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1.
Med Oncol ; 38(11): 137, 2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1439757

ABSTRACT

The covid-19 pandemic has impacted the management of non-covid-19 illnesses. Epithelial ovarian cancer (EOC) requires long-duration multidisciplinary treatment. Teleconsultation and shared care are suggested solutions to mitigate the consequences of the pandemic. However, these may be challenging to implement among patients who come from the lower economic strata. We report the disastrous impact of the pandemic on the care of EOC by comparing patients who were treated during the pandemic with those treated in the previous year. We collected the following data from newly diagnosed patients with EOC: time from diagnosis to treatment, time for completion of planned chemotherapy, and proportion of patients completing various components of therapy (surgery and chemotherapy). Patients treated between January 2019 and September 2019 (Group 1: Pre-covid) were compared with those treated between January 2020 and December 2020 (Group 2: During covid pandemic). A total of 82 patients were registered [Group 1: 43(51%) Group 2: 39(49)]. The median time from diagnosis to start of treatment was longer in group 2 when compared to group 1 [31(23-58) days versus 17(11-30) days (p = 0.03)]. The proportion of patients who had surgery in group 2 was lower in comparison to group 1 [33(77%) versus 21(54%) (p = 0.02)]. Proportion of patients who underwent neoadjuvant (NACT) and surgery were fewer in group 2 in comparison to group 1 [9(33%) versus 18(64%) p = 0.002]. Among patients planned for adjuvant chemotherapy, the median time from diagnosis to treatment was longer in group 2 [28(17-45) days, group 1 versus 49(26-78) days, group 2 (p = 0.04)]. The treatment of patients with EOC was adversely impacted due to the COVID-19 pandemic. There was a compromise in the proportion of patients completing planned therapy. Even among those who completed the treatment, there were considerable delays when compared with the pre-covid period. The impact of these compromises on the outcomes will be known with longer follow-up.


Subject(s)
COVID-19/prevention & control , Carcinoma, Ovarian Epithelial/therapy , Neoadjuvant Therapy/methods , Ovarian Neoplasms/therapy , Patient Care/methods , Time-to-Treatment , Aged , COVID-19/epidemiology , Carcinoma, Ovarian Epithelial/diagnosis , Carcinoma, Ovarian Epithelial/epidemiology , Female , Humans , Middle Aged , Neoadjuvant Therapy/trends , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/epidemiology , Pandemics , Patient Care/trends , Retrospective Studies , Time-to-Treatment/trends
2.
BMJ Case Rep ; 14(7)2021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1295190

ABSTRACT

A 51-year-old woman was referred to oral medicine with a 2-month history of progressive paraesthesia of the right lip, chin and oral mucosa. Examination revealed decreased sensation to the right dermatone of the inferior alveolar nerve and allodynia to light touch of the lower lip. An MRI of the head revealed bilateral cisternal trigeminal nerve pathological enhancement. While blood tests suggested a connective tissue disorder as the cause of the trigeminal neuralgia, a subsequent diagnosis of high-grade serous ovarian cancer gave a differential diagnosis of paraneoplastic syndrome.


Subject(s)
Ovarian Neoplasms , Paraneoplastic Syndromes , Trigeminal Neuralgia , Chin , Female , Humans , Middle Aged , Ovarian Neoplasms/complications , Ovarian Neoplasms/diagnosis , Paraneoplastic Syndromes/diagnosis , Paraneoplastic Syndromes/etiology , Trigeminal Nerve , Trigeminal Neuralgia/diagnosis , Trigeminal Neuralgia/etiology
3.
J Ovarian Res ; 14(1): 35, 2021 Feb 18.
Article in English | MEDLINE | ID: covidwho-1090643

ABSTRACT

China and the rest of the world are experiencing an outbreak of the 2019 novel coronavirus disease (COVID-19). Patients with cancer are more susceptible to viral infection and are more likely to develop severe complications, as compared to healthy individuals. The growing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Ovarian debulking surgery combined with the frequent need for chemotherapy is most likely why ovarian cancer was rated as the gynecologic cancer most affected by COVID-19. Therefore, ovarian cancer presents a particular challenging task. Concerning the ovarian cancer studies with confirmed COVID-19 reported from large-scale general hospitals in Wuhan, we hold that the treatment plan was adjusted appropriately and an individualized remedy was implemented. The recommendations discussed here were developed mainly based on the experience from Wuhan. We advise that the management strategy for ovarian cancer patients should be adjusted in the light of the local epidemic situation and formulated according to the pathological type, tumor stage and the current treatment phase. Online medical service is an effective and convenient communication platform during the pandemic.


