient with SLE an agent of their healthcare. Improving the patients' access to evidence-based information must be a goal of healthcare professionals that treat patients with SLE.

13.
Advanced Therapeutics ; 5(8), 2022.
Article in English | EMBASE | ID: covidwho-2007088

ABSTRACT

Cancer gene therapy based on various gene delivery vectors has some potential but also has obvious disadvantages. In this study, a new M13 phage-based oncolytic virus is constructed that carried the RGD peptides to target tumor cells and the 3C gene of Seneca Valley virus (SVV) preceded by a eukaryotic initial transcriptional region (ITR) to transcribe an oncolytic protein to kill tumor cells. Recombinant virus particles of 1200 nm in length are obtained in large quantities by transfecting the recombinant M13 phage plasmid into the host BL2738 and are investigated in vitro in tumor cells and in vivo in tumor-bearing mice to evaluate their antitumor effect. The experiments using Hela cells confirm that the engineered M13 phage can target and enter Hela cells, and express the SVV 3C protein, resulting in apoptosis of target cells by upregulating the expression of caspase 3. Furthermore, the results of experiments in vivo also show that the recombinant phage significantly inhibits the enhanced tumor volume in nude mice compared to the control groups. The M13 phage may be engineered to fuse with a variety of oncolytic proteins to inhibit the growth of tumor cells in the future, providing a promising phage-based targeted oncolytic reagent.

14.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005661

ABSTRACT

Background: Cervical cancer is the leading cause of cancer and cancer-related deaths among women in Nepal, due in part to a lack of access to screening and limited medical providers trained to diagnose and treat women with preinvasive cervical disease. Cancer Care Nepal has partnered with The University of Texas MD Anderson Cancer Center (MD Anderson) and the American Society of Clinical Oncology (ASCO) to implement a 'train the trainer' (TOT) program to teach visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, cryotherapy, thermal ablation, and loop electrosurgical excision procedure (LEEP). Methods: An initial cervical cancer prevention course was held in Kathmandu, Nepal in November 2019, supported by ASCO and with faculty from Civil Service Hospital, Bhaktapur Cancer Hospital, and National Academy of Medical Sciences and MD Anderson. As a continuation of this program, a TOT course was implemented for local specialists from five participating institutions throughout Nepal to learn how to deliver these trainings. Each participating institution then holds their own local course for nurses and doctors in their region. The training is complemented with monthly Project ECHO (Extension for Community Healthcare Outcomes) telementoring videoconferences. Results: The program was launched in November 2021. To date, two TOT training courses (2-day duration) have been held for clinicians from the 5 participating regions. Due to COVID-19 pandemic travel restrictions, didactic lectures were held virtually with MD Anderson and ASCO staff and included epidemiology of cervical cancer, screening guidelines, colposcopy, and treatment of cervical dysplasia. This was followed by hands-on training using simulation models to teach VIA, colposcopy, ablation and LEEP, led by the Nepalese faculty who had participated in the 2019 course. There were 41 participants in total (23 in the first course and 18 in the second course), including 21 gynecologists, 4 gynecologic oncologists, 1 medical oncologist, 1 general practitioner, and 14 nurses. 39 participants (73%) completed both the pre-and post-survey results. 86% of respondents from the first course and 100% of respondents from the second course reported that they intended to change their practice as a result of knowledge gained from the course. In addition, Cancer Care Nepal became a new hub for Project ECHO and held its first session in January 2022, with 20 participants representing two regions. The specialists from each of the 5 participating sites will be holding local courses for doctors and nurses in their respective regions throughout 2022. Conclusions: Our work shows that the TOT strategy can widen the reach of training in cervical cancer prevention in Nepal. Despite travel restrictions during the COVID-19 pandemic, global health training and mentoring can continue, though they require adaptions and use of virtual platforms.

15.
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.

