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Endocrine ; 71(1): 14-19, 2021 01.
Article in English | MEDLINE | ID: covidwho-1008085


PURPOSE: During the COVID-19 pandemic, there have been particular concerns regarding the related impact on specialist tumour services. Neuroendocrine tumour (NET) services are delivered in a highly specialised setting, typically delivered in a small number of centres that fulfil specific criteria as defined by the European Neuroendocrine Tumour Society (ENETS). We aimed to address the COVID-19-related impact on specialist NET tumour services in England and other countries. METHODS: Electronic survey addressing patient access and delivery of care distributed to all ENETS Centres of Excellence (CoE) in England and matching number of ENETS CoE elsewhere. Semi-quantitative and qualitative analyses of survey responses were performed. RESULTS: Survey response of ENETS CoE in England was 55% (6/11). Responses from six non-UK ENETS CoE elsewhere were received and analysed in a similar manner. Relevant disruption of various NET services was noted across all responding Centres, which included delayed patient appointments and investigations, reduced availability of treatment modalities including delayed surgical treatment and a major negative impact on research activities. The comparison between English and non-UK ENETS CoE suggested that the former had significantly greater concerns related to future research funding (p = 0.014), whilst having less disruption to multidisciplinary meetings (p = 0.01). A trend was also noted towards virtual patient appointments in ENETS CoE in England vs. elsewhere (p = 0.092). CONCLUSIONS: Restoration of highly specialised NET services following COVID-19 and planning for future service delivery and research funding must take account of the severe challenges encountered during the pandemic.

COVID-19/epidemiology , Health Services Accessibility , Neuroendocrine Tumors/therapy , Pandemics , Belgium/epidemiology , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , England/epidemiology , France/epidemiology , Greece/epidemiology , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Israel/epidemiology , Italy/epidemiology , Netherlands/epidemiology , Neuroendocrine Tumors/epidemiology , SARS-CoV-2 , Surveys and Questionnaires
Eur J Endocrinol ; 183(2): G79-G88, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-701828


In viral pandemics, most specifically Covid-19, many patients with neuroendocrine neoplasms (NENs), including phaeochromocytomas, paragangliomas and medullary thyroid carcinoma, may develop Covid-19 in a mild or severe form, or be concerned about the influence of viral infection relative to their anti-tumoral therapy. In general, newly presenting patients should be assessed, and patients recently receiving chemotherapy, targeted therapy or radionuclide therapy, or showing tumour growth, should be closely followed. For previously diagnosed patients, who have indolent disease, some delay in routine follow-up or treatment may not be problematic. However, patients developing acute secretory syndromes due to functional neuroendocrine neoplasms (such as of the pancreas, intestine or lung), phaeochromocytomas and paragangliomas, will require prompt treatment. Patients with life-threatening Covid-19-related symptoms should be urgently treated and long-term anti-tumoral treatments may be temporarily delayed. In patients with especially aggressive NENs, a careful judgement should be made regarding the severity of any Covid-19 illness, tumour grade, and the immunosuppressant effects of any planned chemotherapy, immunotherapy (e.g. interferon-alpha), targeted therapy or related treatment. In other cases, especially patients with completely resected NENs, or who are under surveillance for a genetic disorder, a telephone or delayed consultation may be in order, balancing the risk of a delay against that of the possible development of Covid-19.

Betacoronavirus , Coronavirus Infections/therapy , Disease Management , Neuroendocrine Tumors/therapy , Pneumonia, Viral/therapy , Telemedicine/trends , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endocrinology/methods , Endocrinology/trends , Humans , Neoplasm Grading/methods , Neoplasm Grading/trends , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/methods
Endocrine ; 70(1): 6-10, 2020 10.
Article in English | MEDLINE | ID: covidwho-654265


Primary neuroendocrine tumors of the thymus are extremely rare. In patients with advanced disease, tumor growth control, and sometimes also syndrome control are the main goals of systemic therapy. Unfortunately, no standard therapies are available in clinical practice; therefore, clinical studies are strongly recommended. Axitinib (AXI) is a tyrosine kinase inhibitor, currently under investigation in an international phase II/III trial including thymic neuroendocrine tumors. Over the past 5 months, the entire world has been facing a devastating medical emergency brought about by a pandemic due to a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in Wuhan, China, in late 2019. Since then, health professionals have been expending all their efforts on trying to provide the best available treatments for patients involved. Patients with cancer, especially those with thoracic involvement, are at higher risk of coronavirus disease 19 (COVID-19) and its complications because of their immunosuppressive status caused by the cancer and the anticancer therapies. As it remains unclear how to optimally manage such patients, we wished to report our experience with a patient with a metastatic neuroendocrine tumor of the thymus infected with SARS-CoV-2 in the hope that it may provide some insights and reflections on the management of cancer patients during this challenging time in our history.

Betacoronavirus , Carcinoid Tumor/drug therapy , Coronavirus Infections/epidemiology , Neuroendocrine Tumors/drug therapy , Pneumonia, Viral/epidemiology , Thymus Neoplasms/drug therapy , Aged , Axitinib/adverse effects , Axitinib/therapeutic use , Azithromycin/therapeutic use , COVID-19 , Carcinoid Tumor/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Humans , Hydroxychloroquine/therapeutic use , Italy/epidemiology , Male , Neuroendocrine Tumors/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Protein-Tyrosine Kinases/antagonists & inhibitors , Randomized Controlled Trials as Topic , SARS-CoV-2 , Thymus Neoplasms/epidemiology , Tomography, X-Ray Computed , Treatment Outcome