Subject(s)
COVID-19/prevention & control , Ovarian Neoplasms/therapy , SARS-CoV-2/isolation & purification , COVID-19/epidemiology , COVID-19/virology , China/epidemiology , Female , Gynecology/methods , Hospitals, General , Humans , Medical Oncology/methods , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/epidemiology , Pandemics , SARS-CoV-2/physiology
4.
Mol Biol Rep ; 48(1): 983-987, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-973586

ABSTRACT

Recently, our lab, part of a referral center in Italy, reported its experience regarding the execution of germline BRCA1/2 (gBRCA) testing during the first months of the coronavirus disease-2019 (COVID-19) pandemic, which highlights a substantial reduction (about 60%) compared with the first 2 months of the current year. This evidence appeared to be a lockdown effect due to extraordinary restriction measures to slow down the spread of SARS-CoV-2. In this study, we aimed to evaluate the overall effects of the ongoing pandemic on gBRCA testing in our institution and to understand how COVID-19 has influenced testing after the complete lockdown (March 8-May 5, 2020). Additionally, we compared this year's trend with trends of the last 3 years to better monitor gBRCA testing progress. This detailed analysis highlights two important findings: (1) gBRCA testing did not increase significantly after the lockdown period (May-October 2020) compared with the lockdown period (March-April 2020), emphasizing that even after the lockdown period testing remained low. (2) Comparing the total tests per year (January-October 2017, 2018, 2019, with 2020), the impact of COVID-19 on gBRCA testing is apparent, with similarities of trends registered in 2017. These evidences reveal a gBRCA testing delay for cancer patients and healthy patients at this moment, and the new era of gBRCA testing in the management of ovarian, breast, pancreas and prostate cancer patients has been seriously questioned due to the COVID-19 pandemic. As consequence, we underline that measures to guarantee oncogenetic testing (e.g., gBRCA testing) along with new diagnostic/clinic strategies are mandatory. For these reasons, several proposals are presented in this study.


Subject(s)
BRCA1 Protein/blood , Breast Neoplasms/diagnosis , COVID-19/epidemiology , Ovarian Neoplasms/diagnosis , Pancreatic Neoplasms/diagnosis , Pandemics , Prostatic Neoplasms/diagnosis , Biomarkers, Tumor/blood , COVID-19/psychology , Delayed Diagnosis/ethics , Early Detection of Cancer/statistics & numerical data , Female , Health Policy , Humans , Italy/epidemiology , Male , Physical Distancing , Quarantine/psychology , SARS-CoV-2/pathogenicity
5.
Expert Rev Mol Diagn ; 21(1): 101-107, 2021 01.
Article in English | MEDLINE | ID: covidwho-962282

ABSTRACT

Background: The SARS-CoV-2 pandemic introduced a global distraction effect in cancer patients' care. The aim of this study was to explore the effect of the pandemic on the largest molecular diagnostics center for cancer patients and high-risk individuals in Serbia.Research design and methods: EGFR, KRAS/NRAS, BRAF, and BRCA1/2 mutation testing were performed by qPCR and NGS. NGS was used for panel testing of hereditary breast/ovarian cancer and cancers associated with Lynch syndrome. The analytical output during the state of emergency (SoE) was compared to the period before and after the outbreak using one-way ANOVA. Statistical significance was set at p < 0.05.Results: A 38% reduction in the number of analysis was detected during the SoE. After the SoE, a 19% reduction was noted compared to SoE and 50% compared to the period before the SoE (p = 0.038). Three of the 48 scheduled appointments for pretest genetic counseling were carried out during the SoE, but the number of NGS tests increased by 50%.Conclusions: The SARS-CoV-2 pandemic had a profound negative effect on the diagnostic output of our centralized molecular diagnostics center. The only positive effect was shortening of waiting lists for hereditary cancer patients and high-risk individuals.