16.
Journal of General Internal Medicine ; 37:S576, 2022.
Article in English | EMBASE | ID: covidwho-1995800

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: Given that cervical cancer screening (CCS) rates have declined during the COVID-19 pandemic, and the extent to which logistical barriers contribute to delayed CCS, this quality improvement project aims to improve CCS rates in our clinic through dedicated, convenient clinical sessions for Pap tests. DESCRIPTION OF PROGRAM/INTERVENTION: The UPMC General Internal Medicine-Oakland (GIMO) Clinic held “Pap Days,” clinic sessions dedicated for CCS and conducted by women's health-trained GIM faculty. Eligible patients were those who: 1) see PCPs at GIMO, 2) were eligible for CCS based on age and pelvic organ status (i.e. had not had hysterectomy for benign reasons), and 3) were overdue for CCS. Bulk EMR-generated messaging was used to invite eligible patients to schedule an appointment. PCPs could also directly refer patients. MEASURES OF SUCCESS: We will analyze the administrative burden involved in scheduling the sessions and the return on that investment, e.g. the number of invitations sent, the number of appointments made, and the number of appointments completed. As the goal of CCS is to identify and treat precancerous lesions before they become cancerous, we will quantify the abnormal results that are detected and any recommended follow-up testing. We will also analyze patient characteristics, to guide future Pap Days. FINDINGS TO DATE: 70 appointment slots were scheduled over 4 days in November and December 2021. 1086 patients were contacted through a secure messaging portal. 67 appointments were scheduled for 63 unique patients;38 visits were completed (57%), 5 were no-shows (7.5%), 22 cancelled (33%), 2 were not for CCS (3.3%). 57 of 63 patients (90%) were insured by the health system's affiliated health plan;39 (62%) had employer-sponsored plans, 5 had Affordable Care Act plans (8%), 16 had Medicaid (25%), and 3 had Medicare (5%). 12/63 (19%) patients had no prior CCS records in our EMR. Of the 38 Paps that were performed, 30 (79%) were normal, 2 (5.3%) were ASCUS/ HPV-, 2 (5.3%) were ASCUS/HPV+, and 4 (11%) were unsatisfactory. Evaluation of how long patients were overdue is ongoing. KEY LESSONS FOR DISSEMINATION: This project demonstrates the feasibility and success of a quality improvement intervention-dedicated CCS sessions-to improve rates of CCS. Recruiting patients and scheduling appointments was relatively easy to implement, and anecdotal feedback from the patients and physicians was very positive. We recruited a wide array of patients from our clinic panel. Challenges were encountered because our EMR often defaults to 3-year CCS intervals and requires that providers manually update the interval to 5 years where appropriate, so outreach lists included patients who were wrongly identified as overdue. Nevertheless, the results of this program suggest that it is scalable to more patients and would be easy to implement in outpatient clinics of any size and geographical area.

17.
Journal of General Internal Medicine ; 37:S169, 2022.
Article in English | EMBASE | ID: covidwho-1995589

ABSTRACT

BACKGROUND: Timely follow-up of abnormal cancer screening test results (“abnormal screens”) is critical but often not achieved. As part of an NCI funded intervention trial (mFOCUS: multilevel Follow-up of Cancer Screening, ClinicalTrials.gov NCT03979495), we report on abnormal screens that were identified and tracked to identify eligible patients overdue for study inclusion. While not anticipated when this study was conceived, the COVID-19 pandemic resulted in a larger than anticipated backlog of patients in need of follow-up of abnormal screens. METHODS: Patients in two primary care practice networks affiliated with Mass General Brigham who had an abnormal screen for breast, cervical or lung cancer were identified using computerized algorithms and then tracked for completion of appropriate follow-up based upon the cancer type and the severity of the abnormal result. Since the intervention was designed as a “fail safe” system, additional time (2-6 months depending on the severity of the abnormal screen) was added after the recommended follow-up interval. We report the number of abnormal screens by cancer type and severity of the abnormality and the number of patients who completed follow-up based upon guideline and expert recommendations. RESULTS: Patient tracking and enrollment started with abnormal screens for breast and lung on 8/24/2020 and cervical cancer on 10/16/2020. Enrollment ended for all abnormal screens on December 15, 2021. Over the study period, 4003 abnormal breast, 5214 abnormal cervical, and 478 abnormal lung screens were identified. High risk abnormalities were most common for cervical (51.7%, recommended colposcopy or endometrial biopsy), lung (22.6%, LRADS 4B, 4X or 5), and lowest for breast (0.4%, BIRADS 5). Rates of completing recommended follow-up of abnormal screens by cancer type and severity of the result are shown in the table. CONCLUSIONS: Maximizing the benefits of cancer screening requires the timely follow-up of abnormal screening results. Though likely exacerbated by the COVID-19 pandemic, we identified that timely completion of abnormal screens is often not achieved. Rates of completion varied by cancer type and the severity of the abnormal result but highlight the need for systems based, multi-level interventions to identify, report and track abnormal results.

