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1.
Cancer Rep (Hoboken) ; 5(1): e1427, 2022 01.
Article in English | MEDLINE | ID: covidwho-1274682

ABSTRACT

BACKGROUND AND AIM: This study quantifies how changes in healthcare utilization and delivery during the first months of the COVID-19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies within an academic health system. METHODS AND RESULTS: Patients diagnosed with a GI malignancy (ICD10: C15-C26) who received medical care within the health system during the observation period (first 44 weeks of 2019 and 2020) were identified for a retrospective cohort study. Deidentified patient encounter parameters were collected for this observation period and separated into pre-pandemic (weeks 1-10) and early pandemic (weeks 11-20) study periods. Difference-in-difference analyses adjusted for week-specific and year-specific effects quantified the impact of the COVID-19 pandemic on care delivery between pre-pandemic and early pandemic study periods in 2020. Across all GI malignancies, the COVID-19 pandemic has been associated with a significant decline in the number of patients with new patient visits (NPVs) (p = 1.2 × 10-4 ), Radiology encounters (p = 1.9 × 10-7 ), Surgery encounters (p = 1.6 × 10-3 ), Radiation Oncology encounters (p = 4.1 × 10-3 ), and infusion visits (6.1 × 10-5 ). Subgroup analyses revealed cancer-specific variations in changes to delivery. Patients with colorectal cancer (CRC) had the most significant decrease in NPVs (p = 7.1 × 10-5 ), which was significantly associated with a concomitant decrease in colonoscopies performed during the early pandemic period (r2  = 0.722, p = 2.1 × 10-10 ). CONCLUSIONS: The COVID-19 pandemic has been associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC, diagnosed and managed by periodic screening, has been affected most acutely.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care , Gastrointestinal Neoplasms/therapy , SARS-CoV-2 , Female , Humans , Male , Retrospective Studies
2.
United European Gastroenterol J ; 9(7): 787-796, 2021 09.
Article in English | MEDLINE | ID: covidwho-1260575

ABSTRACT

BACKGROUND: The novel Coronavirus (SARS-CoV-2) has caused almost 2 million deaths worldwide. Both Food and Drug Administration and European Medicines Agency have recently approved the first COVID-19 vaccines, and a few more are going to be approved soon. METHODS: Several different approaches have been used to stimulate the immune system in mounting a humoral response. As more traditional approaches are under investigation (inactivated virus vaccines, protein subunit vaccines, recombinant virus vaccines), more recent and innovative strategies have been tried (non-replicating viral vector vaccines, RNA based vaccines, DNA based vaccines). RESULTS: Since vaccinations campaigns started in December 2020 in both the US and Europe, gastroenterologists will be one of the main sources of information regarding SARS-CoV 2 vaccination for patients in their practice, including vulnerable patients such as those with Inflammatory Bowel Disease (IBD), patients with chronic liver disease, and GI cancer patients. CONCLUSIONS: Thus, we must ourselves be well educated and updated in order to provide unambiguous counseling to these categories of vulnerable patients. In this commentary, we aim to provide a comprehensive review of both approved COVID-19 vaccines and the ones still under development, and explore potential risks, benefits and prioritization of vaccination.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , /therapeutic use , /therapeutic use , Gastroenterology , Gastrointestinal Neoplasms/therapy , Humans , Inflammatory Bowel Diseases/therapy , Liver Diseases/therapy , SARS-CoV-2
3.
Nutrients ; 13(3)2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1146555

ABSTRACT

BACKGROUND: People with upper gastrointestinal cancer are at high risk for malnutrition without universal access to early nutrition interventions. Very little data exist on the attitudes and views of health professionals on providing nutrition care to this patient cohort delivered by electronic health methods. COVID-19 has fast-tracked the adoption of digital health care provision, so it is more important than ever to understand the needs of health professionals in providing health care via these modes. This study aimed to explore the perspectives of health professionals on providing nutrition care to upper gastrointestinal cancer patients by electronic methods to allow the future scaling-up of acceptable delivery methods. METHODS: Semi-structured qualitative interviews were conducted face-to-face or by telephone and recorded, de-identified and transcribed. Thematic analysis was facilitated by NVivo Pro 12. RESULTS: Interviews were conducted on 13 health professionals from a range of disciplines across several public and private health institutions. Thematic analysis revealed three main themes: (1) the ideal model, (2) barriers to the ideal model and (3) how to implement and translate the ideal model. Health professionals viewed the provision of nutrition interventions as an essential part of an upper gastrointestinal cancer patient's treatment with synchronous, telephone-based internal health service models of nutrition care overwhelmingly seen as the most acceptable model of delivery. Mobile application-based delivery methods were deemed too challenging for the current population serviced by these clinicians. CONCLUSION: The use of novel technology for delivering nutrition care to people receiving treatment for upper gastrointestinal cancers was not widely accepted as the preferred method of delivery by health professionals. There is an opportunity, given the rapid uptake of digital health care delivery, to ensure that the views and attitudes of health professionals are understood and applied to develop acceptable, efficacious and sustainable technologies in our health care systems.