Subject(s)
Breast Neoplasms/diagnosis , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Mutation , Ovarian Neoplasms/diagnosis , BRCA1 Protein/genetics , BRCA2 Protein/genetics , Breast Neoplasms/genetics , COVID-19 , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , DNA Mutational Analysis , ErbB Receptors/genetics , Female , GTP Phosphohydrolases/genetics , Genetic Counseling , Genetic Predisposition to Disease , Humans , Liquid Biopsy , Membrane Proteins/genetics , Ovarian Neoplasms/genetics , Pandemics , Pathology, Molecular , Pharmacogenetics , Proto-Oncogene Proteins B-raf/genetics , Proto-Oncogene Proteins p21(ras)/genetics , Serbia/epidemiology
6.
ESMO Open ; 5(Suppl 3)2020 07.
Article in English | MEDLINE | ID: covidwho-688771

ABSTRACT

The rapid spread of severe acute respiratory syndrome coronavirus 2 infection and its related disease (COVID-19) has required an immediate and coordinate healthcare response to face the worldwide emergency and define strategies to maintain the continuum of care for the non-COVID-19 diseases while protecting patients and healthcare providers. The dimension of the COVID-19 pandemic poses an unprecedented risk especially for the more vulnerable populations. To manage patients with cancer adequately, maintaining the highest quality of care, a definition of value-based priorities is necessary to define which interventions can be safely postponed without affecting patients' outcome. The European Society for Medical Oncology (ESMO) has endorsed a tiered approach across three different levels of priority (high, medium, low) incorporating information on the value-based prioritisation and clinical cogency of the interventions that can be applied for different disease sites. Patients with gynaecological cancer are at particular risk of COVID-19 complications because of their age and prevalence of comorbidities. The definition of priority level should be based on tumour stage and histology, cancer-related symptoms or complications, aim (curative vs palliative) and magnitude of benefit of the oncological intervention, patients' general condition and preferences. The decision-making process always needs to consider the disease-specific national and international guidelines and the local healthcare system and social resources, and a changing situation in relation to COVID-19 infection. These recommendations aim to provide guidance for the definition of deferrable and undeferrable interventions during the COVID-19 pandemic for ovarian, endometrial and cervical cancers within the context of the ESMO Clinical Practice Guidelines.


Subject(s)
Coronavirus Infections/therapy , Genital Neoplasms, Female/therapy , Medical Oncology/methods , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Betacoronavirus/physiology , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Delivery of Health Care/statistics & numerical data , Delivery of Health Care/trends , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/epidemiology , Endometrial Neoplasms/therapy , Europe/epidemiology , Female , Genital Neoplasms, Female/diagnosis , Genital Neoplasms, Female/epidemiology , Humans , Medical Oncology/organization & administration , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/epidemiology , Ovarian Neoplasms/therapy , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2 , Societies, Medical , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/therapy
8.
Mol Biol Rep ; 47(6): 4857-4860, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-209514

ABSTRACT

The first person-to-person transmission of the 2019-novel coronavirus in Italy on 21 February 2020 led to an infection chain that represents one of the largest known COVID-19 outbreaks outside Asia. Hospitals have been forced to reorganized their units in response to prepare for an unforeseen healthcare emergency. In this context, our laboratory (Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS) re-modulated its priorities by temporarily interrupting most of the molecular tests guaranteeing only those considered "urgent" and not postponable. In particular, this paper details changes regarding the execution of germline BRCA (gBRCA) testing in our laboratory. A substantial reduction in gBRCA testing (about 60%) compared to the first 2 months of the current year was registered, but the requests have not been reset. The requesting physicians were mainly gynaecologists and oncologists. These evidences further emphasize the new era of gBRCA testing in the management of cancer patients and confirms definitively the integration of gBRCA testing/Next Generation Sequencing (NGS) into clinical oncology. Finally, a re-organization of gBRCA testing in our Unit, mainly related to delayed and reduced arrival of tests was necessary, ensuring, however, a high-quality standard and reliability, mandatory for gBRCA testing in a clinical setting.


Subject(s)
BRCA2 Protein/genetics , Breast Neoplasms/diagnosis , Coronavirus Infections/epidemiology , Early Detection of Cancer/statistics & numerical data , Ovarian Neoplasms/diagnosis , Pandemics , Pneumonia, Viral/epidemiology , Betacoronavirus/genetics , Betacoronavirus/pathogenicity , Biomarkers, Tumor/genetics , Breast Neoplasms/genetics , Breast Neoplasms/pathology , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/pathology , Early Detection of Cancer/methods , Early Diagnosis , Female , Genomics/methods , High-Throughput Nucleotide Sequencing/statistics & numerical data , Humans , Italy/epidemiology , Mutation , Ovarian Neoplasms/genetics , Ovarian Neoplasms/pathology , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/pathology , Referral and Consultation/statistics & numerical data , SARS-CoV-2
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