18.
Cancer Research ; 82(12), 2022.
Article in English | EMBASE | ID: covidwho-1986469

ABSTRACT

Background: The COVID-19 pandemic has affected use of healthcare services, especially disrupting individual participation in cancer screening programs. The National Cancer Screening Program (NCSP) of Korea provides screening services for six common cancers - stomach, liver, colorectum, breast, cervix, and lung. As complete national lockdown measures were not implemented, the NCSP continued operation during the three major COVID-19 waves in Korea, which allowed us to assess the changes in health-seeking behavior. We examined the cancer screening rates for breast and cervical cancers among NCSP participants in different geographic regions and by age group, in association with the COVID-19 pandemic. Methods: From the National Health Insurance Service database, we obtained information on the number of eligible population and NCSP participants from January 2019 to December 2020. The target group for biennial mammography screening is women aged 40 years and over, and that for biennial pap smear is women aged 20 years and over. We compared monthly screening rates for breast and cervical cancer between 2020 vs 2019 and described them as a percentage change. Results: The overall cancer screening rate has decreased in both cancers in 2020 compared with that of 2019: breast (55.8% vs 63.8%), cervical (52.2% vs 57.8%). Screening rates for both cancers declined in all age groups in March and December of 2020, which corresponds to the first and third COVID-19 wave. The month of March 2020 had the sharpest drop in screening rates, by 57.9% for breast cancer and 43.7% for cervical cancer compared with March 2019. In June 2020, screening rates for both cancers rebounded compared with 2019 (breast, +29.2%;cervical, +26.3%), which remained higher compared with the same months in 2019 until November 2020. By December 2020, screening rates for both cancers have dropped, compared with December 2019 (breast, -19.5%;cervical, -21.0%). For breast cancer, the screening rate decreased in all age groups, and the largest decline was observed in women aged 80 years and over. Although the cervical cancer screening rate has been steadily increasing since 2010, it decreased in all age groups in 2020 compared with that of 2019, with the exception of the 20-29 age group. Considering social distancing measures that were implemented nationwide during each COVID-19 wave, we observed a similar pattern of cancer screening rates in major cities. Conclusions: It was observed that after the two major COVID-19 waves, mammography and pap smear rates declined compared with that of 2019. The largest decline in cancer screening rates was seen in elderly women. The pattern of screening rate changes was comparable according to geographic region. In contrast to reports showing a deficit in cancer screening in other countries, our results suggest a substantial recovery in cancer screening in Korea. Additional analyses are needed to assess the effect of the 6-month extension of NCSP.

19.
International Journal of Radiation Oncology*Biology*Physics ; 114(1):A11-A13, 2022.
Article in English | EMBASE | ID: covidwho-1984266
20.
Radiotherapy and Oncology ; 170:S33, 2022.
Article in English | EMBASE | ID: covidwho-1967459

ABSTRACT

Purpose or Objective The high burden of COVID-19 in hospitals puts increased pressure on oncological care worldwide, forces prioritization of healthcare resources and causes delays in cancer treatment pathways. Prior research underlined the importance of timely oncological care, as longer waiting times from diagnosis to treatment could result in poorer outcomes for some common malignancies. The aim of this study was to determine the impact of waiting time from diagnosis to treatment on overall survival in patients with cervical cancer treated with surgery or radiotherapy with curative intent. Materials and Methods Patients from a nationwide population-based cohort with newly diagnosed cervical cancer between 2010 and 2019 were studied. Patients who underwent surgery or radiotherapy with curative intent were selected. Waiting time was defined as the time interval between first pathologic confirmation of carcinoma and the day of first treatment. Waiting time was modeled as continuous (i.e. linear per week), dichotomized (i.e. ≤8 versus >8 weeks), and polynomial (i.e. restricted cubic splines). The association between waiting time and overall survival was examined using Cox proportional hazard analyses. Results Among 6,895 patients with newly diagnosed cervical cancer, 2,831 patients treated with primary surgery and 1,898 patients who received primary radiotherapy were included. Waiting time to surgery was 8.5 (±4.2) weeks on average and >8 weeks in 1,287 patients (45%). Waiting to radiotherapy was 7.7 (±2.9) weeks on average and >8 weeks in 681 patients (36%). In the surgery group, a longer waiting time was associated with younger age, fertility treatment, adenocarcinoma histology, poor differentiation grade, LVSI, higher T- and N-stage, and previous conization or portio amputation. Adjusted for confounders, waiting time to surgery was not significantly associated with overall survival (continuous HR 0.99 [95%CI: 0.95- 1.02], dichotomized HR 0.93 [0.69-1.26], polynomial HR in Figure 1). In the radiotherapy group, a longer waiting time was associated with higher BMI, higher number of co-morbidities, and lower T-stage. Chemotherapy was administered concurrently with radiotherapy in 1,276 patients (67.2%) and was not associated with a longer waiting time. Adjusted for confounders, a longer waiting time to radiotherapy was not significantly associated with poorer overall survival (continuous HR 0.97 [95%CI: 0.93-1.00], dichotomized HR 0.91 [0.76-1.09], polynomial HR in Figure 2). Conclusion This large population-based cohort study demonstrates that a longer waiting time from diagnosis to treatment (of up to 12 weeks) in patients with cervical cancer treated with curatively intended surgery or radiotherapy does not negatively impact overall survival. These results could help inform and reassure patients regarding their waiting time, for example when time is needed for fertility preservation.

SELECTION OF CITATIONS
SEARCH DETAIL