Subject(s)
Attitude of Health Personnel , COVID-19/epidemiology , Gastrointestinal Neoplasms/therapy , Nutrition Therapy/methods , Adult , COVID-19/complications , Female , Health Services Accessibility , Humans , Interviews as Topic , Male , Middle Aged , Mobile Applications , Nutrition Therapy/psychology , Telemedicine/methods , Trust
4.
Eur J Cancer ; 144: 200-214, 2021 02.
Article in English | MEDLINE | ID: covidwho-987581

ABSTRACT

Neuroendocrine neoplasms (NENs) are a heterogeneous family of uncommon tumours with challenging diagnosis, clinical management and unique needs that almost always requires a multidisciplinary approach. In the absence of guidance from the scientific literature, along with the rapidly changing data available on the effect of COVID-19, we report how 12 high-volume NEN centres of expertise in 10 countries at different stages of the evolving COVID-19 global pandemic along with members of international neuroendocrine cancer patient societies have suggested to preserve high standards of care for patients with NENs. We review the multidisciplinary management of neuroendocrine neoplasms during the COVID-19 pandemic, and we suggest potential strategies to reduce risk and aid multidisciplinary treatment decision-making. By sharing our joint experiences, we aim to generate recommendations for proceeding to other institutions facing the same challenges.


Subject(s)
COVID-19 , Carcinoid Tumor/therapy , Gastrointestinal Neoplasms/therapy , Medical Oncology/standards , Pancreatic Neoplasms/therapy , Thoracic Neoplasms/therapy , Carcinoid Tumor/diagnosis , Consensus , Gastrointestinal Neoplasms/diagnosis , Humans , Pancreatic Neoplasms/diagnosis , Thoracic Neoplasms/diagnosis
8.
JCO Glob Oncol ; 6: 1046-1051, 2020 07.
Article in English | MEDLINE | ID: covidwho-638037

ABSTRACT

PURPOSE: Many patients with cancer, often those with rare cancers such as sarcomas, travel long distances to access expert care. The COVID-19 pandemic necessitated widespread changes in delivery of cancer care, including rapid adoption of telemedicine-based care. We aimed to evaluate the impact of telemedicine on patients, clinicians, and care delivery at the Royal Marsden Hospital (RMH) Sarcoma Unit during the pandemic. METHODS: Data were extracted from patient records for all planned outpatient appointments at the RMH Sarcoma Unit from March 23 to April 24, 2020. Patients and clinicians completed separate questionnaires to understand their experiences. RESULTS: Of 379 planned face-to-face appointments, 283 (75%) were converted to telemedicine. Face-to-face appointments remained for patients who needed urgent start of therapy or performance status assessment. Patients lived on average > 1.5 hours from RMH. Patient satisfaction (n = 108) with telemedicine was high (mean, 9/10), and only 48% (n = 52/108) would not want to hear bad news using telemedicine. Clinicians found telemedicine efficient, with no associated increased workload, compared with face-to-face appointments. Clinicians indicated lack of physical examination did not often affect care provision when using telemedicine. Most clinicians (n = 17; 94%) believed telemedicine use was practice changing; congruently, 80% (n = 86/108) of patients desired some telemedicine as part of their future care, citing reduced cost and travel time. CONCLUSION: Telemedicine can revolutionize delivery of cancer care, particularly for patients with rare cancers who often live far away from expert centers. Our study demonstrates important patient and clinician benefits; assessment of longer-term impact on patient outcomes and health care systems is needed.


Subject(s)
Ambulatory Care/methods , Coronavirus Infections/epidemiology , Medical Oncology/methods , Pandemics , Patient Satisfaction , Pneumonia, Viral/epidemiology , Sarcoma/therapy , Telemedicine/methods , Workload , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Delivery of Health Care/methods , Female , Gastrointestinal Neoplasms/therapy , Gastrointestinal Stromal Tumors/therapy , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Soft Tissue Neoplasms/therapy , Travel , United Kingdom/epidemiology , Young Adult
9.
Dig Liver Dis ; 52(11): 1346-1350, 2020 11.
Article in English | MEDLINE | ID: covidwho-598784

ABSTRACT

After the lockdown during the emergency phase of the Covid-19 pandemic, we have to deal with phase 2, a period of uncertain duration, with a controlled and progressive return to normalization, in which we need to reconcile our work and our movements with the presence of the virus on our territory. Digestive endoscopic activity is a high-risk transmission procedure for Covid-19. The measures put in place to protect healthcare personnel and patients are stressful and "time-consuming" and lead to a reduction in the number of endoscopic procedures that can be performed. In this scenario, the Oncological Institutes are forced to make a rigorous selection of patients to undergo endoscopic examinations and treatments, according to lists of exceptional priorities, in order to guarantee cancer patients and subjects at high risk of developing digestive tumors, a preferential diagnostic and therapeutic process, protected from contagion risks. For this purpose, cuts and postponing times of endoscopic performances are here proposed, which go beyond the guidelines of scientific societies and have little evidences in the literature. These changes should be applied limited to this exceptional period and in proportion to the capacity of each operating unit in order to meet the demands of the patients.


Subject(s)
Cancer Care Facilities/organization & administration , Endoscopy, Gastrointestinal , Patient Selection , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/transmission , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/therapy , Humans , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2
10.
Clin Colorectal Cancer ; 19(3): 156-164, 2020 09.
Article in English | MEDLINE | ID: covidwho-342937

ABSTRACT

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak poses a major challenge in the treatment decision-making of patients with cancer, who may be at higher risk of developing a severe and deadly SARS-CoV-2 infection compared with the general population. The health care emergency is forcing the reshaping of the daily assessment between risks and benefits expected from the administration of immune-suppressive and potentially toxic treatments. To guide our clinical decisions at the National Cancer Institute of Milan (Lombardy region, the epicenter of the outbreak in Italy), we formulated Coronavirus-adapted institutional recommendations for the systemic treatment of patients with gastrointestinal cancers. Here, we describe how our daily clinical practice has changed due to the pandemic outbreak, with the aim of providing useful suggestions for physicians that are facing the same challenges worldwide.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Gastrointestinal Neoplasms/therapy , Pneumonia, Viral/epidemiology , COVID-19 , Clinical Decision-Making , Decision Making , Disease Outbreaks , Humans , Italy/epidemiology , Pandemics , Risk Assessment , Severity of Illness Index
11.
Dig Liver Dis ; 52(6): 597-603, 2020 06.
Article in English | MEDLINE | ID: covidwho-295511

ABSTRACT

INTRODUCTION: Patients treated for malignancy are considered at risk of severe COVID-19. This exceptional pandemic has affected countries on every level, particularly health systems which are experiencing saturation. Like many countries, France is currently greatly exposed, and a complete reorganization of hospitals is ongoing. We propose here adaptations of diagnostic procedures, therapies and care strategies for patients treated for digestive cancer during the COVID-19 epidemic. METHODS: French societies of gastroenterology and gastrointestinal (GI) oncology carried out this study to answer two main questions that have arisen (i) how can we limit high-risk situations for GI-cancer patients and (ii) how can we limit contact between patients and care centers to decrease patients' risk of contamination while continuing to treat their cancer. All recommendations are graded as experts' agreement according to the level of evidence found in the literature until March 2020. RESULTS: A proposal to adapt treatment strategies was made for the main GI oncology situations. Considering the level of evidence and the heterogeneous progression of the COVID-19 epidemic, all proposals need to be considered by a multidisciplinary team and implemented with patient consent. CONCLUSION: COVID-19 epidemic may significantly affect patients treated for digestive malignancies. Healthcare teams need to consider adapting treatment sequences when feasible and according to the epidemic situation.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Gastrointestinal Neoplasms , Infection Control , Pandemics , Patient Care Management , Pneumonia, Viral , Antineoplastic Agents/therapeutic use , Betacoronavirus/isolation & purification , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Digestive System Surgical Procedures/methods , France/epidemiology , Gastrointestinal Neoplasms/epidemiology , Gastrointestinal Neoplasms/therapy , Humans , Infection Control/methods , Infection Control/organization & administration , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS-CoV-2 , Societies, Medical
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